Effective Assisting

Timothy M. Bizga, DDS, FAGD

www.2thLectures.com

ABOUT ME

Holy Toledo

What makes an Effective Assistant

Type A

Application

Attitude

Why Customers Leave

• 9% Leave because of competitors

• 10% Leave due to other reasons

• 14% Leave due to product dissatisfaction

• 67% Leave due to attitude or indifference (connection issue)

Where is your skill level?

3 Things Employers Look For

1. Loyalty/ Dependability

2. Positive Attitude

3. Desire to learn new things and keep growing

• Anything that is healthy, keeps growing!

9 things we hate about our employees

1. We hate when you are only nice to us on special days

– This stems from a lack of appreciation

– 90:10 rule= we only remember the 10% bad

2. We hate when we have to nag for things to get done

3. We hate when you chew gum

– This presents a very unprofessional look to patients

4. We hate when you don’t check the floor after cleaning a room

– Cleanliness matters to patients and a dirty floor means a dirty facility

5. We hate when you do not introduced us to new patients

– We need to know if we alreadymet the patient

6. We hate when you do not help us get to know the patients

7. We hate when we have to do ALL the talking

– We need you to EDUCATE the patient too

– 75% conversation should be business and 25% social chitchat

– You are not just an employee, you are a TEACHER

8. We hate the personal use of cell phones and Internet at the employee’s desk

– This is a form of TIME EMBEZZLEMENT

9. We hate when you cry

– Belittling or criticizing in front of a patient IS NEVER RIGHT

– Using tears as a form of control IS NEVER RIGHT

Patient types

✓ Never Been to a Dentist

✓Acute needs before FIXES

Patient types

✓ Dental Phobic

✓Motivated by Pain

Patient types

✓ Last Trip about every 2-5 years

✓No Insurance

✓Be aggressive in treatment….do not

monitor small things TREAT

Patient types

✓ Regulars

✓ Learn their preferences

✓Cost Conscience

✓Want the Best

✓Missing teeth

✓Basics and Function First

✓Esthetically driven

Challenges with Patients

• Time

• Patients don’t tell the whole truth

• We have to marry NEEDS with WANTS

• “A Profession in Transition”

Rapport is Power

• Total responsiveness between people

The Magic of Rapport

1. Rapport is created by feeling of commonality

2. Words are only 7% of communication

3. Matching and Mirroring

– Milton Erickson, MD

– People like people who are LIKE THEMSELVES; or how they would like to be

4. Style is more important that substance INITIALLY

Light Polymerization and Curing Lights

37% of composite restorations are being insufficiently cured.Price R., Felix C., (2010). Factors Affecting the Energy Delivered to Simulated Class I and Class V Preparations. JCDA Applied Research.

An insufficient cure can lead to adverse effects on physical properties, such as

− reduced bond strengths,

− breakdown at the margins & microleakage,

− and ultimately secondary caries.

Boksman, L., Santos GC., (2012). Principles of Light Curing. Inside Dentistry, Volume 8, Issue 3. d failure.

Seal! Insufficient cure continues to be an issue

Proper Light Use

• Light curing should be based on depth

• Deeper preps require longer curing times

Beam Collimation and Performance Over Distance

Collimated Not Collimated

Collimated Not Collimated

Beam Collimation and Performance Over Distance

There are hot and cold spots within the curing light tip, and they vary with every light.

Distribution of LEDs

Beam Profile

SmartLite Focus has a homogenous beam profile for uniform performance in the curing area

The effective part of the light beam should be evenly distributed across the face of the light tip to maximize curing effectiveness, and minimize the negative impact of operator technique.

Effect of Light Angle on Curing

undercured

Curing Light Tip

Most lights only deliver 35% of stated output to bottom of deep box

©BlueLight Analytics Inc., 2012

Composite Placement and Curing

Tips for success with curing:

• Position the patient so you can access the tooth

• Stabilize with finger rests while curing

• Position as close to tooth as possible

• Position perpendicular to the tooth/restoration

• Increase curing time for deeper preparations

• Air cool or wait in between cycles

• Use orange shields so you can “look at the light”

• Keep light guide tip clean and free of debris

Microcopy

Shade Analysis and Communication

SHADE TAKING FACTS

1. 60% of remakes are blamed on poor color match

2. It takes 5 new crown cases to cover the cost of

one remake

3. Improper color selection causes great frustration

for the doctor, the laboratory and the patient,

losing time and money for the dentist and

laboratory.

Principles of Light

Shade Selection

CLINICAL TIP:

Determine the Shades Needed for the

Restoration Prior to Tooth Preparation

Shade Selection

• A Desiccated Tooth Will

Appear Lighter than Normal

• Select the Dentin Shade By

Examining the Dentin

What is necessary to see color?

• Light

• Object to interact with the light energy

Limitations

x

x

What Color is This?

X

1. MOST CRUCIAL component for shade taking in Dentistry in VALUE

2. Second most crucial component for shade taking is TRANSLUCENCY

3. Third most crucial component for shade taking is CHROMA

4. LEAST CRUCIAL component for shade taking is HUE

Dental Shade Guides

VITA Classical Shade guide

RULES FOR TAKING shade

1. Patient sitting UPRIGHT at an EYE-EYE conversation distance

2. WELL-ILLUMINATED area preferably with color-corrected lighting or Ott-Lites® (sold at Office-Max or Target) held 2 feet from patient

3. Take the shade before you start the procedure

4. Match VALUE first, then CHROMA, then HUE keeping in mind TRANSLUCENCY and its important for anteriors

5. Take a PHOTO

– Be sure to place the shade tab IN THE SAME PLANE as the teeth, incisal edge to incisal edge

6. Recharge your RODS and CONES by looking at an Neutral Gray or Light Blue

7. Lightly wet the teeth and the shade tabs with a clear liquid glaze prior to evaluation

Rite Lite 2 ™ Tri-Spectra LED Shade Matching Light

Alginate

Tray Selection

“The Journey of a Thousand Miles Begins with a Single Step” -Lao-tzu

Fixed Prosthodontic Landscape

• An average office performs 256 single unit crowns per year

• 256 x 150,000 general dentists = 38 million single unit crown procedures per year!

Function of Temps

• Maintain static contacts

• Calm state

• Maintain occlusion

• Trial OVD

Adequate Anatomy

Minimal Inflammation

How do you control bleeding?

Gingival bleeding! Resin composite cements contraindicated!

Hemostatic Agent

Cord, Traxodent & Cap

Adapting the cap so that it contacts the soft tissue is imperative

Images courtesy of Abdi Sameni. DDS

Features of Provision Materials

1. Polymerization Choice

– Dual v. Auto

2. Air-inhibited layer

3. Fluorescence

4. Flaking when trimming

– Margin design

5. Fracture Strength

– Clearance

6. BPA free

Taking a Matrix Impression

• Use a impression tray (closed bite, closed tray, quadrant tray, custom tray, etc)

• Create a putty matrix

Taking a Matrix Impression

Try in the tray first!

Taking a Matrix Impression

Bleed the cartridge twice

Taking a Matrix Impression

Load the tray, don’t overfill

Taking a Matrix Impression

Pucker up!

Taking a Matrix Impression

For a closed or stock tray, stabilize using a claw grip

Taking a Matrix Impression

Evaluate the impression

Preparing the Matrix

• The matrix impression can be modified to ensure the provisional:

– Has better interproximal contact

Dispensing the Provisional Material

Bleed the cartridge twice

Dispensing the Provisional Material

• Fill approximately ⅔ of the tooth in the matrix impression, don’t overfill to prevent excess

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Final cure using a light curing unit (for 5 sec each surface per unit).

Extrude into the impression material and place into mouth within 45 seconds.

~ 0’45”

Set into the mouth for approximately 1 minute to 1’15”.

~ 2’00”

Remove from the mouth and remove excess material. If necessary, tack cure each tooth unit for 1-2 seconds.

~ 2’45”

~ 3’00”

Polish.

TEMPSMART™ can quicken fabrication of a temporary restoration due to its dual-cure option.

Three Minute Setting & Curing

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Integrity† Integrity

Multi Cure†

(light cure)

Structur2† Structur3†

Thickness: 1.5mm

Fluorescence

TEMPSMART™(light cure)

ProtempPlus†

LuxatempFluoresence†

LuxatempUltra†

Thickness: 1.5mm

Seating the Matrix

• When using a closed bite tray, re-seat tray into the mouth making sure it is fully seated and the teeth fit into the impression with the patient fully closed

Light Curing the Provisional

• Let the material set for 90 seconds in the mouth then remove and command set with 20 seconds of light curing

Trimming, Adjusting, Polishing

• Trimming:– Use a straight nose handpiece

and acrylic burs

– Palm-thumb grip

Trimming, Adjusting, Polishing

• Polishing:– Use a straight nose

handpiece and brushes or rag wheels

– Palm-thumb grip

Inlays and Onlays

• Triple tray method gives a very stable result, but there are other aleternatives

• FERMIT- Ivoclar

• Modified Microfill

• Requires NO-CEMENT

• EXPENSIVE

• Clip Flow- Voco

• Works exactly like Fermit, but not as costly

Efficiency is Key

Protection

Question

• Who are you going to be in 5 years?

– Answer: Very much the same you EXCEPT 3 things…

• Books you read

• People you meet

• Thoughts you tolerate in your mind

Contact Info

• Dr. Tim Bizga• Like Dr. Tim Bizga on Facebook

• @DrTimBizga

• 2thLectures.com

• Email: 2thLectures@gmail.com

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