MarionThe Newsletter of the Polk The NewsletterMarion & of Polk the Marion Dental Polk Society Dental Society OctoberMarch 2011 2018 “Prosthetic Principles to Maximize Results in the Esthetic Zone” Lauren Manning, DDS, DMSc, from OHSU

Written by David Swiderski, DDS, MD Relative tooth dimensions Lower lip line On February 13, 2018 the MP dental society Smile symmetry received a lecture from Dr. Lauren Manning, DDS, DMSc, a private practice prosthodontist Laboratory controlled from Portland who teaches part time at the Level of the interdental contact dental school. Her lecture was entitled, Basic features of tooth form Prosthetic Principles to Maximize Results in Tooth characterization the Esthetic Zone. The goal of her presentation Surface texture was to help us as restorative dentists to Color Incisal edge configuration understand the multiple parameters that are in play while restoring the esthetic zone, master For gingival health, she recommended and control them to make a beautiful smile for optimization prior to restorations and our patients. prosthetics. She discussed a rule for interdental closure, i.e. papilla filling the space between In training for full prosthodontic restorative prosthetics. You will get 100% of papilla fill if cases, many of us were taught to use a the bone is within 5 mm of the contact. As the checklist with patient diagnosis such as ridge distance increases to 6mm, the papilla will fill type, smile esthetics, bone quality, etc. to 56% of the time and finally if there is 7 mm predict the outcome and avoid pitfalls. But distance papilla will fill on 27% of the time, many dentists don’t have a similar list for leaving dark triangles. anterior esthetics. However, she explained that such a checklist does exist and consists of 14 The zenith of gingival contour usually is items; eight that the restorative dentist controls slightly distal of the midline of the tooth and is and six the prosthetic lab controls. These are an easy was to spot if a crown is implant listed below with a reference of Magne P, supported. She recommended slightly Belser UC. (2002) Chicago/Berlin: distalizing implants to maximize to match Quintessence Books natural surrounding teeth. Gingival heights should balance side to side with a reminder that the gingival heights of contour should be the Dentist controlled Gingival Health same for the centrals and canines with the Interdental closure laterals have 1mm less towards the incisal Tooth axis edge. Zenith of the gingival contour (Continued on page 6) Balance of the gingival levels

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MARION & POLK E XECUTIVE B OARD DENTAL SOCIETY MPDS Executive Board Meeting Committee Minutes: BOARD OF DIRECTORS BOARD NOTES– February 6, 2018 PRESIDENT Paul Brannen, DMD PRESIDENT-ELECT/VP Recruitment and retention: 5- members joined, Jennifer Frankel, DMD 0 transferred out. 1 retired. 0 deceased. The PAST PRESIDENT numbers: Total=210. William Trevor, DDS Speaker Schedule updates: 2018-2019 SECRETARY/TREASURER schedule confirmed. 3 CE Risk Management is Kerry Csiga, DMD scheduled Dec 11, 2018. Article review assigned. REPRESENTATIVE AT LARGE Financial Update: Accounts verified. Jev Clark, DMD, MD Advertisement sponsorships available. Portable REPRESENTATIVE, MARION COUNTY David Swiderski, DDS, MD hard drive to be swapped. Hance given authority REPRESENTATIVE, POLK COUNTY to cancel extra room for low attending CE course. Selma Moon Pierce, DDS Recruiting for Treasurer board position. EXECUTIVE DIRECTOR/ADMIN SEC Old Business: ODC at the Oregon Convention Sabrina Hance Center, Portland- April 5-7, 2018. Website PEER REVIEW COMMITTEE-CHAIR updated, however; ADA has development still Holly Chamberlain, DDS working on photo problem showing ½ pictures. Update your Find-A- Dentist profiles. HOD in Bend, OR- Sept 8, 2018. Recruiting HOD ADA alternates. Policy wording finalized for new PH: (800) 621-8099 FAX: (312) 440-2500 benefit of executive director. Xu is new Peer Website: www.ada.org Review Member. Clark Interim Rep at Large. Campaign donations being accepted through ODA October 18, 2018 for ADA president Elect. Make PH: (800) 452-5628 checks out to: Rick Asai for President Elect and FAX: (503) 218-2009 mailed to Rickland G. Asai, DMD 11786 SW Email: [email protected] Barnes Rd, Suite 340 Portland, OR 97225. Website: www.oregondental.org New Business: Trevor to remain in Past President position. All board positions covered except MP PH: (503) 581-9353 Treasurer through May 2019. Meeting rooms FAX: 503) 581-0628 reserved for courses through December 2019 and Email: [email protected] board meetings through May 2019. Catering Website: www.mpdentalce.com reserved for Sept. 2018. Financial CE course 3040 Commercial St. SE, Suite 125, Salem 97302 opened to staff. MPDS is going paperless.

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Thank you, Lauren Manning, DDS, DMSc, from OHSU for presenting “Prosthetic Principles to Maximize Results in the Esthetic Zone ” on February 13, 2018.

Page 4 March 2018 Tuesday– March 13, 2018 “Getting To and Through your Retirement” Presented by Larry Hanslits, CFP , from The H Group

LOCATION: Roth’s Event Center– West Salem Staff encouraged to attend! 1130 Wallace Rd NW, Salem, OR 97304

COURSE OBJECTIVE: • To give participants the tools they need to successfully build a secure and fulfilling retirement.

Hygienist, staff, and spouses welcome.

1.5 CE

COST: $30 cash or check only please. No debit/credit cards. Registration is required.

MENU: Painted Hills 8oz. prime rib, garlic mashed potatoes, carrots, Caesar salad, rolls with butter, and iced St. Patrick’s Day cookies. Beverage service. (Vegetarian option by request only: Baked ziti. Please email Sabrina.)

DEADLINE: Thursday, March 8th, 2018, Noon. All registrations reserved and not honored will be billed.

PARKING: Free parking available behind venue only. Kindly use back entrance which is handicap accessible.

RSVP: Email Sabrina [email protected] or call (503)581-9353. You are asked to register, for proper seating and food preparation. Thank you!

SPONSORS: Saalfeld Griggs, Artisan Dental lab, Rich Duncan Construction, and Columbia Bank

Marion Polk Dental Society has been designated an approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 8/1/15 to 7/31/19.

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Remember to “Spring Forward” on Sunday, March 11, 2018!

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Marion & Polk Dental Society member dues did not change in 2018, and proudly have not changed since 2009! Your membership payments are due and can be processed online or by calling the ODA at 1-800-452-5628.

“Prosthetic Principles...” (Continued from page 1) Tooth dimensions should follow the rule of “golden proportions” i.e. when viewed from the midline, the central should be 1.6 times larger than the lateral with the canine 0.6 times the size of the lateral. If moving your view laterally, these dimensions will change. She also stated the length of a central incisor should be 120% of its width. The lower lip line will ultimately determine the arch form and incisal edge configuration.

She then continued the discussion on variables the lab can control. The level of the interdental contact is most incisal between the two centrals moving more apically as you move distally. This can be manipulated if no interdental papilla exists. She reviewed the three basic tooth forms consisting of Square, Ovoid and Triangular. She instructed that square was most forgiving, ovoid most youthful in appearance and triangular most difficult to match due to the higher likelihood of darker triangles forming. She also said the lateral incisor can have the most variability and can make a smile appears more natural and still esthetic by having slight differences between the pair. Tooth characterization consists of slightly different colorization of the teeth, addition of craze lines, translucent porcelain at the incisal edges, etc. She mentioned how this may become a dying art in our modern era of pressing and milling crowns.

Color consists of three parameters, Value, Chrome and Hue. Value is the brightness and was discussed as the most important with Hue as the color. She recommended reorganizing our Vita Shade Classic shade guides by hue to help in matching. The order would be B1, A1, B2, D2, A2, C1, C2, D4, A3, D3, B3, A3.5, B4, C3, A4 and C4.

She then discussed multiple cases where she had restored single implants, implants and natural teeth and only natural teeth in the esthetic zone. Several pearls emerged throughout the discussion of the cases as listed below: Obtaining natural papilla fill is most difficult between two implants located in the central and lateral incisor positions. (Continued on page 9)

Page 7 March 2018 Thank you Dr. Kerry Csiga for volunteering your time and dedication to Marion & Polk Dental Society as the Treasurer/ Secretary in 2016- 2018. You will be missed. We wish you the best as you transfer to the Portland area.

ADA MORNING HUDDLE...

Scientists Developing Chewing Gum to Detect Peri-Implant Disease. PBS NewsHour (8/15, Dengler) reports scientists are developing a chewing gum that detects peri-implant disease by using the tongue as a detector. The article explains that the team added to the gum a bitter compound called denatonium attached to a biological tripwire – a molecule that gets chopped up by enzymes in the saliva of patients with peri-implant disease. The article adds that the biological sensor and denatonium are tasteless and do not dissolve in healthy saliva, whereas if peri-implant disease enzymes are present in the saliva, they chew away the sensor and expose the denatonium and bitter flavor. The team has tested the gum with an electronic tongue and plan to test it in humans in the future.

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“Prosthetic Principles...” (Continued from page 6) If tooth positions are not ideal, consider orthodontics prior to implants and restorations. Diagnostic wax-ups are helpful for the patient to envision the final outcome, but making a temporary snap on acrylic on-lay is best to help them visualize the intended outcome. Use of custom healing abutments can preserve surrounding gingival contours when placing an immediate dental implant. Prior to the final restoration, each case has a screw retained provisional for 8-12 weeks even up to 16. This will help develop gingival contours, solidify papilla position and allow the patient to see them and approve of the final restorations. They also help you make adjustments. Wait at least one month after bleaching teeth before shade matching. Bleaching can result is some hypo-mineralized areas that may need to be matched for the restorations. Finally, make sure your patient truly stopped for one month. When taking intraoral photos for color matching, use a lower exposure setting on your camera to avoid bleaching out the photo. Your lab will thank you. There are multiple shades available for cements that can alter the hue of the crown if the match isn’t perfect. Some kits have a putty that can be used to check the color match before applying the final cement. Tissue won’t adhere to resin or porcelain no matter how bad you want it to. With the new crown materials, if your restorations are coming back bulky, you may not be giving your lab enough tooth reduction. Give them a call to review how much material they need. Consider gold crowns for second molars as they don’t show when smiling. Finally, the seven P’s of Prosthodontics…Prior Proper Planning Prevents Piss Poor Performance! Thank you to our sponsors Rich Duncan Construction, Assured Dental Lab, Artisan Dental Lab, and O’Brien Dental Lab. Your support is noticed and appreciated.

Fee For Service Dental Procedure Rate Increase On January 12, 2018, The Oregon Health Authority (OHA) announced it will update the FFS payment rates for certain dental proce- dures. Specifically, the agency will: • Apply a 10 percent rate increase to specific diagnostic and preventive codes, and • Apply a 30 percent rate increase to specific oral surgery codes. The rate increase will apply to care and services provided on or after February 1, 2018. For additional information, contact OHA: [email protected] or call 800-336-6016. ODA Member News 2/20/18

Page 10 March 2018 Marion & Polk Dental Society EVENT CALENDAR (This page may be printed.)

Tuesday, March 13, 2018 **Tuesday, December 11, 2018 Does your staff Roth’s in West Salem Roth’s West Salem need CE credits? “Getting To & Through your “Risk Management” 3 CE All courses were Retirement” 1.5 CE Chris Verbiest approved for staff Larry Hanslits, CFP 5:00-9:30pm and spouses 5:30-8:10pm this year .

Tuesday, May 8, 2018 Roth’s in West Salem “TAD’s & Implants” 1.5 CE David Swiderski, DDS. MD. 5:30-8:10pm

Classified Ads

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Staff Appreciation Day is March 2, 2018. THEY ARE MAKING A DIFFERENCE Every day!

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Thank you to our Course Sponsors

The Sponsorship program enables MPDS to have nationally renowned speakers and programs. Sponsors are invited to all the MPDS meetings and are recognized for their generous continued support. This allows MP to offer dentists in our society important education opportunities at reduced costs. When you see sponsors at each meeting please, thank them by checking out their products and displays. Sponsors of the February 13, 2018 CE: Rich Duncan Construction– Chad Elliott Artisan Dental Lab– Chelsea Feist O’Brien Dental Lab– Bryan Becker Assured Dental lab– Steve Leonetti

Page 12 March 2018 Seeking Campaign Donations! Checks for Oregon’s ADA President Elect candidate can be made out to: Rick Asai for President Elect, and mailed to : Rickland G. Asai, DMD 11786 SW Barnes Rd, Suite 340 Portland, OR 97225

Arrives March 20, 2018!

ADA MORNING HUDDLE... Study: Dentists Could Start Using Squid Ink Instead of Periodontal Probe. Washingtonian Magazine (DC) (9/11) reports on a new study published in the Journal of Dental Research that shows squid ink could replace the periodontal probe. Here’s how it would work, the article says: First, a patient would swish around a diluted squid ink solution. Through capillary action, the squid ink would cling to the pockets in between the gums and teeth. Next, an ultrasound would be taken of the mouth, and the squid ink would then highlight the pockets through photoacoustic imaging. According to Jesse Jokerst, one of the study authors and assistant professor at University of California’s Department of Nanoengineering, they didn’t want to create a new material that would be subjected to years of scrutiny and testing. By using a material that is already approved as a

food, [they] hope to speed up the time needed to get this into dental offices.

Page 13 March 2018 Welcoming New /Renewed MPDS Members

• Dr Linda Truong joined 1-31-18. She works for Yakima Valley Farm Workers Clinic in Woodburn. She graduated from the University of Florida in 2016.

• Dr. Geoffrey Blatter joined and transferred 2/15/18. He was a member of South West Oregon Dental Association. Dr. Blatter owns Lebanon Family Dental and graduated from OHSU in 2013.

Win Your Choice of a 2017 Toyota Car! Give A Grin. Get a Grin. Maybe Win!

Purchase a raffle ticket and you will be giving a grin to Oregon children by supporting the DFO and their programs like the Tooth Taxi. Only 2,000 tickets will be sold. The drawing is on Saturday, April 8th at approximately 12:54 PM. Purchase tickets online or call 1-503-594-0880. You must be 18 years old and a resident of Oregon to purchase tickets online.

A Severe Hot Flashes May Be Linked to Greater Risk for D A Sleep Apnea HealthDay (11/1, Preidt) reports that as if severe hot flashes alone H weren’t enough of a problem for menopausal women, research indicates U these symptoms may also be tied to a greater risk for sleep apnea and D related heart issues. Investigators found that compared with women who had mild or no D L hot flashes, those who reported severe hot flashes were nearly twice as likely to have E obstructive sleep apnea. The findings were published in Menopause.

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September 8-2018 House of Delegates ODA leadership is excited to announce that MPDS MISSION the ODA House of Delegates is moving to a STATEMENT one day format in 2018! Mark your calendar “Committed to fostering and plan to serve as a delegate for your collegiality, component society. A social event will be education and community held on Friday, September 7th with the service.” formal business of the House being held on Saturday, September 8th at Sunriver Resort.

Reminder...MPDS will offer our own Does MP have your current e-mail address? Risk Management course at Roth’s Stay in the loop. If you have a change of ad- December 11, 2018 dress, please update with the MPDS office so you will continue to receive your fax and e-mail blasts for upcoming CE courses, newsletters, and more.

Special thanks to Dr. Chamberlain for stepping up and helping Wednesday, February 21st with the Tooth Taxi at the Salem School for the Deaf. You are appreciated!

Page 15 March 2018 ADA MORNING HUDDLE...

Scientists Developing Vaccine to Prevent Tooth Decay. Futurism (9/19) reports that researchers from the Wuhan Institute of Virology of the Chinese Academy of Sciences are developing vaccine that could help protect teeth against dental caries, and their findings are published in Scientific Reports. The article reports that additional testing is needed before a version of this vaccine could be ready for clinical tests. The article adds that although this potential vaccine could help keep teeth healthy, it is not intended as a replacement for proper oral hygiene.

Robot Completes Dental Implant Surgery in China. USA Today (9/25, Molina) reports that a robot has successfully completed the first autonomous implant surgery, fitting two teeth into a woman’s mouth. The one-hour procedure took place in China, and while medical staff were present...the surgery itself was handled solely by the robot. The (9/25, Gibbs) reports that the robot performed the procedure using preprogrammed directions. IFL Science (9/25) reports that the teeth were placed with a margin of error of 0.2 -0.3 millimeters, which is the required standard for this kind of operation.