Splint vac-more than a one dimensional tool

Splint vac-more than a one dimensional tool

Picture yourself communicating better pt. 1

Picture yourself communicating better part 2

Look in the mirror..

I had to laugh reading the lastest thread in Dentalfrown concerning denture clinic chains that have sprouted up all over the US.
Private practice Drs. questioning why or how can these operations be flourishing when, as they accuse, they bait and switch and overcharge for what they consider simple procedures.
I have no comment concerning the clinical aspects of what these companies deliver, but I can assure you that if many general dentists were taught more about removable and had a better understanding of removable treatment, and realized that treatment is more than a mush bite, and handing the patient a mirror followed by directions to set, process and finish, these places couldnt grow at the pace they are.

I can cite several thread and thread comments from many of these same townie Drs who publically hate treating denture patients but are still the ones that bitch the loudest about denture clinics in their areas. They want their cake and eat it too.

The answer is staring general dentistry right in the face.
Spend more time teaching dental students about hand holding and actually treating the patient rather than looking at their watches and treating them as some sort of commodity. Otherwise, expect business models like clinic chains and denturism to gobble that segment of your practice.

my opinion and nothing more....

Web Exclusive

The Science Behind Removable Prosthetics


Even for the novice denture technician, creating esthetic, durable, functional removable prosthetics is not all that complicated if you follow some basic guidelines.

By Richard Palmer, Managing Editor

The surge in the demand for removable prosthodontics may be taking some dental laboratory owners somewhat by surprise, but others had the foresight to prepare for a rise in denture caseloads through formal education and training as well as their own day-to-day working experience. Tom Zaleske, AS, owner of Matrix Dental Laboratory & Consulting in Crown Point, Ind., has spent the past 25 years perfecting his denture craftwork as well as his business management philosophy so that each meets his personal and professional specifics.

"The reason I'm in removable prosthetics has nothing to do with anything other than me looking at demographics of what the 20-year window was going to look like for me when I hit 50 and where I was going to be," said Zaleske. "I chose in school to specialize in removable prosthetics because I saw that there was going to be a dire need for it. And it turned out that I was right."

Working exclusively in removable prosthodontics, Zaleske shares his experience and knowledge through lectures around the country as well as in his role as Technical Coordinator for Keystone Industries, providing telephone support for technicians. He emphasizes that technicians need to position themselves as the "go-to technical resource" for their dentist-clients not only to strengthen the technician-clinician partner relationship but also to ward off competition.

"Every large megabox lab has got a denture department. If they don't, they're getting one. If you're going to compete by buying equipment, you're done. You'll never win that battle because all a guy's got to do is buy the same thing you have and now you're at the same level," he warned. "You have to develop techniques and offer services that take time and a learning curve, which eliminates 95% of your competition because now most labs don't have the time or the inclination to want to do that. So now you're dealing with 5% of the guys who understand the equation, and those are the guys you compete against."

In his courses, Zaleske gets right down to the very elemental makeup of denture materials, laying the groundwork for working with the materials. “You've got to understand the chemistry of the product,” he said. “Understand that denture base acrylics form molecular chains, polymer chains. The longer the chains, the fewer the breaks in the chains, obviously the stronger the product. All of that is involved in time. What's critical is that technicians understand that there are basic time-involved procedures that when they are shortcut, they eliminate that baseline strength and start to compromise in areas where you can't track down where the problem might be coming from.”

Hot vs. cold

He advocates using a heat-cure acrylic that affords more control over the polymerization process by the technician. “The big thing to understand is the differences between a cold-cure and a heat-cured resin is that polymer chains develop because there's heat induced the product. The auto-curing material uses chemistry to produce heat that forms the chains, but once the chemistry burns out, that's it,” he said. “The heat-cured acrylic does have some initiation chemicals that get the reaction going, but the actual polymerization chains develop through outside heat source, which then you can control the duration and the intensity. By being able to go low and slow, you're able to extend the duration of the polymerization and also the amount that it produces. You are able to form longer chains, and you're able to drive off any of the chemistry that might remain after polymerization has occurred.”

He added that auto-cure resins can be very technique sensitive and require care in mixing the correct ratios. In addition, it is likely to have some leftover residual monomers that can cause problems when leftover monomers aren't used up by either the chemistry or heat, which can lead to various problems.

Low and slow

Zalaske’s “low and slow” approach to heat-curing starts with hand-mixing just enough acrylic that he can pack within the recommended working time. “You have roughly about 9 minutes before the material reacts to where it’s ready to pack, and you only have a window of 4 to 5 minutes between the time that it’s ready and the time that you start to enter where the product starts to get stiff and dry and doesn’t bond well to teeth.”

His advice to technicians facing 10 or more cases that need packing is to take it in stages. Mix enough acrylic for 4 or five cases, let it react and get ready, then mix up another batch; while the second batch reacts, the technician has enough time to pack the molds properly using the first batch, all before the second batch is ready for packing.

Once the acrylic is ready for packing, Zaleske hand packs the mold a bit at a time, using pneumatic flask pressure between increments, then lets it bench set for 20 minutes to allow the heat caused by the initial chemical curing to dissipate before placing the clamped flask into a water bath for heat curing.

He strongly warns against placing a prepared flask directly into a heated water bath rather than heating the water after placing the flasks inside. “A lot of guys have water that's warm because they don't want to wait for it to reach 165°F. They pack the flask by overfilling it, then squeeze it a bunch of times until it doesn't squeeze out any more. Then they clamp it and stick in water that's 165°F. One of the biggest reasons you have porosities is because the acrylic on the inside of the mold that you just packed is going through its initial stage, which generates its own heat initially and kicks the reaction off. When they drop it in 165°F water, it's now getting heat from the outside, and it's generating heat from the inside. All of this has to do with climb rate accelerating; it reaches 163°and above inside the mold a lot quicker because it's already generating heat itself on the inside.”

Next, it’s time for it to sit in the hot water. “Nothing comes out of my lab that isn’t cured 8 hours at 163°F,” said Zaleske. “It goes long, and it never goes into ice-cold water to cool it at the end of the cure. It’s always brought down at a slow temperature.”

This extended, controlled process is designed to allow material to transform from monomers to longer polymer chains than possible in faster auto-cure resins. The shorter cure time causes more breaks in the polymer chains, which results in porosity that can in turn cause malodor and discoloration.

Quality dictates time

“I would say that 80% of the problems out there with acrylics—whether it’s the bonding of teeth, a patient has a bad taste in their mouth, porosity—all have something to do with the technician trying to cut time,” said Zaleske. “They don’t know how to be proactive. The doctor says he needs it tomorrow, and they are trying to find a way to get it done as quick as they can. A lot of times, that means using 20-minute monomer, which does not allow enough time for good polymerization.”

Which is where knowledge and skill come into play. By being the resource of information that clinicians not only want but often need, the lab can be proactive with clients. “Labs want to be amenable to the doctor. There’s so many labs that are hungry out there that they’ll do anything to get an account” said Zaleske. “They feel if they can’t do it in a day, then the doctor will find somebody who can. I cannot do what they expect me to do if I’m always pushed into a corner to perform in the shortest period of time.”

By being strong with clients, he has set the rules for them, not the other way around. “I don’t let time dictate quality. Quality dictates time.”


Zaleske's Tips

• Mix only enough acrylic that you can hand-pack before it starts to set

• Pack material into mold in small increments, closing between portions until filled

• Apply 2500-psi final pressure to flask

• Let packed flask bench-set for 20 minutes

• Place flask into room-temperature water bath, then heat water to 163°F + or - 5 degrees

• Heat cure for minimum 8 hours

• Let cure acrylic bench-set to cool before deflasking

Fee Survey Blues

Where does your laboratory place among the numbers of the latest fee survey? Why are you below the average, or are you above it? Are you happy with your position in the survey? What can you do to change your position next year? What kinds of things can you provide as standard services to project higher value in your products? What additional services can you offer as options for your Drs. treatment plan?

When we charge more for our work we must provide a value which substantiates the fee. Conversely, if your work is based on mere acceptability, and only on the value of being such, you can expect nothing but just acceptable fees.There are several areas in the fabrication of removable prosthetics which we can enhance with additional effort that will project and substantiate their provision.

Communication and fabrication techniques are categories I identify as areas to provide direction for change. Communication tools would be the primary place to begin elevating your laboratories value to your clients. Establishing minimum guidelines of what you must be supplied in order to fabricate at an acceptable level must be understood before you can ask and deliver something beyond. Many laboratories under emphasize what they need in order to lessen the burden of clinical performance to new accounts. This begins a cascading effect of competing by providing a path of least resistance to accounts. Laboratories that want to project higher value must ask for the most information needed to justify the result. Although you have a "wish list" of things you want, always be sure you understand that by asking for more you also agree to deliver more. By asking for the world and only delivering a continent you actually can do more harm than good in establishing your higher value. So, realistically elevaluate what level you can perform, and establish by policy, what you must have to be there. as your talents improve in utilization, establish higher minimums of communication.
Tools available to enhance communication can include things as simple as a thoroughly complete prescription,
fully adjustable articulators, digital photography, duplicate denture custom trays, processed baseplates, alma gauge and papillameter measurements.

Techniques which take standard materials and enhance their look or performance is another area that evokes a value response. Shape and shade modifying denture teeth, and custom color characterization of the base are just two ways in which we can take an "off the shelf" product, and with slight modification techniques make them customized and add subsequent value. A often missed opportunity to increase value perception also involves the base contours as they relate to the wax try-in, and its depiction of the final denture. The best clinical evaluation of removable prosthetics stems from contours that are exact as possible to the final product. Concerning the clinical evaluation, a stabilzed fit of the baseplate using a pre-processed base, which
which possesses the exact fit of the final is another way to increase your value. Although I do not suggest them for every case, I do recommend them to my clients when treating patients with deficient, atrophic, or traumatized residual ridges who enter treatment with a chief complaint concerning the fit of their existing dentures.

By the way, do your accounts know what acrylic you use, why you use it, how you pack your mold and what time technique of cure you use and why? Amazingly, most Drs. have no idea of the methods and advantages of techniques you use on their cases. It is surprising how we miss emphasizing the simple things we do to provide value to our products and possibly stand out from the crowd.

By emphasizing some of these ideas and others, next time you read a dental laboratory fee survey you will find that you are in a position that better reflects the fees you want coupled with a comensurate value.

First off, I want to thank the unbelievable amount of calls supporting my first article as benchtop editor "The dental technician, our most valuable tool" published in Dental Lab Products magazine. As many who know me can attest, this article is only an extension of what I have been expounding for my years on the lecture circuit, that being, how important a role we as technicians play in the entire picture of restorative dentistry and how a"proactive" and not a "reactive" mindset can carve out and establish our position of being the "technical resource" and not just somebodys "lab guy".

http://www.dentalproductsreport.com/articles/show/dlp0311_BM-Zaleske

With that being said I wanted to address an accusation that pops up from time to time regarding myself being associated with a product or manufacturer. For those who want to label me as a salesperson please re-adjust your thinking. I am a "spokesperson" for products I represent, buying and using the products on a day to day basis, just like other technicians. A spokesperson must be extremely careful to only associate themselves with products they purchase, use and believe in, otherwise they are indeed just a salesperson.

My suggestion to those who have a muddied view of the differences between salesperson and spokesperson is to try and attend one of my lectures. You will find that although I discuss products, our heaviest emphasis is on the techniques that make those products sing, and you, the dental technician, whom is restorative dentistrys most valuable tool and dwindling resource.

Rev'ed Up

The lecture/show season for twentyleven is in full swing, and man Im revved up about it. Next stop for me is the CDLA Spring meeting and Im excited since this will be the first time I get to dance for a Colorado audience. Im also looking forward to seeing Bruce Keeling at the and having some dinner. The last time we broke bread at the same table, it was with John Bach and my dear friend Bill Seward. Bruce is one of those "nice guys" who has been a mainstay in our industry.

Anyway, I get four hours and as many who have seen me can attest, I will be jammin the info out as fast as my lips can move.

A big thanks to Dan Elfring for setting the stage for my visit and to Molly for making sure things run smoothly.

Now back to work.....

The simple things

One of the easiest ways to bone up on your education is to visit Quintessence Publishing and order yourself up some of the latest and greatest books on dental technology. I love having books on hand as they are even easier to access than going online every time you want some info. Most of my books are dogeared and have the character of an old pair of running shoes. Coffee and food stains mark the pages with the information I continue to return to. Maybe Im old school, but theres something about the tactile sensation of turning a page of paper that still gives me a comfortable feeling.
On that note I wanted to express the sadness I experienced when I made a trip over to the Borders Book store thats closing in our area. There is now a book wasteland in our area as Barnes and Noble just closed in our area as well. There has always been a comforting feeling whenever I went to a bookstore and perused everything and anything. The Internet is a great resource but theres still something really cool and comforting reading paper in an acoustically dampened room full of books. It reminds me of the rainy and heat wave ridden days of my youth when my brother Bill and I would seek refuge from the dampness or heat in the Bensenville Community library. Little did I realize then, I would miss those simple things so much.

Twentyleven baby...

Twenty eleven, doesnt really roll off the tongue like twenty ten, but it still promises to be a good year. Maybe I'll just shorten it to twentyleven for pronunciation sake.
Just got back from a week at the Chicago Dental Society Midwinter meeting which has really morphed into the Chicago Midwinter Dental Convention which isnt just restricted to clinical dentistry since LMT magazine decided to run a concurrent venue years ago to give all dental professionals a common place to congregate together.
The twentyleven version of the show seems to have been all that it had promised to be. Many educational venues, lots of purchasing, and after several downer attitude years, a fresh perspective seems to have found its way into our mindset as an industry. Im not sure if its because those who were clinging on to old mindsets finally retired or moved on to some other way to make a living, but there was without a doubt a sense of renewed vigor. The cool thing was that it wasnt coming from one demographic of our industry but from them all. The largest demographic, the small 1-5 man lab owners seem to have either started embracing technology, or decided they were going to grow and promote their business with what they know and excell at, being the technical resource for their new and existing clients. I met several small lab owners that were either purchasing scanners, milling machines, or both. These were labs that in the past never thought they would ever embrace the technology end because they were either too old, too small or both. WOW, what a difference a year or two or being pounded in the head with a velvet sledgehammer will produce. Velvet? maybe not..

For me, its another year of lectures, this will be my 8th year and it never gets old for me, and obviously not for those who come to see me dance. I had a nice full capacity room in Chicago this weekend with a great mix of first time Zaleske lecture attendees and seasoned(or should I say numb) grizzeled vets. ~smile~ Besides lectures in twentyleven I have also been given the opportunity to do some writing and work with Dental Lab Products magazine as their "benchtop" editor. Eight years ago I authored a bi monthly column for a year for LMT which I enjoyed, and I am looking forward to sharing my perspective and techniques on removable fabrication during the course of the year with the staff of DLP.

Lastly, I would like to thank those over the last year who have been so supportive in attending my lectures and offering their social media friendships.
Thanks and heres a raised glass to your continued health and success in dental technology.

Tom

Pro Form BasicForming

Pro-form Equipment Setup

Pro Foam BasicFinishing

Reason to be Optimistic
By Thomas Zaleske


Thanks to the growing number of aging baby boomers, the emphasis on cosmetic
dentistry, and the success of television programs concerning cosmetic makeovers,
removable prosthetic treatment is finally being recognized for the potential impact its comprehensive treatment can afford the edentulous populace.
If you don’t believe it, just look around, the signs are all around us. In the last two years alone, the average denture tooth shade being ordered in the A1, B1 or brighter range has increased two fold. Have you noticed like I have the increase in the words natural or cosmetic in regard to removable prosthetics? Maybe like me, you have also noticed the increase in multi-layered denture teeth being offered, or the increase in kits that offer the option to custom colorize teeth and bases. If you are internet savvy do a word search on cosmetic dentures and you will realize that there are thousands of websites that reference this topic. This is not because of a younger population of edentulous patients, but rather agrowing number of patients and practitioners, beginning to understand that being edentulous does not mean it is the end of the line in looking attractive or having self esteem.

Many may read this and say, how does an A1 shaded denture tooth equate to natural or
cosmetic for a patient in their twilight years?
It is my belief that although a tooth shade this bright for a removable prosthesis may not exactly fit the physiologic age of the patient, it definitely identifies a growing edentulous patient desire to look more youthful and feel complete. This sets up a great position for us serving the edentulous public to be in.
If we comprehensively treat patients by understanding and applying such concepts as
golden proportions of esthetics, natural tooth emergence profiles, base contouring,
polychromatic base coloring, palatal contouring in regard to phonetics, and cater to the treatment philosophy of subliminal acceptance, we can propagate this already growing esthetic demand in removable prosthetic treatment.
Its time to start honing and augmenting cosmetic esthetic concepts with our knowledge
base of what we already understand constitutes good fit, and occlusal function. Nothing is more bothersome than the prevailing attitude by some in dentistry that feel being edentulous somehow rates lower in regard to patient need, than the dentate patient. As we know, removable treatment is by far the most multi-disciplinary treatment afforded the dental patient. With this in mind, let us use the groundswell of patients seeking to enhance their lives with facial cosmetics to enhance our image as providers of a viable cosmetic and functional treatment. One of the greatest challenges we have always faced is identifying and satisfying the subjective needs and desires of the edentulous, but presently these needs and desires are very identifiable.
If our actions are dictated by the subjective nature of removable prosthetics, then the idea, of reducing them any longer to a commodity, can never flourish.