Tạp chí Implant tháng 10 2013 vol 6 no5

Tạp chí implant tháng 10 2013 Vol 6 No5

clinical articles • management advice • practice profiles • technology reviews PROMOTING EXCELLENCE IN IMPLANTOLOGY Legacy™4 Implant A Legacy of Innovation October 2013 – Vol No Corporate profile Carestream Dental Missing lateral incisors: overcoming the problem of insufficient space Dr Ian Hallam Practice profile Dr Robert J Miller Product profile BIOMET 3i launches its new 3i T3® Implant CAD/CAM anterior esthetic implant restorations Dr Dean Vafiadis SEE BACK COVER FOR MORE DETAILS PAYING SUBSCRIBERS EARN 24 CONTINUING EDUCATION CREDITS PER YEAR! WHEN THE OSTEOTOMY MUST BE NARROW - SO MUST YOUR IMPLANT CHOICE Choose the LOCATOR® Overdenture Implant System 2.5mm Cuff Heights 4mm 2.4mm Diameters 2.9mm included with each Implant It’s a fact – denture patients commonly have narrow ridges and will require bone grafting before standard implants can be placed Many of these patients will decline grafting due to the additional treatment time or cost For these patients, the new narrow diameter LOCATOR Overdenture Implant System (LODI) may be the perfect fit Make LODI your new go-to implant for overdenture patients with narrow ridges or limited finances and stop turning away patients who decline grafting Your referrals will love that LODI features all the benefits of the LOCATOR Attachment system that they prefer, and that all of the restorative components are included Discover the benefits that LODI can bring to your practice today by visiting www.zestanchors.com/LODI/31 or calling 855.868.LODI (5634) ©2013 ZEST Anchors LLC All rights reserved ZEST and LOCATOR are registered trademarks of ZEST IP Holdings, LLC EDITORIAL ADVISORS Steve Barter BDS, MSurgDent RCS Anthony Bendkowski BDS, LDS RCS, MFGDP, DipDSed, DPDS, MsurgDent Philip Bennett BDS, LDS RCS, FICOI Stephen Byfield BDS, MFGDP, FICD Sanjay Chopra BDS Andrew Dawood BDS, MSc, MRD RCS Professor Nikolaos Donos DDS, MS, PhD Abid Faqir BDS, MFDS RCS, MSc (MedSci) Koray Feran BDS, MSC, LDS RCS, FDS RCS Philip Freiburger BDS, MFGDP (UK) Jeffrey Ganeles, DMD, FACD Mark Hamburger BDS, BChD Mark Haswell BDS, MSc Gareth Jenkins BDS, FDS RCS, MScD Stephen Jones BDS, MSc, MGDS RCS, MRD RCS Gregori M Kurtzman, DDS Jonathan Lack DDS, CertPerio, FCDS Samuel Lee, DDS David Little DDS Andrew Moore BDS, Dip Imp Dent RCS Ara Nazarian DDS Ken Nicholson BDS, MSc Michael R Norton BDS, FDS RCS(ed) Rob Oretti BDS, MGDS RCS Christopher Orr BDS, BSc Fazeela Khan-Osborne BDS, LDS RCS, BSc, MSc Jay B Reznick DMD, MD Nigel Saynor BDS Malcolm Schaller BDS Ashok Sethi BDS, DGDP, MGDS RCS, DUI Harry Shiers BDS, MSc, MGDS, MFDS Harris Sidelsky BDS, LDS RCS, MSc Paul Tipton BDS, MSc, DGDP(UK) Clive Waterman BDS, MDc, DGDP (UK) Peter Young BDS, PhD Brian T Young DDS, MS CE QUALITY ASSURANCE ADVISORY BOARD Dr Alexandra Day BDS, VT Julian English BA (Hons), editorial director FMC Dr Paul Langmaid CBE, BDS, ex chief dental officer to the Government for Wales Dr Ellis Paul BDS, LDS, FFGDP (UK), FICD, editor-in-chief Private Dentistry Dr Chris Potts BDS, DGDP (UK), business advisor and ex-head of Boots Dental, BUPA Dentalcover, Virgin Dr Harry Shiers BDS, MSc (implant surgery), MGDS, MFDS, Harley St referral implant surgeon PUBLISHER | Lisa Moler Email: lmoler@medmarkaz.com Tel: (480) 403-1505 MANAGING EDITOR | Mali Schantz-Feld Email: mali@medmarkaz.com Tel: (727) 515-5118 ASSISTANT EDITOR | Kay Harwell Fernández Email: kay@medmarkaz.com Tel: (386) 212-0413 EDITORIAL ASSISTANT | Mandi Gross Email: mandi@medmarkaz.com Tel: (727) 393-3394 DIRECTOR OF SALES | Michelle Manning Email: michelle@medmarkaz.com Tel: (480) 621-8955 NATIONAL SALES/MARKETING MANAGER Drew Thornley Email: drew@medmarkaz.com Tel: (619) 459-9595 PRODUCTION ASST./SUBSCRIPTION COORD Lauren Peyton Email: lauren@medmarkaz.com Tel: (480) 621-8955 MedMark, LLC 15720 N Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Tel: (480) 621-8955 Fax: (480) 629-4002 Toll-free: (866) 579-9496 Web: www.implantpracticeus.com SUBSCRIPTION RATES year (6 issues) years (18 issues) Shifting trends: osseointegration to peri-implant esthetics T he implant world is rapidly evolving Final restorative seating of cases with a more natural look with scalloped tissues is the newest, fastest growing trend in implantology The implant field has progressed: we no longer discuss modification of the implant surface to promote osseointegration; more focus is on the soft tissues surrounding the implant The focus is now on maintaining tissue height, contour, and esthetics by using surgical techniques or by using implant surface modifications such as Laser-Lok® (BioHorizons®) or platform switching “This is clearly the focus of implant dentistry today Crestal bone preservation at the head of the implant Platform switching, slopping shoulder, laser microchannels and microgrooves are the predominant macro and micro geometries currently discussed,” according to Maurice Salama, DDS Implants have been shown to be successful in the treatment of multiple restorative needs: replacing single teeth, multiple teeth, or a full mouth of teeth with fixed or removable restorations Technology and research have improved to modify the surfacing of the implant to help increase bone-to-implant contact, decrease healing times, and improve the long-term restorability of implants Initial research was first focused on the integration of titanium to bone, and long-term followup was needed to show if this therapy was a good treatment option for patients Today, we have over 50 years of research to show that implants integrate with bone and have long-term success rates We also have the benefit of state-of-the-art technology, like CBCT imaging, and improved surgical techniques, such as guided surgery, to remove much of the guesswork from procedures, and aid in the success rates of implant therapy and placement Due to this paradigm shift in the implant world from simply getting implants to work to emphasizing esthetic outcomes, there has been a change in the focus of implant dentistry from osseointegration to peri-implant esthetics Proper soft tissue development is of the utmost importance to today’s clinicians, because it improves both the peri-implant esthetics of the final case and also the longterm stability of implants Prior to implant placement, the soft tissue can be modified, using one of many techniques, to promote proper tissue contour There are different ways of improving the peri-implant tissue It can be achieved by grafting with soft tissue or alloderm, modifying the amount of keratinized tissue with various surgical techniques, or developing the soft tissue scallop/papilla around an anterior tooth before making the final crown The long-term esthetic success of an implant is dependent upon maintenance of the implant by the doctor to help avoid infection that could lead to failure of the implant This is done by properly placing implants in the correct position, and secondly, by properly restoring implants Clinicians should always avoid concave pontics, ridge-lapped crowns, and open contacts These make it hard for patients to clean and maintain, ultimately leading to complications such as peri-implantitis Getting the patients invested in the hygienic care of their implant can also help mitigate potential issues before they become big problems that can threaten the success of the implant Integration of implants has proven to be successful long term, but in a still-developing field, there remains a need for more research to develop the soft tissue around implants Dentists placing implants need to be more concentrated on how to properly develop tissue in order to avoid complications in the future Using what we learned yesterday, and focusing on research today, will give us better outcomes tomorrow $99 $239 © FMC 2013 All rights reserved FMC is part of the specialist publishing group Springer Science+Business Media The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it The views expressed herein are those of the author(s) and not necessarily the opinion of either Implant Practice or the publisher Volume Number Daniel Domingue, DDS, FICOI, MICOI, DICOI, ASAAID, FAAID, DABOI Mentor/Lecturer: Rocky Mountain Dental Institute, Denver, Colorado Lecturer: Implants in Black and White, Lafayette, Louisiana Implant practice INTRODUCTION October 2013 - Volume Number TABLE OF CONTENTS Clinical Practice profile Dr Robert J Miller: Setting the bar high This clinician discusses the true joy of treatment success and his recipe for delivering high quality care in a predictable fashion CAD/CAM anterior esthetic implant restorations: the BellaTek Encode healing abutment and CADBlock ceramics Dr Dean Vafiadis delves into the use of a coded healing abutment 12 Restoring the edentulous maxilla Dr Ross Cutts discusses a cost effective way to restore the edentulous upper arch 20 Bridge construction in the anterior tooth area of the maxilla Dr Steffen Wolf juggles esthetic requirements to produce pocketfriendly results for a patient with very particular needs 26 Case study Hybrid dentures provide a Corporate profile practical solution Dr Daniel Domingue illustrates a case treated with fixed-detachable dentures 30 Carestream Dental This company continues to develop imaging systems and software and enter new markets Implant practice Volume Number TABLE OF CONTENTS Continuing education Missing lateral incisors: overcoming the problem of insufficient space Dr Ian Hallam presents a case study providing a solution for a patient who does not wish to undergo orthodontic treatment, using narrow implants 34 Dental rehabilitation of a 6-yearold boy with a rare tumor of the mandible Drs T Nyunt, K George, H Chana, and G.I Smith discuss treatment and maintenance of an unusual pediatric case 40 On the horizon “Lok”-ed and loaded Dr Justin Moody explores Laser-Lok implant technology 44 Technology CBCT and implants: the new era in treatment planning and diagnosis Dr Randolph Resnik discusses the benefits of 3D imaging in a modern implant practice 46 Industry news 46 CBCT and implants: the new era in treatment planning and diagnosis Implant essentials Product profile The big debate Drs Michael Norton and Julian Webber discuss — implants or endodontics? 50 BIOMET 3i launches its new 3i T3® Implant 58 Practice development GALILEOS® Comfort Plus by Sirona 60 Diary .62 Apply current tax laws to improve patient care Bob Creamer explains Section 179 and Bonus Depreciation 54 Osteogenics Biomedical to host 2014 Global Bone Grafting Practice management Symposium in Scottsdale, Arizona World-renowned speakers showcase latest in bone grafting techniques, materials, and research .48 Materials & equipment .63 Growing the money tree William H Black, Jr discusses the financial advantages of having a good plan in place 56 Implant practice Volume Number The comprehensive offering includes the ANKYLOS®, ASTRA TECH Implant System™ and XiVE® implant lines, digital technologies such as ATLANTIS™ patient-specific abutments, Symbios ™ regenerative bone products and professional development programs We are dedicated to continuing the tradition of DENTSPLY International, the world leader in dentistry with 110 years of industry experience, by providing high quality and groundbreaking oral healthcare solutions that create value for dental professionals, and allows for predictable and lasting implant treatment outcomes, resulting in enhanced quality of life for patients We invite you to join us on our journey to redefine implant dentistry For more information, visit www.dentsplyimplants.com Facilitate™ www.dentsplyimplants.com 79570-US-1307 © 2013 DENTSPLY International, Inc DENTSPLY Implants is a leading provider of comprehensive implant solutions that allow for successful long-term outcomes PRACTICE PROFILE Dr Robert J Miller Setting the bar high What can you tell us about your background? I am a graduate of Hobart College in Geneva, New York where I earned a BS in Chemistry I received my DMD at the Henry M Goldman School of Dentistry at Boston University I also did my residency in Periodontics at Boston University, receiving a CAGS (Certificate of Advanced Graduate Study) I have been in private practice since 1986 in Plantation, Florida Is your practice implants? limited to No, we also offer all phases of periodontal therapy, including regenerative therapy, mucogingival surgery, and anterior esthetic procedures When I was a resident, implant dentistry was still not widely accepted and was not part of the curriculum As a result of my early training, when confronted with a compromised tooth, my instinct is to try save it I believe that this is an advantage, as comprehensive treatment has to include salvaging teeth whenever it is appropriate Why did you decide to focus on implantology? I received my first training in implant placement in 1987 This course changed the way I viewed dentistry For the first time, there was a predictable option for tooth replacement Taking this course opened my eyes to what I perceived as cutting edge and the future of dentistry With this in mind, I ultimately dedicated myself and my practice to providing state-of-the-art implant therapy to my patients At some point, I recognized that many patients who would like implant therapy were not necessarily candidates due to anatomical limitations This was an impetus to work towards focusing on restorative-driven implant solutions versus surgically-driven Guided bone regeneration soon became the focus of the practice, and is still a large part How long have you been practicing, and what systems you use? I began private practice in 1986 and placed Implant practice my first dental implants in November of 1987 This patient still returns for periodontal maintenance, and I am proud to say that the original prosthesis is still in position I have used several systems through the years, including the original NobelPharma system for approximately 10 years I switched to Straumann® in 1998, which I have been using exclusively for the past 13 years This system provides me with all the surgical and restorative options that are necessary for state-of-the-art implant rehabilitations What training undertaken? have you I have taken many courses through the years, including the NobelPharma surgical certification course at Boston University in 1987 Early on, there were very few comprehensive courses, and learning was more a function of groups of people getting together and discussing the various issues facing implant surgery and restoration As implant dentistry evolved, certain individuals began to separate themselves as the true leaders and innovators in the profession These included Drs Ron Nevins, Dennis Tarnow, Burt Langer, and Alan Meltzer These people were instrumental in my early training in surgical placement More recently, I have had the opportunity to take the Masters Level Bone Grafting course with Dr Danny Buser at the University of Bern, Switzerland There are many people who have been part of the evolution of implant dentistry, and I would like to think that the next 27 years will be equally as exciting Who has inspired you? I have had many people inspire me through the years; however, as a resident, there are two people who come to mind Drs Steve Pollins and Simao Kon each had a hand in helping me to develop a practice philosophy and setting the bar high As a periodontal resident at Boston University, they would spend hours discussing cases and aspects of treatment for which they were passionate I learned from them the true joy of treatment success and a recipe to deliver high quality care in a predictable fashion What is the most satisfying aspect of your practice? I often say that my practice is primarily composed of my “friends” coming to “my house” to visit me Having been in practice for 27 years, I have many patients who have been part of the “family” for a number of years It is extremely gratifying to have patients return to the office for periodontal maintenance who have had their implant rehabilitations functioning for over 20 years Professionally, what are you most proud of? I am most proud of becoming a Fellow of the ITI (International Team of Implantology) Attaining this goal was a culmination of a lot of hard work and dedication Five years ago, with the urging of my close friend Dr Jeff Volume Number have been an option However, as they say, don’t give up your day job! What you think is unique about your practice? What is the future of implants and dentistry? One of the nicest parts of our practice is the fact that we have four hygienists who have each been working in our office no less than 20 years Patients continually remind me how comforting it is to see the same familiar faces My surgical assistant has been with me for 15 years, making her truly my right hand I am extremely excited about the future of implants and dentistry I see restorative dentistry moving more towards CAD/CAM restorations comprised of materials that are even more esthetic Ultimately, dentists who are not involved in digital dentistry are being left behind As far as the future of dental implants per se, I feel that there will be a push towards robotic implant placement removing human involvement In the short term, with the advent of zirconia dental implants, the concept of custommilled dental implants may get some traction However, due to the fact that these are medical devices, FDA approval will be an uphill battle, making the concept very difficult to get off the ground What has been your biggest challenge? My biggest challenge to date has been incorporating the new technologies in our office in a cost-effective and efficient manner Dentistry changes every months, particularly from a technological perspective, but in the end, they may not be adding value to our practices Weeding through technology that is relevant and appropriate for my practice has been an ongoing challenge; however, this is never a chore as I have always embraced change and innovation What would you have become if you had not become a dentist? More than likely I would have worked with my father in the dress business However, as I have been more involved in product development, I have a lot of respect for biomedical engineers As I learn more about their importance in the medical device industry, I find myself more intrigued with this profession Perhaps this would What are your top tips for maintaining a successful practice? The best tip that I can give is to empathize with patients I firmly believe that one should keep the Golden Rule in mind, which is, “One should treat others as one would like others to treat them.” If you use this as your mantra while treatment planning, you will always have the patient’s best interest in mind This translates to patient satisfaction that results in a successful practice you to choose your cases carefully, as there is no worse feeling than failure Often, less experienced clinicians will undertake procedures that may be too advanced for their experience level, resulting in an undesirable outcome This results in a black eye for both the clinician and the profession as a whole I also strongly suggest that less experienced clinicians should hitch their star to a surgical or restorative mentor and should also seek out top quality companies, as this is an area that one shouldn’t compromise If clinicians undertake procedures that are within their comfort zone using high quality materials, there is no reason that they should not enjoy success What are your hobbies, and what you in your spare time? My favorite hobby is skiing However, for a South Florida resident, it becomes logistically difficult I try to ski on average 10 to 15 days a year, which is admirable for the geographically challenged Other hobbies include squash, photography, fly fishing, yoga, and working out Top Favorites A nice sinus graft My i-CAT Straumann Dental Implant System Single Malt Scotch Good initial stabilization A “white out” at Ajax Mountain Quiet time with my family Finishing a bike ride up Maroon Bells New attachment! 10 Salmon roll with brown rice 11 Downshifting into third gear and accelerating in an open road! What advice would you give to budding implantologists? My advice to budding implantologists would be to find a mentor who can help Volume Number Implant practice PRACTICE PROFILE Ganeles, I began to pursue the fellowship, which requires a high level of activity in education, research, or leadership It was at that time I decided to take advantage of publishing opportunities and went on staff as a Courtesy Appointment with the Community Based division program at the University of Florida Hialeah Dental Clinic Becoming a Fellow of the ITI has opened up many doors and continues to be a source of inspiration and resources for education and leadership CORPORATE PROFILE A history of proven technology, a future dedicated to innovation W ith roots that can be traced back to the 19th century, Carestream Dental certainly has a long history of innovation when it comes to dental specialties— including implantology This legacy carries on still, as the company continues to develop imaging systems and software and enter new markets It’s because of this proud tradition that more than 800 million images are captured each year on products from the company’s imaging portfolio Today, Carestream Dental is focused on providing implantologists with the products they need to facilitate treatment planning and improve patient care History of Carestream Dental The Carestream Dental of today was built on the shoulders of major industry leaders of the past — starting in 1896 when Eastman Kodak introduced the first photographic paper designed specifically for dental X-rays As technology improved and became more digitalized, Trophy Radiologie filed a patent for the world’s first digital intraoral sensor in 1983 Already known for producing intraoral X-ray generators, the digital intraoral sensor earned Trophy a reputation as the world’s leader in dental digital radiography In 2000, PracticeWorks emerged as a dominant dental software company when it acquired several other software companies PracticeWorks went on to acquire Trophy Radiologie in 2002, and was purchased the next year by Eastman Kodak to expand its presence in the dental business With the integration of PracticeWorks/Trophy, Eastman Kodak built the industry’s leading portfolio of film, digital imaging systems, and practice management software Then, in 2007, Onex Corporation purchased Kodak’s Health Group, and Carestream Dental was born The Carestream Dental Factor “We exist to make your practice better,” said Marc Gordon, Carestream Dental’s General Manager, U.S Equipment and Software “Our number one goal is to make user-friendly, yet sophisticated, technology to put our customers’ practices at the forefront.” Implant practice 3D Symposium Carestream Dental’s dedication to advancing implantology can be summed up by the Carestream Dental Factor; three pillars on which the company bases all of its products and services.  Incorporating the key elements at the heart of Carestream Dental’s philosophy, the company’s main focus is on delivering diagnostic excellence, workflow integration, and humanized technology Workflow integration: Administrative tasks cut into time that can be better spent communicating with and treating patients For this reason, Carestream Dental designs systems and software to enhance treatment planning and fit seamlessly into busy implant practices Ensuring that every link in the chain fits and contributes to the workflow as a whole allows implantologists to increase productivity and efficiency Intuitive technology and software are the hallmarks of Carestream Dental By developing imaging systems that can be quickly utilized by practitioners — and are even compatible with third-party products — implant specialists can eliminate time that would have been spent troubleshooting problems and instead focus on patients Humanized technology: Patients are an integral part of every implant practice, so Carestream Dental is committed to providing solutions that facilitate communication between the implant specialist and patient When communication is optimized, patients are happier and healthier — allowing them to make better, more informed decisions regarding their proposed treatment plan and, in turn, increasing case acceptance Diagnostic excellence: When evaluating sites for implant placement, details are everything To facilitate faster, more reliable implant planning, Carestream Dental has created a number of cuttingedge diagnostic tools that enable implant specialists to capture sharp, high-quality images quickly From industry-leading 3D imaging systems to high-resolution intraoral sensors, Carestream Dental offers a range of solutions that allow practitioners to identify areas of concern and determine the best course of action Technology developed clinicians, by clinicians for The Carestream Dental Factor isn’t the only thing driving user-focused and innovative products, and services — the clinicians at the heart of the company also play a large role Through meetings and forums with doctors in the field, Carestream Dental Volume Number IMPLANT ESSENTIALS Dr Julian Webber Dr Michael Norton Drs Michael Norton and Julian Webber field questions at their lecture endodontic therapy should be given priority in treatment planning for periodontally sound single teeth with pulpal and periradicular pathology that are restorable And to me, that’s very simple Implants should be given priority in treatment planning for teeth that are planned for extraction.” Dr Webber was happy to explain his cut-off for referring patients for implant treatment “It’s pretty simple,” he explained ‘”If you can’t restore it, and it’s periodontally unsound – it’s time to go.” When treatment fails Both clinicians agreed that trying to root treat a hopeless case was damaging, with the critical decision resting on when to “pull the plug.” “Endodontic treatment on a hopeless tooth is just as unethical as implant treatment on a tooth that could be restored,” said Dr Webber And Dr Norton corroborated this, adding: “The problem with endodontics is that if it’s done badly, you scar that patient’s attitude towards endodontics forevermore Perhaps dentists doing bad endodontics make it easier for patients to make the wrong decision about retreatment.” There is no mystery about why a lot of root canal treatment fails, Dr Webber 52 Implant practice explained “Without doubt,” he said “One of the biggest causes of failure in endodontics is lack of coronal seal.” And he warned: “If you’re going to embrace endodontics – if you want it to be successful – then you’ve got to embrace the technology as well Modern endodontics is driven by the technology, but you’ve got to come out of the dark ages to see that.” Keeping up with technology is also a must when it comes to implant placement, said Dr Norton And complications are just as important to bear in mind when considering either treatment He asked: “What about the potential for procedural complications? We all know that not every implant case is a slam dunk, either.” “If I see that the risks of extracting a tooth to replace it with an implant are possibly greater than the risks of keeping the tooth, then I will encourage the patient to give endodontics a try What have we got to lose?” He concluded: “If it’s not a good implant candidate, it’s going to be a disaster Implants are an expensive alternative to root canal treatment, so they need to be better in every way.” Complementary closure Despite the very different makeup of the speakers’ practices, there was only one message to the evening Forget the competition, because endodontics and implants complement each other That sentiment was even echoed by the sponsors for the evening, with Dentsply Implants and Dentsply jointly supporting the debate Drs Webber and Norton regularly refer patients to one another, and their cast-iron belief that this is the best possible way forward for patients was evident throughout Dr Norton closed his lecture by quoting from the AAE guidelines that both speakers referred to throughout their presentations He said: “Endodontic and implant treatment are most predictable procedures when undertaken with complete care and attention to diagnosis, planning, and execution of treatment.” “The natural tooth is the ultimate implant,” Dr Webber said, quoting endodontist Cliff Ruddle in his own closing remarks “The question of when to save and when to replace comes down to the considerations for treatment planning One of the main considerations is ethics So before you answer it, first ask yourself this: what’s best for the patient?” IP Volume Number Own the New Piezosurgery ® for as low as *$276 per month! *On Approved Credit - US Dentists only - Special 3.98% Interest Arrangement with Highland Capital Corp PRACTICE DEVELOPMENT Apply current tax laws to improve patient care Bob Creamer explains Section 179 and Bonus Depreciation T hriving dental practices understand that patients are the lifeblood of the dental practice Indeed, without patients, a dental practice does not exist Success is therefore determined by the quality of patient care provided and the overall patient experience In the last decade, we have seen many important and amazing advancements in dental equipment that have assisted dentists in the delivery of ultimate patient care One of the newest, but well-proven advancements is with 3D CBCT technologies Investing in equipment and technology upgrades can provide a number of benefits for your practice – a competitive advantage, expanded services, improved efficiency, and overall patient comfort These advantages can certainly make a difference to your bottom line, especially when you incorporate significant tax incentives for investing in your practice and yourself In recent years, we have enjoyed a series of tax laws enabling dentists to take accelerated tax deductions when purchasing equipment and technology A couple of tax code provisions that have been very beneficial to dentists are known as Section 179 and Bonus Depreciation Both provisions allow for accelerated deductions even when purchases are financed These laws are so advantageous that I am often asked, “Should I purchase some new equipment this year to help reduce taxes?” I trust their true objective in upgrading their practice is not to simply create a tax deduction, but rather to provide better services and improved care Patients recognize and appreciate the dentist who makes patient care the focal point of the practice During the recent Bob Creamer, CPA, is president of the accounting firm Creamer & Associates, PC, specializing in financial and retirement planning, dental transitions, practice enhancement, wealth creation, tax savings and related services He is also a founding member of the Academy of Dental CPAs Bob can be reached at 800-248-1120 or Bob@bestcpas.com 54 Implant practice struggles in our country’s economy, I witnessed that dentists who invested in their practices to improve the quality of care they provided, attracted a loyal patient following and a market share that continued to increase even while others struggled It is with these practices that patients were willing to spend their precious dental dollars However, investing in the practice provides a reward for dentists far beyond income and tax deductions – the peace of mind of knowing that they are delivering the highest level of patient care possible Section 179 and Bonus Depreciation Section 179 of the IRS Tax Code was introduced as a way to stimulate the economy by allowing business owners to deduct the full cost of a qualified asset in the year it is acquired, rather than spreading deductions over the normal depreciable life or many years During its early years, Section 179 allowed a maximum accelerated tax deduction of $10,000 to $24,000 This amount has varied as needed to spur Volume Number economic growth, and was increased to a very generous $500,000 maximum deduction in 2010 and 2011 That amount dropped to a $139,000 deduction for 2012, but was retroactively raised after the first of this year back to $500,000 for tax calculation purposes for 2012 Additionally, the maximum deduction for Section 179 for 2013 was originally set at $25,000 However, during Congressional wrangling early in the year to address the ominous “fiscal cliff” predictions, Congress adjusted the law to again allow a maximum Section 179 deduction in the amount of $500,000, with a spending cap of $2,000,000 before phase-outs begin Looking ahead, the law as currently written (as of the writing of this article) has deduction limits scheduled to drop all the way down to $25,000 for 2014, unless Congress acts to change the law and keep the deduction limit elevated Therefore, there may be a drastic reduction in deduction limits for those who wait until next year to make their purchases Section 179 provides tax incentives for purchasing both new and used equipment and technology The complementary Bonus Depreciation provides incentives for new purchases only For new equipment and technology purchases in 2013, a dentist can take a 50% Bonus Depreciation deduction on all purchases without purchase limitation While Section 179 has a $2,000,000 cap with a dollar phase-out for every dollar spent over the cap, Bonus Depreciation has no spending cap Unlike Section 179, which is scheduled to simply be reduced, Bonus Depreciation is currently scheduled to end on January 1, 2014 Today’s tax laws allowing accelerated deductions have led many dentists to rightfully consider them as a key aspect of their yearly tax and financial planning As the tax rates continue to increase, there is greater incentive to invest in yourself and your practice In addition to tax laws that make practice investments attractive and accessible, historically low interest rates on equipment loans have made it easier to incorporate practice upgrades that may have seemed out of reach just a few years ago While today’s accelerated tax deductions can be highly advantageous from a business perspective, they are not permanent as I have already illustrated When considering the forthcoming expiration or reduced deduction laws, and the recent significant tax rates increases for those making $250,000 or more, it certainly makes sense to invest in equipment and technology where needed When you couple this with low interest rates, which may soon be on the rise, there seems to be a window of opportunity for dentists to make their purchases during 2013 I strongly advise my doctors to invest in their practices and purchase equipment and technology, provided it’s for the right reasons After all, it is not tax rates, accelerated tax deductions, or even low interest rates that determine whether or not you need to invest in your practice, it’s the need to continually take extraordinary care of your patients So if you need to invest to deliver the care you desire, why wouldn’t you take advantage of Section 179 and Bonus Depreciation to help you accomplish your professional goals? It only makes great sense! IP Volume Number Implant practice 55 PRACTICE DEVELOPMENT Patients recognize and appreciate the dentist who makes patient care the focal point of the practice During the recent struggles in our country’s economy, I witnessed that dentists who invested in their practices to improve the quality of care they provided, attracted a loyal patient following and a market share that continued to increase even while others struggled It is with these practices that patients were willing to spend their precious dental dollars However, investing in the practice provides a reward for dentists far beyond income and tax deductions – the peace of mind of knowing that they are delivering the highest level of patient care possible PRACTICE MANAGEMENT Growing the money tree William H Black, Jr discusses the financial advantages of having a good plan in place Y our practice is established You have a good reputation and a good management team in place Gone are the days of building the practice and putting all profit back toward growth That’s the good part! But success creates other questions and concerns When clients first come to us they typically have the same refrain: “I am paying salaries, sick pay, vacation pay, major medical, matching Social Security and Medicare, paying into unemployment and Workman’s Comp I have to pay a lot of money in income taxes…How I keep more of what I make? No one has any solutions for me!” What I’ve found clients really mean is they want an idea that is not “outside the box,” that won’t increase their audit profile, an idea that won’t get them in trouble with Internal Revenue The simple answer is to consider a custom-designed qualified plan! In other words, consider a form of a pension plan (known as “qualified” because the contribution qualifies for an income tax deduction) Think about it this way: there is not a company on the New York Stock Exchange, a union, or government agency that doesn’t have a pension plan So using the rules that are on the books to create a custom-designed plan for the closely held professional practice may be the answer • Plan assets grow tax deferred • Plan assets are protected from judgment creditor claims1 • Plan assets are eligible for tax-free rollover to one’s IRA account • Qualified plans receive up-front approval from Internal Revenue in the form of a Favorable Determination Letter Let me clear up a few myths straightaway These plans are not about retirement; they are about the tax benefits and asset accumulation features, i.e., your money tree Who’s worried about retirement? It’s the employees putting $25 a week into their 401(k) plan More power to those employees, but we, as business owners, are past that Look at a plan as a way to pay yourself on a tax-favored basis! Here is how to look at the merits Assume a 39% federal income tax rate and assume a 6% state income tax rate So, for brevity, we will assume an overall tax rate of 45% Since there is no requirement to have a plan, what does it look like without one? For every $10,000 in taxable income, what does it look like with a plan or without one? (We use $10,000 in this analysis because it is scalable Want to know what $50,000 would do? Multiply by $75,000? Multiply by 7.5, etc.) Here is where it gets interesting On one hand you have $10,000 working for Consider the benefits: • Contributions are income tax deductible you; on the other, you have $5,500 The tax benefits alone give you 81% more (10,000 ÷ 5,500) right out of the gate Now, consider the plan’s assets grow tax deferred while the non-plan grows taxably Add it all together, and you can see the benefits growing with every passing year! Many believe, initially, that the plan will cause all employees to come in, with contributions for all, and any employee is entitled to take his/her contribution out immediately While plans like that exist, they are not well designed or well thought out ERISA, the Employee Retirement Income Security Act of 1974, gives us 39 years of instruction on how to design a plan In other words, these plans are black and white, really no gray area Now the question becomes how to design a plan to benefit the rainmaker? That is the easy part! Many different options exist, hence the need for customization Many “cookie cutter” plans are out there, a one-size-fitsall approach These are commonly referred to as “bundled” plans While those plan designs have their place, they cannot be all things to all people What to do? Start with a checklist of basic questions What is the annual budget for the contribution? How is the business set up, as a Corporation either Without a Plan With a Plan Taxable Income William H Black, Jr has been in the pension administration business for 34 years The firm Pension Services, Inc administers both defined contribution and defined benefit plans, employs an ERISA attorney, an Enrolled Actuary, and complete clerical staff Mr Black is qualified to give continuing education to CPAs in 47 different states He has spoken nationally and internationally on retirement plans, has been quoted in USA Today, written articles for several industry journals and has appeared on many financial radio shows discussing the topic of retirement and financial matters He may be contacted at bill@pensionsite.org 56 Implant practice $10,000 $10,000 Tax at 45% $4,500 $0 After-tax Balance $5,500 $10,00 Comments on graph: • No tax on the “with a plan” column as the contribution is income tax deductible • After-tax balance is as of the present day In the future, monies coming out of an IRA or qualified plan are subject to ordinary income taxes • The chart does not take into account asset protection benefits • This is scalable Considering a $50,000 contribution? The values are five times as much, etc Volume Number us they typically have the same refrain: “I am paying salaries, sick pay, vacation pay, major medical, matching Social Security and Medicare, paying into unemployment and Workman’s Comp I have to pay a lot of money in income taxes…How I keep more of what I make? S or C, as an LLC, LLP, PA, Partnership, or Sole Proprietor? How many employees? Are there existing plans in place now? How is the ownership structured, all in the hands of one person, or two or more? With the above, and an employee census, i.e., employee names, dates of birth and dates of hire, job titles and annual salaries, a projection can be created that will show, in black and white, what the benefits and detriments are Look at it in conjunction with your CPA and make a business decision on what is right for your situation IP This discussion is not intended as tax advice The determination of how the tax laws affect a taxpayer is dependent on the taxpayer’s particular situation A taxpayer may be affected by exceptions to the general rules and by other laws not discussed here Taxpayers are encouraged to seek help from a competent tax professional for advice about the proper application of the laws to their situation References Patterson v Schumate (http:// financial-dictionary.thefreedictionary.com/ Patterson+v.+Shumate) Volume Number Implant practice 57 PRACTICE MANAGEMENT When clients first come to PRODUCT PROFILE BIOMET 3i launches its new 3i T3® Implant BIOMET 3i, one of the world’s leading dental implant manufacturers, announced the launch of its new BIOMET 3i T3 Implant The BIOMET 3i T3 Implant is a contemporary hybrid implant with a new multi-surface topography designed to deliver esthetic results through tissue preservation: • Coarse Micron Topography: A resorbable media blasting process using calcium phosphate particles provides 10 micron features, which facilitate blood clot retention along the threaded body of the implant.1,2 • Fine Micron Topography: A dual acidetching process provides a 1-3 micron peak-to-peak surface (OSSEOTITE®) that supports platelet activation.3,4 This surface overlays the coarse micron topography and is designed to mitigate the risk of periimplantitis at the coronal aspect of the implant.5 • Sub-Micron Topography: The option exists for a more complex topography with the discrete crystalline deposition of calcium phosphate nanoparticles This surface treatment has demonstrated increased integration throughout the early healing process, helping to facilitate Bone Bondingđ*.6 ã Integrated Platform Switching: BIOMET 3i Implants with integrated platform switching (BIOMET 3i T3 and PREVAIL® Implants) have smaller restorative platforms relative to the total implant platform This medializes the implant-abutment junction inward, helping to maintain bone levels Studies show that BIOMET 3i Implants with integrated platform switching demonstrated crestal bone loss as low as 0.37 mm.7 ã Certainđ Internal Connection and the Gold-Titeđ Screw: The Certain Internal Connection in conjunction with the Gold-Tite Screw is designed to reduce microleakage through its exacting interface tolerances and maximized clamping forces.8 The Gold-Tite Screw design increases the clamping force by 113% versus non-coated screws, maximizing abutment stability The Gold-Tite surface lubricates and compresses to provide a tighter fit between implant components.9 For more information, please contact your local BIOMET 3i Sales Representative IP 58 Implant practice The BIOMET 3i T3 Implant is a contemporary hybrid implant with a new multisurface topography designed to deliver esthetic results through tissue preservation with operations throughout North America, Latin America, Europe, and Asia-Pacific For more information about BIOMET 3i, please visit www.biomet3i.com or contact the company at 800-342-5454; outside the U.S dial 561-776-6700 About BIOMET 3i BIOMET 3i LLC is a leading manufacturer of dental implants, abutments, and related products Since its inception in 1987, BIOMET 3i has been on the forefront in developing, manufacturing, and distributing oral reconstructive products, including dental implant components and bone and tissue regenerative materials The company also provides educational programs and seminars for dental professionals around the world BIOMET 3i is based in Palm Beach Gardens, Florida, * Bone Bonding is the interlocking of the newly formed cement line matrix of bone with the implant surface This information was provided by BIOMET 3i References Kuzyk PR, Schemitsch EH The basic science of peri-implant bone healing Indian J Orthop 2011 Mar;45(2):108-15 Davies JE† Understanding Peri-Implant Endosseous Healing J Dent Educ 2003 Aug;67(8):932-49 Kikuchi L, Park JY, Victor C, Davies JE† Platelet interactions with calcium-phosphate-coated surfaces Biomaterials 2005 Sep;26(26):5285-95 Park JY, Gemmell CH, Davies JE† Platelet interactions with titanium: modulation of platelet activity by surface topography Biomaterials 2001 Oct;22(19):2671-82 Zetterqvist et al A prospective, multicenter, randomized controlled 5-year study of hybrid and fully etched implants for the incidence of perimplantitis J Periodontol April, 2010 Lin A, Wang CJ, Kelly J, Gubbi P††, Nishimura I The role of titanium implant surface modification with hydroxyapatite nanoparticles in progressive early bone-implant fixation in vivo Int J Oral Maxillofac Implants 2009 Sep–Oct;24(5):808–816 Östman PO†, Wennerberg A, Albrektsson T Immediate occlusal loading of NanoTite Prevail Implants: A prospective 1-year clinical and radiographic study Clin Implant Dent Relat Res 2010 Mar;12(1):39-47 Suttin Z††, Towse R††, Cruz J†† A Novel Method for Assessing Implant-Abutment Connection Seal Robustness BIOMET 3i, Palm Beach Gardens, Florida, USA Poster Presentation, Academy of Osseointegration, 27th Annual Meeting; March 2012; Phoenix, AZ http://biomet3i.com/Pdf/Posters/Poster_ Seal%20Study_ZS_AO2012_no%20logo.pdf Byrne D, Jacobs S, O’Connell B, Houston F, Claffey N Preloads generated with repeated tightening in three types of screws used in dental implant assemblies J Prosthodont 2006 MayJun;15(3):164-71 Aforementioned have financial relationships with BIOMET 3i LLC resulting from speaking engagements, consulting engagements and other retained services † Joell Cruz, Prabhu Gubbi, Ph.D., Zach Suttin and Ross Towse conducted this research while employed by BIOMET 3i †† Volume Number PRODUCT PROFILE Galileos® Comfort Plus For a new dimension of success in your practice T he high-end CBCT unit with HD mode, large field-of-view and integrated FaceScan offers maxillofacial surgeons, orthodontists, radiologists, general dentists, and ENT doctors all of the options they need for diagnosis, treatment, and patient consultation The optional HD mode of Galileos® Comfort Plus ensures the highest image quality for a clear and quick diagnosis, even in difficult cases • 15.4 cm spherical volume with MARS • Close-up feature with 125μ resolution for endodontic applications • Lateral and AP/PA cephalometric views • One of the lowest diagnostic doses per volume size available and stable patient positioning • 14-second scan for minimized patient movement • Seamless workflow integration • Software with superior diagnostic features Integrated FaceScan The FaceScan plots the patient’s facial surfaces at the same time the X-ray image is taken With a realistic image of their own face, patients understand and accept treatment recommendations more readily Integrated implantology Achieve implants with a final prosthesis in fewer visits The prosthetic suggestion from the CEREC® software is united with the 3D X-ray data, helping to achieve the perfect final outcome Compatible with Dolphin software The Dolphin 3D imaging software is a powerful tool for orthodontists that makes processing 3D data from any Sirona CBCT X-ray system extremely simple Dolphin 3D features tools for on-screen manipulation and analysis of volumetric datasets Images are easily oriented and rotated, and tissue density thresholds can be adjusted for detailed views of the craniofacial anatomy Measurements and digitalization can be performed in both 3D and traditional 2D views In addition to Dolphin integration, Sirona CBCT systems are also compatible 60 Implant practice with other popular orthodontic software programs IP For more information, visit sirona3D.com This information was provided by Sirona Volume Number DIARY lllllllllllllllllllllll OF EVENTS llllllllllllllllllllllllllllllllllllllllllllllllllll Soft Tissue Grafting Around Teeth and Implants Dr Paul A Fugazzotto October 17–19, 2013 Milton, MA www.straumann.us/en/professionals/ continuing-education/courses.html Aesthetics through Innovation October 22, 2013 Novi, MI October 29, 2013 Chicago, IL October 30, 2013 Denver, CO Contemporary Soft Tissue Grafting for Implant Reconstruction Dr Mike Pikos October 17-19, 2013 Trinity, FL www.pikosinstitute.com/programscourses/implant-soft-tissue-grafting-forimplant-reconstruction Practical Solutions for Immediate Full Arch Restoration with Hands-On October 18, 2013 Vienna, VA www.biomet3i.com Practical Solutions for Immediate Restoration of the Full Arch Dr Brent Boyse and Dr Sheldon Sullivan October 26, 2013 www.biomet3i.com November 5, 2013 Quincy, MA www.biomet3i.com Chicago Implant Forum–A Multidisciplinary Perspective of Advanced Esthetics from Treatment Planning to Final Restorations Dr Bach Le October 23, 2013 Chicago, IL www.biohorizons.com/ chicagoimplantforum.aspx 62nd Annual American Academy of Implant Dentistry Annual Meeting (AAID) October 24-26, 2013 Phoenix, AZ AAP National Conference & Exhibition October 26–29, 2013 Orange County Convention Center Orlando, FL www.aapexperience.org American Dental Association (ADA) Annual Session October 31–November 2, 2013 New Orleans, LA www.ada.org The GHSU/AAID Maxi-Course Comprehensive Training Program in Implant Dentistry November 14-17, 2013 Atlanta, GA www.straumann.us/en/professionals/ continuing-education/courses.html The Realities of Advanced Bone Grafting and Implant Placement Dr Paul A Fugazzotto November 14-16, 2013 Milton, MA www.straumann.us/en/professionals/ continuing-education/courses.html 3D Summit November 15-16, 2013 Bellevue, WA www.3DSummit.com 62 Implant practice Volume Number MATERIALS lllllllllllll & lllllllllllll EQUIPMENT Hu-Friedy introduces the Black Line Surgical Collection New group of instruments designed for performance Hu-Friedy, a global leader in the manufacturing of dental instruments and products, has launched the Black Line Surgical Instrument Collection, featuring a performance-engineered coating to enrich contrast and reduce light reflection during procedures in order to consistently deliver optimized clinical outcomes The 51 meticulously handcrafted HuFriedy Black Line instruments include periosteals, periodontal knives, periotomes, luxating elevators, surgical curettes, bone chisels, and sinus lift instruments The instruments were engineered to deliver efficiency throughout the entire perio and surgical procedure The collection features a performance engineered coating for a harder, smoother surface, providing enhanced lubricity and superior edge retention In addition, the black finish allows for visual acuity at the surgical site and underlying tissue For more information call 1-800-HU-FRIEDY or visit www.hu-friedy.com enCore® combination allograft: a synergistic combination enCore® combination allograft is the first particulate dental bone grafting product combining mineralized and demineralized bone in a single bottle Already a popular combination among many specialists, enCore® leverages the complementary benefits of spacemaintaining mineralized bone with osteoinductive demineralized matrix to optimize the environment for the regeneration of vital bone Throughout processing, steps are taken to not only ensure each lot is safe for the patient, but to also verify that each lot of enCore® is osteoinductive For more information, contact Osteogenics Biomedical at 888796-1923 or visit osteogenics.com Sunstar GUM® announces new size and redesign of Proxabrush® Go-Betweens® Cleaners The new Ultra Tight size is ideal for healthy patients and will help improve compliance, effectiveness, and the overall comfort of the patient To continue the innovation in its line of custom fit interdental brushes that help prevent disease, Sunstar GUM® has introduced its new size of Proxabrush® Go-Betweens® Cleaners – Ultra Tight Proxabrush Go-Betweens are clinically proven to remove plaque as well as string floss and are convenient, reusable and easy-touse Highlights of the newly designed Ultra Tight Proxabrush GoBetweens include: • More Plaque Removal The redesigned Proxabrush family of interdental brushes has been constructed to remove up to 25 percent more plaque with new unique triangular bristles Additionally, it stays clean between uses through an antibacterial agent that has been incorporated into the bristles The central wire of each brush is coated for added comfort and to help prevent galvanic shock • New Flexible Handle The new, flexible handle has been ergonomically designed for better comfort, control, and grip in order to make it easier to use The bendable neck and longer length also makes it easier for patients to clean their posterior teeth In addition, Sunstar will be applying the new design elements to each of the existing Proxabrush Go-Betweens Cleaners sizes: Tight, Moderate and Wide For more information, visit www.US-Professional.GUMbrand.com NuOss® XC expandable composite The latest development in natural bone substitutes: • Supports bone growth in periodontal and oral maxillofacial defects • Is a composite bone grafting material comprised of mineralized deproteinated bovine granules and purified Type I bovine collagen When placed into a bleeding site, the material expands to a predetermined size and shape • Available in both socket and sinus forms Features and Benefits: • Self-expanding composite material allows for placement while in a compressed form, then fills the entire defect upon hydration • Simple implantation technique • Composite nature of the material enhances graft stability and minimizes particulate migration • Optimizes spacing between particulate to allow for bone ingrowth • Expands immediately after implantation with blood contact For more information on NuOss XC or other NuOss products, please contact ACE Surgical Supply at www.acesurgical.com or by calling 800-441-3100 Volume Number Implant practice 63 MATERIALS lllllllllllll & lllllllllllll EQUIPMENT Ultradent Products announces new whitening product: Opalescence Go Opalescence Go comes in an innovative, ready-made UltraFit™ tray that adapts instantly and comfortably to the teeth for a better fit and improved whitening experience Opalescence Go provides powerful, professional whitening for the on-the-go lifestyle The Opalescence Go 10% hydrogen peroxide gel allows for a 30-60 minute wear time with flavor choices of mint, melon, or peach The 15% hydrogen peroxide gel is available in mint flavor and allows for a 15-20 minute wear time DenMat introduces Perfectemp10 DenMat has introduced Perfectemp10, a premium multifunctional acrylic crown and bridge temporary material that delivers the strength that patients need at a competitive price that dentists desire Perfectemp10 features a 10:1 auto-mix formulation, accelerated set times (1:30 intra-oral, 4:30 full cure), minimal shrinkage, minimal oxygen inhibited layer for optimal handling, bio-compatibility with natural dentin and enamel, and a natural looking luster with minimal to no polishing required It is free of Bisphenol A and has minimal heat generation for maximum patient comfort and safety Perfectemp10 is available in a 50ml cartridge pack that includes auto-mix tips and comes in five Vita shades; A1, A2, A3.5, B1 and BL2 It is also available in a 10ml syringe that includes auto-mix tips and comes in three Vita shades; A1, A2 and A3.5 Dentists can purchase Perfectemp10 by phone at 1-800-4DENMAT (1-800-433-6628), online at www.denmat com/perfectemp10, or through their outside field representatives Early warning from Osstell The unique UltraFit tray material easily conforms to any patient’s smile and offers molar-to-molar coverage, ensuring that the gel comes into contact with more posterior teeth than before The tray’s superior adaptability ensures that the maximum amount of gel stays in contact with the teeth during whitening The convenient, pre-filled trays cans be worn right out of the package Additionally, Opalescence Go contains potassium nitrate and fluoride (PF) Potassium nitrate has been shown to help reduce sensitivity For more information, call 800-552-5512 or visit www.ultradent com 64 Implant practice Osstell gives clinicians an early warning if the biological process is not progressing as expected It helps avoid costs due to premature loading and allows dentists to treat more patients with risk factors in a more predictable manner If the initial mechanical stability is high enough, a one-stage approach is often used together with immediate or early loading By measuring stability with Osstell before final restoration, and comparing the value to the baseline value taken during placement, the practitioner gains a better basis for deciding whether to proceed For more information, please visit www.osstell.com, call 1-877296-6177, or email osstellusa@osstell.com Volume Number The Ideal 3D Imaging Systems • Availability of multiple imaging modalities in one machine (3D, anatomically accurate extraoral bitewing program, panoramic, and cephalometric) • Versatile volume sizes (small ø4 x cm, medium ø8 x cm, large ø8 x 11 cm or ø8 x 14 cm with vertical blending) for a single impaction to full dentition, and beyond • Over 30+ Imaging Programs • Space saving - small footprint and compact design • Delivered with PLANMECA Romexis™ software for viewing, image enhancement, and treatment planning • Mac OS compatible and DICOM compliant Optional 2D SmartPan Panoramic and bitewing images are taken with the same flat panel sensor as the 3D images are taken, eliminating the risk of equipment damage and time constraints from switching sensors PLANMECA® Not ready for 3D yet? Enter for your chance to win an upgradeable, 3D-ready ProMax S3 panoramic machine! Schedule a free in-office demo and be entered automatically for a chance to win a FREE ProMax S3-2D panoramic machine! For a free in-office consultation, please call 1-855-245-2908 or email WinProMaxS3@planmecausa.com Winner will be announced live at the 2014 Chicago Midwinter Dental Conference!!! A Legacy of Innovation New Legacy™4 Implant All-in-1 Packaging includes implant, fixturemount, abutment, transfer, cover screw & healing collar — $225 SBM, $250 HA surface Torque- safety feature prevents damage to implant interface Square top detaches with impression for Concave transgingival profile metal to metal transfer accuracy matched with healing collar to shape soft tissue for improved esthetics Two-Piece fixture-mount (patent pending) with preparable abutment Quadruple-lead micro-threads Progressively deeper buttress threads A Legacy of Innovation from Dr Gerald Niznick Legacy – the culmination of 30 years of evolution Introducing a revolutionary 2-piece fixture-mount/abutment that provides the accuracy of an open-tray transfer with the simplicity of a closed-tray transfer Square top detaches with the impression, providing a snap attachment for abutment/analog Three long cutting grooves The abutment portion of the fixture-mount snaps onto the transferred top for the accuracy of a metal-to-metal connection Angled Multiple-Unit Plastic GPS™ Laboratory Straight Straight 15° Angled Gold/ Zirconia/Ti Temporary w/Cap & Transfer Ball GPS™ Abutment Snap-On Contoured Contoured Plastic Abutment Abutment Attachment Attachment Attachment Straight Angled Our price $85 $100 $100 $100 $120 $120 $40 $112 $100 $120 $100 $120 www.implantdirect.com | 888-649-6425 ... (480) 62 9-4002 Toll-free: ( 866 ) 579-94 96 Web: www.implantpracticeus.com SUBSCRIPTION RATES year (6 issues) years (18 issues) Shifting trends: osseointegration to peri -implant esthetics T he implant. .. call 800.944 .63 65 today © Carestream Health, Inc., 2013 9438 DE AD 0713 CORPORATE PROFILE Implant planning Implant planning with software is better able to understand the needs of implant specialists... Institute 69 3 Fifth Avenue New York, NY 100 22 212-319 -63 63 www.NYSI.org 12 Implant practice Figure precision of design and calibration of all tissue contacting points of the emerging abutment.7 -10 The