Lori Trost, DMD, a well-known practitioner and lecturer, shares her experience, advice, and opinions related to choosing equipment and technologies to build a successful cosmetic dentistry practice with our editor-in-chief, Damon Adams, DDS.
You recently began a new practice. How did you arrive at that decision?
Dr. Trost: Once we successfully get past this crisis involving COVID-19, I feel that we will once again be able to say that there has never been a better time to practice dentistry! I decided to create a new practice after selling my former practice of many years and taking a sabbatical. Because I love dentistry, the patients, and the community, I really missed the day-to-day interaction, confirming that I was not ready to retire or take a back seat. The idea of starting over again initially seemed daunting, but the challenge of building a new practice based on experience gained over the years, clinical relevance, and practice management was intriguing and ultimately professionally satisfying.
Would you please tell us about your practice vision?
Dr. Trost: Much like we do in delivering quality clinical dentistry, a practice vision begins with the finish line in sight. So, just like a comprehensive treatment plan that fosters creativity, this process allowed me to explore and consider a variety of options from certain technologies to the look and feel of a space. However, at the core of the new practice process is understanding what type of patient you would like to serve/attract, the local demographics, and the procedures that will be offered. With that said, literally every decision, from inception to the finalized product, revolves around the goal to create a positive impact on each patient by utilizing the most advanced technology available. My vision was a practice space that offered clean lines, glass, and no clutter—a more intimate, high-tech, boutique-like practice. By keeping the patient at the center of the design effort, I became inspired to provide comfort, offer visual aids, and invoke a sense of the familiar with confident care.
|Figure 1. Positioning a patient in the CBCT scanner (XMIND TRIUM [ACTEON North America]).||Figure 2. Curing a posterior composite using the SmartLite Pro (Dentsply Sirona).|
|Figure 3. Each operatory has comfortable seating for the patient and ergonomic access for the dentist, hygienist, or assistant (Midmark).||Figure 4. Capturing a periapical image using the NOMAD Pro 2 (KaVo Kerr) handheld radiograph unit.|
|Figure 5. Showing a patient her treatment plan on an operatory monitor.||Figure 6. Color-coded organizational tubs and trays (Zirc Dental Products).|
|Figure 7. Smartphone screenshot of our patient communication system, Weave.||Figure 8. Digital scanning a patient using the Omnicam (Dentsply Sirona).|
|Figure 9. Intraoral camera images (DEXIS DEXcam 4 HD [KaVo Kerr]).|
How did you ensure that your vision became a reality?
Dr. Trost: Working with knowledgeable technology and equipment specialists is critical to turn a dream into reality. I was fortunate in partnering with Ryan Swift from my local Patterson branch, who listened to my ideas and was able to create an alliance between technology, equipment, and design. That is, of course, no small task!
Anyone who considers or builds a new practice must understand that this is a process that cannot be rushed. During this time, details matter! You must take into consideration workflow patterns, procedures, digital integration, and how patients enter and exit the operatories, along with infection control. I cannot begin to tell you how many times we used markers and tape to map movement and traffic patterns. We took into consideration the size and requirements for specific equipment/technologies, such as chair footprints, a 3-D imaging unit vs a panoramic unit, and even noise reduction from the compressor/vac room. We also considered possible additions and secured wiring and support backing for any possible future mounts or add-ons. During this phase, a “Master Dreams List” was compiled and prioritized. There is always a difference between practicality and a dream list, but the key is to strike a balance between the 2. In the modern world, it is so easy to get caught up with the newest, latest, and greatest products. However, like with everything else we want, I too had to come to the realization that every purchase decision had to be justified.
|Figure 10. (a) The DEXIS CariVu system (KaVo Kerr) unit chairside, (b) guiding the DEXIS CariVu system over a patient’s maxillary left quadrant (DEXIS), and (c) transillumination of an interproximal carious lesion that was circled for the patient (DEXIS).|
What specific equipment was at the top of your “must have” list?
Dr. Trost: Digital dentistry has transformed how we diagnose, plan, and choose treatments, all for the betterment of our patients. With that in mind, selecting and integrating a 3-D imaging unit was central to my practice goals and vision. Deciding what unit was the best fit for my practice required research. This also included talking to trusted colleagues and considering their recommendations.
I strongly believe a CBCT unit sets a high standard of care and creates predictability, especially when diagnosing and placing implants, doing endodontics, or treating growth and airway cases. Our unit, the XMIND TRIUM (ACTEON North America) is showcased in the heart of the office. This imaging unit offers incredible scan clarity, radiation dosage control, and predictable bone density, and it can easily be adjusted to patients, whether they are standing or sitting. I am confident in the XMIND TRIUM and how it provides a reliable assessment of bone quality, especially when I place implants. This technology ultimately increases the predictability of procedural and long-term clinical success.
|Figure 11. Maxillary restoration finishing using an NLZ electric handpiece (NSK).||Figure 12. Prophy polishing a patient with the cordless AeroPro Cordless Prophy System (Premier Dental).|
Restorative dentistry remains the “bread and butter” procedures of most practices. Ensuring the thorough light cure of any chosen composite restorative material, adhesive, or resin cement is critical. While there are many excellent curing lights on the market by a variety of quality manufacturers, for my new practice, I chose the SmartLite Pro (Dentsply Sirona). This curing light offers a small profile for direct access for tight spaces, has 2 interchangeable batteries so that the clinician is never without a charge, and also includes a transillumination tip for fracture/craze line identification.
Can you describe your operatories?
Dr. Trost: With the design framed around creating a positive patient experience and to create engagement, each operatory has been equipped with comfortable chairs (Midmark) and with operatory lights (Midmark) that have multiple exposure settings (low to high brightness), along with a resin filter to prevent the premature setting of composites. I also chose rear-delivery units from Midmark.
In keeping with the clean design, there are no x-ray units on the walls. Instead, we use a portable x-ray unit NOMAD Pro 2 (KaVo Kerr) with DEXIS sensors (KaVo Kerr).
Another key element in each operatory is a large monitor that is used for patient education and entertainment, as well as for practice marketing information. We use this space to not only inform and engage with patients but also to have fun with them through contests, random facts, and trivia!
Regarding sterilization, each procedure is color-coded by the use of cassettes and tub systems. These organizational products (Zirc Dental Products) have not only streamlined our procedures but have also reduced our stress levels. Because of this system, we can truly focus more on the patient.
What technology has been a real game changer in your new practice?
Dr. Trost: Our patient communication system, Weave (getweave.com), has laid the groundwork for a truly integrated patient journey. Their unique system allows for 2-way texting, patient appointment reminders, birthday wishes, and also a secure payment portal. Essentially, this system is like having an invisible employee working in the background 24/7! Weave has completely enhanced our patient experience. In a world of online reviews, we all can agree that it is crucial to capture positive patient experiences. Weave provides patients with an instant link to quickly access Facebook or Google. Without a doubt, my eyes have been opened to the importance of personally communicating with patients and having them truly feel that we are a patient-centered dental practice.
You mentioned that your new patient exam protocol has been elevated. What specific equipment or technologies compliment this, and how do they work?
Dr. Trost: More than ever before, patients are better educated about dentistry and want to be involved in their treatment. They also want to understand all their options. As dental professionals, we must show, tell, and engage them. However, we often do not know how to do this.
As a new patient enters any practice, he or she immediately begins to make comparisons regarding his or her own prior dental experiences. The key is to capitalize on using digital tools to create a customized diagnostic approach for the patient. In essence, the exam becomes the patient’s dental story. We start by digitally scanning (Omnicam [Dentsply Sirona]) each patient. It is easy to do, and patients are very impressed with this technology. Next, we use the DEXIS DEX and cam4 HD (KaVo Kerr) to capture a minimum of 5 standard images, along with any other areas of specific mention/concern. We then follow this with transillumination using the DEXIS CariVu system (KaVo Kerr). Finally, we take a 3-D image (XMIND TRIUM). All this information offers a complete diagnostic menu allowing the clinician and team to better understand the patient’s needs and wants. In addition, a uniquely customized treatment plan can then be developed for the patient. This protocol using these digital tools helps to elevate the patient’s perceived value and overall experience.
As dentists, we must realize that we have to become better communicators and to offer more value to create more treatment opportunities. With this in mind, the monitors in each operatory are invaluable and become the point of engagement. They help to tell each patient a story. Patients believe what they see, and, more importantly, they are more likely to remember and commit if you engage them and create a memorable interaction.
What product has delivered the most from a return on investment (ROI) standpoint?
Dr. Trost: I have been a big proponent of early caries detection and remineralization for many years. To date, challenges existed with various caries detection technologies, such as whether they utilized fluorescence or transillumination and how/if they could be quantified or integrated into a patient’s chart. Several colleagues shared their experiences with transillumination, and I ultimately purchased a DEXIS CariVu system. Interproximal surfaces that look pristine to the eye and are virtually absent on a magnified radiograph can be illuminated to show early changes in the enamel. For me, this radiation-free exam tool has been an eye-opener. Furthermore, the ROI has been multifold. More importantly, patients are benefitting from early caries detection that supports and reinforces a minimally invasive treatment approach. Once their pictures go up on the monitor, they already understand that something needs attention, and they want it addressed.
In what other ways have your choices of technology and equipment impacted your patients’ experience?
Dr. Trost: Whether it was choosing comfortable chairs or ensuring radiation reduction with the use of the CBCT scanner, the office was built through the eyes of the patient experience. I am not exaggerating when I say at least 4 patients per day walk in and mention how this dental office is unlike any other that they have visited.
We also utilize aromatherapy and have received an overwhelmingly positive response. Smell is the strongest and most memorable sense humans possess. To be able to create an immediate relaxing feeling vs the typical sterile office sets our practice apart. You will routinely smell blends of lavender or bergamot.
Another surprising element has been the older demographic of patients who are ready and want to improve their oral health. Again, demographics play an important role. Many of these edentulous patients want to secure their existing dentures with implants, and others are interested in updating their current care. Regardless, many of these patients remember their “typical” dental experience and truly welcome the modern change with technology that helps us discuss their care using pictures.
What specific technology has helped to increase your efficiency?
Dr. Trost: Digital scanning has brought a new level of efficiency and clinical excellence to the practice. Compared to traditional physical impressions, digital impressions reduce remakes, eliminate the need to pour models, and raise the level of accuracy. The ability to view the preparation, detail the margin, and ensure proper occlusion reduction is invaluable when doing all-ceramic restorations. I have been using an Omnicam for over 7 years now. The learning curve was minimal, and I have not looked back. Because of my practice schedule, I choose to scan and then send the scan to my lab team electronically for restoration design and milling. Our patients wear temporaries for 5 days at most. I would be remiss without saying that delivering the final restoration is also much easier due to the spatial accuracy.
Another key efficiency component of our paperless practice is the use of a cloud-based practice management system, Open Dental (opendental.com). This system not only integrates with the radiographs and imaging technologies but also updates seamlessly, has excellent customer service, and creates timely reports that are necessary for goal setting.
What specific equipment did you consider for improved ergonomics?
Dr. Trost: If you plan on practicing for any length of time, ergonomics have to be considered and not compromised. This is especially important to ensure hand and shoulder health. That being said, the workhorse of the practice—the high-speed handpiece—must be carefully considered. Handpieces are used every day, and we ask them to perform a wide variety of tasks on a broad range of materials and structures. I have used both air-driven and electric handpieces and, over time, have experienced their evolution. I use and recommend the NLZ electric handpiece (NSK). This lightweight handpiece is smaller than competitors’, balanced, and powerful. The beauty of electric handpieces is the improved control found in using presets for crown prepping, decay removal, polishing, margin placement, and cutting through incredibly hard zirconia materials. Gratefully, I have not had any hand health issues over my career, and I contribute much of that to proper handpiece selection.
Handpieces on the market today have truly evolved, and I really like the cordless, slow-speed units used for hygiene. We use the AeroPro Cordless Prophy System (Premier Dental) and like its portability; how it mandates an infection control standard; and its quiet operation, with 2 speeds from which to select. Also, patients routinely comment about not having cords drag across them during their cleanings. In addition, patients also appreciate the quieter operation found with this handpiece.
What advice do you offer to anyone who is considering a technology purchase?
Dr. Trost: Do your homework. Talk to colleagues. Visit other practices. Create your own compare-and-contrast worksheet. Get your team on board. Commit to learning and implementing the new technology or equipment. And, finally, showcase your decisions on social media.
What do you enjoy about most about your new office/practice?
Dr. Trost: Digital technology and its integration have made dentistry so much more predictable, interesting, and easier. The fun part for me is to see patient interactions, provide incredible accuracy, and witness the benefit found in developing an efficient workflow. All of these components add up to a new level of professional satisfaction. I have heard that if you love what you do, it is never work. It is true!
Dr. Trost received her dental degree from the Southern Illinois University School of Dental Medicine. She maintains a private practice in Red Bud, Ill. Dr. Trost offers postgraduate courses to dentists and their team members that draw from her extensive private practice experience and focus on restorative dentistry, digital technology, dental materials, orthodontics, business management, and patient communication. She is an author, clinical evaluator, and editorial board member and is listed as one of Dentistry Today’s Leaders in Continuing Education. She can be reached at trostdental.co or via email at email@example.com.
Disclosure: Dr. Trost reports no disclosures.