How to Add a Virtual Black Contraster to Your Intraoral Photos

If you’ve been doing intraoral photography for cosmetic cases, you’re likely familiar with the black contraster.  If you’ve only read articles about cosmetic dentistry, you’ve likely seen the photos of a restored arch with a black background to show off the details of the restorations.  It’s a very effective way to draw attention to the restorations by getting rid of the distracting background (tongue, cheeks, opposing arch, etc).

How do they do that?

The traditional approach is to use an instrument designed for that very purpose.  It’s basically a paddle-shaped device that is anodized in black.  When shooting photos of a restored arch, you simply place it behind the teeth and then take the picture.

Black photo contraster – “one size fits all.”

 

Ow!

If you’ve done this, you’ve probably run into cases where it doesn’t quite fit, or you just can’t get a good angle, or there are gaps.  Using a black contraster can sometimes be cumbersome and awkward.  Sometimes it’s very uncomfortable for the patient, and you just can’t get the “shot” you want.

In patients with small mouths, it’s hard to get the contraster in and behind the teeth.

 

And, if you get it in, it stretches and cuts into the commissures. It also stretches the tissues such that the lip gets pulled down over the teeth, obscuring areas that you want to photograph.

So, I’ve developed a way to do it “virtually.”  And, I dare suggest it looks even better.  My technique uses Photoshop to create the black background virtually.  It’s quite easy.  I would expect it can be accomplished similarly in other photo editing programs.

We start with a retracted photo of the upper arch, without the contraster. 

And, here’s how we create a black contraster virtually…. Continue reading

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Trim Your Own Dies???

Who does THAT?  Why would you?

I started my own practice renting space in an existing dental office (shared space).  The other dentist took a lot of pride in his work, and deservedly so.  One of the many things he felt strongly about was trimming his own crown and bridge dies.  He had a stereo-microscope set up in his lab just for that purpose.  So, I started doing it, too.

Eventually, I moved into my own office space, which happened to be next door.  For many years, I continued to visit my friendly neighbors to borrow their microscope to trim my own dies…. and well… to socialize! Recently, I finally got my own microscope.

Why trim your own dies? This isn’t dental school!

I send my Impregum impressions to the lab to be poured and dies pinned and cut (but not trimmed).  They return the models for me to trim the die margins.

I found that you learn a LOT about your preps and your impressions when you study your models / dies under a lab microscope.  It’s very objective and different than observing them in the mouth.  First, you can spin the die (prep) in any direction for viewing angles not possible in the mouth.  Furthermore, as you trim the die, you can’t help but pay very close attention to your prep margin (and learn from it). 

By the way, you can also use the lab microscope to inspect your impressions. The lighting is better than what you have intraorally.  Also, the magnification is much higher.  My lab scope goes up to 45x.  That’s ten times higher than my Designs for Vision 4.5x surgical operating telescopes.  Though 45x is well beyond the practical magnification for trimming a die.  I find 7 – 10 X works well for general / gross trimming.  I use up to 15X for fine tuning or trimming delicate concave areas like buccal furcations of a lower first molar or mesial concavity of an upper premolar.

Trimmed dies.

Holding the prepped “tooth” in your hand and inspecting it (while trimming the margin) under high magnification will make you acutely aware of any shortcomings and precipitate an effort to make your next prep and impression even better.

So, the first benefit is that by seeing your work in the form of a die under high magnification, you become a rather fussy “critic” of your own work.  Accordingly, you can’t help but IMPROVE.  Seeing your preps in the form of a die under a microscope is like listening to an audio recording of yourself.  You sound different on the recording than when you sing in the car, right?

Nothing but the tooth, so help me G.V. Black.

Click on quote above to learn more about their seminar: “Simplifying Complex Cosmetic & Restorative Dentistry!

That margin you thought was smooth and contiguous when you prepped it…. maybe not so much when you look at the die under the microscope!  If you think your preps are smooth after prepping with a coarse diamond, you’ll change your tune when you see the die at 10x or higher.  The axial walls look like a grooved asphalt road!  The axial-occlusal line angles are sharp rather than nicely rounded.  Next thing you know, you’ll be ordering some fine diamonds to polish your preps!

That impression you thought captured the margins perfectly… maybe not so much.  Next time you’ll spend a bit more time with tissue management, including gingival retraction and hemorrhage control.  You might be more careful to not lift the tip of your wash material syringe, creating bubbles at the impression margin.  It can be humbling!  It’s an objective way to evaluate your work, much like reviewing photos of your cosmetic cases.  Your lab will thank you!

Trimming Dental Dies with a Microscope Video:

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Is the Other Bracket About to Drop?

I wrote about DIY orthodontics not long ago.  While it felt good to “unload” my feelings about DIY orthodontics, I had to admit to myself that it was unlikely we (dentistry) would stop this multi-billion dollar juggernaut.  I figured it would meet its demise only if the market (consumers) eventually realized the folly of using their product.  I confess I did not have much confidence in the market doing that any time soon (or later).

Now, there are some signs that the DIY ortho companies may just self-destruct.  Recently, SmileDirectClub (SDC) went “public” with an IPO stock offering.  Subsequently, there have been some reports of some rather interesting, if not questionable, activities and history of SDC.  See the following articles:

The first article is mostly a summary of the 2nd article, which is more than a little damning of SDC’s business practices.  Rather, it is a full-on indictment of their business practices and even the legality of their business model. 

A few of the highlights of the investigation done by Hindenburg Research: (Hover or click link to learn more about them.)

  • SmileDirectClub’s practices have earned it over 1,200 Better Business Bureau complaints in just 5 years as a company. We communicated with one customer who was forced to use wire cutters to remove SDC products after he struggled to breathe. Review sites are replete with other horror stories of customers who had to take emergency dentistry into their own hands.

  • We were told by a former SDC store manager that the company was sending 75 to 100 cases to one orthodontist’s phone, per day, to “crank out” case decisions.

  • The company is another profitless, cash incinerating “unicorn” that we believe has significant added financial headwinds to face as a result of regulatory, legal and customer satisfaction liabilities.

  • All told, we believe SmileDirectClub will wind up as a case study in why it’s a bad idea to invest in a company that attempts to fit a complex, dangerous medical process onto a low-cost, high volume assembly line.

  • We see downside of 70% purely on a valuation basis, and downside of 85% given the above headwinds. We have a one-year price target of $2.

The above excerpts only scratch the surface.  Read the (rather long) article.  It is brimming with a litany of disturbing allegations. 

But, if I was to emphasize the most telling and disturbing part of the report, it would be this: Continue reading

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All My Training and 31 Years of Experience Have Led to This!

About a month ago, we had a close call with Hurricane Dorian, which was a “Cat 5” and got within 100 miles of us.  In the process of putting up my shutters, I smashed the tip of the ring finger on my left hand.  It hurt, but I “walked it off” and continued putting up the shutters.

It never turned black and blue, but it just kept hurting, especially if I put pressure on the distal end of the finger.  I wrapped it in tape, but that wasn’t stabilizing it very well.  I tried a number of finger splints from the drug store.  I even got some off Amazon.com.  They were all bulky and didn’t fit well.  Putting on an exam glove over the splint was difficult. 

The first splint I got at a drug store. Got in the way of everything… slipped off a lot.

Commercially-available finger splints are bulky, don’t fit well, and limit function.

The discomfort (with any pressure) continued, so I took an x-ray.  It clearly shows a fracture of the distal phalanx.

This morning I got to the office early and the light bulb (in my head) went on.  I could make a custom splint!  But, how?  With which materials?  Acrylic?  Bis-acryl?  Hold on a sec… what about using clear retainer material?  Thin and stiff!   OK… here’s a pictorial of how I did it. Continue reading

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Posted in Case Presentation, What Happened Today | Tagged | 2 Comments

Why I Like Guns

Why do I like guns?

  • They are simple mechanical devices and among the few durable items that can be as functional 100 years later as the day they were made.
  • They are powerful.  It’s an explosion you can hold in your hands.
  • They are a tool that enables me to defend the lives of my loved ones and my own.  It’s a seat belt for life!
  • They represent independence and self-reliance.
  • They are functional art.  Some firearms are beautiful to behold.
  • They go BANG!  They are loud.  Did I mention it’s an explosion you can hold in your hands?  What guy doesn’t like blowing shit up? 🙂
  • Science, bitches!  They are an effective and practical demonstration of Continue reading

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Posted in Guns & Knives | Tagged , | 5 Comments

Golden Proportion Template for Treatment Planning and Case Presentation

There are a number of ways you can use Golden Proportion to plan or present an anterior cosmetic case:

  • You could just print a photo of a retracted view of the anterior teeth and draw on it directly with a white “Sharpie” marker.  
  • You could purchase one of the apps out there (actually, I think they are an annual subscription). 
  • Or you could do this… Use a template and Photoshop (or similar photo editing software).  That’s what I did.

The reasons to do this might include:

  • Show a patient the degree of occlusal / incisal wear.
  • Show patients what is possible with restorative cosmetic dentistry.
  • To help you (the dentist) plan a case virtually.

I have found this simple demonstration very effective with patient case presentations.   Here are a couple of examples.  I’ll attach a “how to” video below.

Retracted anterior view.  There is significant anterior wear.

Here is the photo I printed to show the patient:

Golden Proportion template added.  This helped the patient visualize the amount of incisal wear and how it could be restored.

Another example: Continue reading

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This Is What “Organized Dentistry” Thinks Is Good Marketing!?!?

I’ve long been a critic of so-called “organized dentistry” (American Dental Association) at the national, state, and local levels.  And, hoo-boy, do they lob up easy targets for me! 

This is an ad recently created by my state’s dental association.  Surely, we all agree with the main message that an absence of pain or symptoms does not indicate an absence of pathology or potential dental issues.  Scroll down for the video!

But, good golly!  They could not have created a worse ad, in my opinion. 

  • The spokesperson (a dentist?) looks like she either just got out bed or the shower.
  • Her tone and body language is condescending and paternalistic (just like dentists of yore).   She clenches her fist and squeezes her eyes shut to emphasize her point.
  • Watch the full (21-sec) ad below!

    Then she puts her hands on the “patient,” grabbing his head and covering his ears!  I’m not sure what the message is there (besides condoning what might be considered assault).  Is she hiding something from the patient?  Why would she not want him to hear what she says next?  Very, very strange.
  • The “assistant” makes the patient feel dumb with her, “Uh, yeah! DUH!” interjection.

This is the marketing brainchild of the dental association!  What do you think?  Comment below!

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Join the Dark (Insurance) Side, or not?

Those who know me, know that I’ve been “insurance-free” for my whole career.  My practice has been truly FFS (fee for service) for its entire history.  I can tell you, that it has NOT been easy.  But, when I observed the struggles of my insurance-based colleagues, it hasn’t been easy for them, either. 

My friends deal with the vagaries of deeply discounted fees, rejected claims, lost claims, delayed payments, denied payments, down-coding, and demanding patients who expect them to know the intricacies of dozens or hundreds of plans, and so on.

My challenge has been to attract patients who choose to come to my office because of the level of the service we provide rather than where their “insurance booklet” tells them to go.

Maybe I’m an idiot?

But, times have been tough.  I have a lot of empty chair time.  While my goal has never been to simply “be busy,” it’s natural to get worried when things are slow.  And, as time has gone on, it seems people (patients) care less and less about quality of service and more about low cost and “does my insurance cover this?”  There have been times where I doubt myself and think, “maybe I’m an idiot and should join some plans?”

OK, maybe I should look into it?

Last month I decided to at least look into it.  I figured I’d at least get some information from one or two insurance companies about their PPOs.  I started with Cigna.  I had my office manager give them a call and ask for some information to be emailed to me.  They promptly accommodated that request and emailed me a fee schedule. 

I exported my fee schedule from my practice management software into an Excel spreadsheet.  Then I took Cigna’s fee schedule home with me and had my wife dictate the fees to every single code to me, as I input them into another column in the spreadsheet.  I then created another column with a formula to calculate the percentage discount for each fee. 

You can click on the spreadsheet image below Continue reading

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What’s Wrong With This Ad?

My chairside assistant sent this ad to me (from her Facebook feed).  It’s a local dentist. 

What is the appeal to viewers / prospective patients here?  Put yourself in their shoes, so to speak (you know nothing about dentistry). 

“What am I looking at?   Are those teeth he’s holding?  With his bare hands?  What’s that thing with the bolts in it?   What is ‘all on four’?  Is it only four teeth?  Where’s the smile promised by the ad?”

What is the benefit being presented here?   Who would want this service and why?  Which questions are being answered by this ad? 

It reminded me of another blog I wrote:  Don’t Show Them How We Make the Sausage!

But, it should also remind us that our marketing should answer prospective patients’ questions… in lay terms.  

  • Will my smile look good? 
  • Feel good? 
  • Last a long time? 
  • Can I eat anything with them? 
  • Do they stay in or come out?
  • How long will they last?

It’s akin to a plastic surgeon using this photo to advertise breast augmentation:

What do you think is wrong with this ad?  Comment below!

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Talk with and listen to your patients! You never know where the conversation will lead.

A short story for today’s blog:

Today a patient came in for his recall visit. He’s relatively new to the practice… maybe a year. Super-nice guy – 27 years old. We did some routine restorative treatment for him.

He has a history of orthodontic treatment as a kid… and left with a significant anterior open bite. He and his parents were told that was as good as it could be.

In occlusion!

Today, the patient asked me about bleaching his teeth.  He’s got a lot of decalcifications typical with ortho patients whose hygiene wasn’t so great with the appliances on.  That led to questions about porcelain veneers. Continue reading Digiprove sealCopyright protected by Digiprove © 2019 The Dental Warrior®

Posted in What Happened Today | Tagged | 8 Comments