In Her Dreams

By: Cheryl Wika, photos by Dave Davis_dmd_5433-full

Providing the highest quality patient care for children of all ages and those with special needs is the key to success for Caitlin Barnes, DDS. Personal connections with her patients and exceptional care utilizing the most advanced technology has allowed Dr. Barnes to create a special niche for this Alaskan community.

Q. Would you share a little about your education as well as the journey that lead you to where you are today?
A. I grew up in Newport News, Virginia and was the first in my family to pursue a career in dentistry. I attended Virginia Commonwealth University for both college and dental school, enjoying my time there very much. The itch to travel enticed me to visit Alaska for an externship during my third year of dental school, and at that point I completely fell in love with the state. Following graduation I was offered a position as a general dentist in Barrow, Alaska, an area unique for being the northernmost city in the United States and also one of the largest Alaska Native communities. Barrow is known as “the land of the midnight sun” in the summertime, and also for its majestic northern lights during the long winters. I came to love the culture and beauty of this remote community, and during my time there also realized how much I enjoyed working with children as my patients. This is what inspired me to go on to complete a pediatric residency at the Alaska Native Medical Center in Anchorage. Over the course of the next few years, I finished my residency, had many Alaskan adventures, and decided to call Anchorage my home.

Q. How long were you practicing before you decided to open your
own practice?
A. I have been practicing dentistry for nine years, the last five of which were as an associate in private practice. I reached a turning point when having a family of my own. I felt that if I was going to be away from my family, I wanted to be doing something that I felt passionate about. I’ve been lucky enough to take all the positive things I’ve learned from my previous opportunities in dentistry and apply them here. Starting this office has been a dream of mine for some time, and it has been so rewarding to see that dream finally become a reality.

Q. Was there an inspiration for how you wanted the practice to look and feel?
A. Absolutely! Alaska is such a beautiful place that it was easy to feel inspired. From glaciers to mountains to wildlife, there are so many aspects of where we live that I wanted to incorporate into the design of the practice. I especially wanted to showcase the aurora theme, as the northern lights are so uniquely Alaskan. From a practical standpoint, I also wanted my office to meet the needs of every patient from infant to teenager. In addition, we are compliant with the Americans with Disabilities Act and welcome patients with special needs.

Q. How did you get started with this project?
A. Partnering with Burkhart, my vision was to design an office that would maximize treatment space while maintaining a private, comfortable feel for patients and their families. In addition to an open hygiene bay, my priority was to incorporate two “quiet” treatment operatories based on each patient’s unique needs, with a third “quiet” operatory that could be built out at a later date. Burkhart meticulously designed my office space, offering several layouts which incorporated all the details I envisioned. A very important feature that Burkhart assisted with was an efficient office flow. I felt it was imperative to create a separate entrance and exit in order to be conscientious of patient privacy. After several revisions, Burkhart assisted me with an optimal plan that helped turn my vision into reality. Anchorage Burkhart Equipment Specialist Louis Ullrich and Account Manager Arne Valdez carefully attended to every detail, creating the perfect space. I couldn’t be more pleased with the end result!

Q. How would you best describe your treatment philosophy?
A. I want every patient to feel comfortable and confident about their teeth. I strive to provide the highest quality patient care as well as an overall positive experience for every patient. I am excited to build long-lasting relationships with the families in my practice. I love hearing about baseball games, dance recitals and family vacations. What I enjoy most about being a pediatric dentist is watching every child grow up and truly being a part of that process.

Q. What advice would you give to a doctor who is building a new office?
A. The most important aspect of a dental office is location. We are adjacent to two pediatric offices in a hospital setting. We make it convenient for parents to bring their children to the dentist. Find a location that works for you and go from there.

The second most important aspect is identifying how many providers the space should accommodate. This determines the size of the office and appropriate number of operatories required. In addition, plan for success with the possibility to expand. Having room to grow is of the utmost importance.

Third, stick to a budget. When planning a build-out and purchasing dental equipment, prioritize the “must-haves” and the “nice-to-haves.” As the practice gains momentum, there will be opportunities to purchase equipment or incorporate design features that may have been out of reach at the start.

Last but not least, it is crucial to surround yourself with a successful team. The team at Burkhart made my practice start-up easy and streamlined. Louis Ullrich (Burkhart Equipment Specialist), Arne Valdez (Burkhart Account Manager) and Cheryl Wika (Burkhart Account Manager) have been extremely accessible throughout the entire process, and I couldn’t have asked for better service. Thank you Burkhart!


Thanks For Asking

By: Kathy Edwards, RDH, Margaret Boyce-Cooley and Dana Morano of the Practice Support Team


Burkhart’s Practice Support Team provides support to doctors by answering hundreds of questions that come in through our toll-free number and email. It is our pleasure to provide answers and resources—at no fee—to all of our Burkhart clients. Consider it a value-added service from Burkhart. We’ve compiled the most frequently asked questions and shared some insight on those here:

Q. What can you tell me about PPO fee negotiations?
A. It is critical to negotiate reasonable fees for your PPO participation. Fees can be negotiated at the time the contract is signed and every two years after that. There are several key strategies when negotiating fees with insurance companies, but the two listed here are a great place to start:
1. Evaluate your current fees. Evaluate your current UCR fees and make sure they are in the 75-85th percentile for your geographical area. It could be a wasted effort to attempt to negotiate if your current fee schedule is low for your area. You can contact your Burkhart Account Manager for resources to check your fees against other dentists in your zip code to determine your percentile. If you find your fees are low, it would benefit you to correct this situation prior to your negotiations.

2. Determine your leverage. There are some factors that gain more leverage when you enter negotiations. Take the time to determine if your practice can offer something that makes you more valuable as a provider for the insurance company. Some leverage points include:
a. Geographical location
b. Specialty offered, unique reputation
c. Availability in hours offered
d. Size of your practice (the larger the production, the better for negotiating fees)


Q. I went through Burkhart’s PracticeView Program last month and I wanted to get more clarification on what it means to “re-balance” my fees.
A. In addition to performing a 3-5% annual increase to your office (UCR) fees, we often find that the practice’s current fee schedule will need to be rebalanced. Having a balanced fee schedule ensures that all your fees are in a similar percentile that reflects the experience and technology you offer at your practice. Keep in mind that increasing all of your fees allows you more leverage to negotiate with PPO plans, allows higher reimbursement for out-of-network and dual coverage patients, keeps the fee schedules higher for your area as they are based on practice averages, AND ensures you get the highest reimbursement when plans update fees. It will be worth the extra effort to balance fees and, therefore, ensure you are getting the proper reimbursement for all procedures.


Q. I would love to drop all the PPO companies I’m contracted with but I know that may not be wise. How can I get a better handle on them?
A. There are a number of considerations when examining and managing your PPO participation:
• Are you billing full fees and adjusting off the difference?
• How many New Patients are you seeing per month? (count all 0150 and 0180s)
• Have you reviewed the percentage of New Patient flow coming from each PPO plan for the past 12 months?
Compile this data in a grid like the one below in order to develop a strategic approach to your participation. This data helps determine the true impact of each PPO contract administered by the practice. With this factual data, you can make a more informed decision for each individual contracted plan. Please email or call Practice Support Team and request the Excel spreadsheet to begin your analysis.


The Practice Support Team has years
of combined business and dental expertise!
Reach out to us today at no cost to you as a Burkhart account!

Keeping More of Your Hard-Earned Money

By Sam Martin, MBA (tax), CFP®, CPA

pig and person illustration-01

Beyond the overhead of your practice, the next largest expenses in life may well be income and FICA taxes—generated from your practice, other personal assets such as real estate, and of course, your investments.

New Tax Increases
The tax landscape has gotten tougher in recent years with the implementation of new tax increases in 2013 and implementation of taxes embedded in the Affordable Healthcare Act. Here is what you are facing as a successful dentist:

1. Net Investment Income Tax: New 3.8% net investment income tax—a FICA tax on unearned income to the extent of the lesser of unearned income or your Adjusted Gross Income (AGI) in excess of $250,000 (joint). This applies generally and broadly to interest, dividends, rents, royalties, income from passive activities, and most capital gains.

2. Medicare Tax portion of FICA: Also at AGI of $250,000 (joint) or more, a new .9% add-on to the 2.9% Medicare tax portion of FICA kicks in —bringing the total Medicare rate on salary or self-employment income to 3.8%.

3. Itemized Deductions and Exemptions: When Adjusted Gross Income exceeds $300,000 (joint), you begin to lose the benefit of your itemized deductions and your personal exemptions. A stealth tax of 1-2%.

4. Tax Rate Increase: The top tax rate that had been 35% for quite some time has been kicked up to 39.6% on taxable income exceeding $466,950 (joint —2016).

5. Long-Term Capital Gains Tax Rate Hikes: Long-term capital gains tax rates that had been zero and 15% prior to 2013 are now zero on the first $75,300 (joint) of taxable income, 15% for taxable income over $75,300 and less than $466,950 and 20% thereafter. Since most capital gains are subject to the 3.8% FICA tax where Adjusted Gross Income exceeds $250,000, we now have no less than five capital gains brackets: Zero; 15%, 18.8%, 20% and 23.8%.

Many, most or all of these tax increases hit successful dentists right where they live, and we have seen the bottom line increase in tax from slight to $25,000 plus in a single typical year.

Tax Deductions & Savings Strategies Even More Valuable
Every tax deduction or savings strategy you know about, and some you don’t, just became more valuable. When tax rates go up, tax savings techniques become more valuable. Every dollar deducted keeps more money in your pocket than previously. Putting your tax plan into writing as a part of your overall financial plan means you are much more likely to carry it out—much more likely to capture the savings that, in turn, help to fund your long-term goals.

We know what we want to accomplish and we may know how we want to accomplish it—now let’s determine the most tax-efficient way to do so.

A Few Ideas for Tax Savings Your Practice Plan
Investing in your practice is more than important—it is crucial. Work up a five-to-ten year plan for improving your practice. You will need the help of your “team” to put this together. Your dental CPA can help you with the cash flow projections, tax savings and strategy of the plan. Your equipment specialist can assist you with how to effectively spread out and prioritize your upgrades. Your designer/architect can assist with remodel plans. To the extent your plan includes adding new technology to the practice, include in it the time and money to obtain expert training for you and your staff. There is a lot of potential productivity to be had from upgrading your office—but you only optimize this when training is embraced. There may be many other team members to consider given your particular goals.

Save Taxes by Investing in Your Practice
The tax savings from investing in your practice can be quite substantial. Congress has now made “permanent” the Section 179 Equipment Expensing Election at $500,000 and has also given us a few more years to use the alternative “First Year Bonus Depreciation.” Mixing and matching these deduction opportunities can be part of a tax optimization plan—taking advantage of the deduction over one, or in many cases, several years to optimize the tax bracket within which we are taking the deductions.

Retirement Plan
No doubt a big part of your financial plan (you know, the comprehensive one that is in writing and that you review with your advisor once or twice a year) is your retirement accumulation savings plan. Since you need to save, the question becomes—what is the most cost-effective way to do so?

Income Tax Deductions & Deferrals
Generally, the first place we look is to see if we can save on a tax-deductible basis. The reason we look for tax deductibility is that we expect the vast majority of dentists will be in significantly higher income tax brackets during their careers than in retirement. Or think of it this way: If you can obtain an income tax deduction and deferral by taking money from one pocket and putting it into another pocket—why not? We do need to explore the cost benefits of the plan—which is discussed below.

Most Common Plan Types and Funding Amounts
The grid below is a great place to start as the amount of available cash flow needs to be matched to the plan. If you are just starting out and you cannot afford to put away more than $5,500- $11,000, then funding either tax-deductible IRA’s or Roth IRA’s may be the best choice. If you can put away $30,000-$40,000, a SIMPLE-IRA plan might be a good fit for the time being. If you have the ability to fund $50,000-$60,000—a 401(k) plan might be the ticket.

Catalyst Q3 2016_office design_p3-01Higher Funding Needs
For funding needs beyond this, a 401(k) plan can be accompanied by a discretionary profit sharing plan that will allow you to fund up to $53,000 ($59,000 if 50+) for just yourself—plus whatever your spouse may qualify for, if applicable. Beyond the 401(k)/profit sharing combination, there is the defined benefit plan—including the increasingly popular cash balance plan that could add another $100,000-$200,000 to the funding. In any case, there is a plan type that will match up with your funding needs and ability.

Cost Benefit
When you fund traditional or Roth IRA’s, there is no staff cost to consider. However, for all of the other plans mentioned, there are staff costs and some level of administrative cost. Administrative costs start out close to zero for a SIMPLE-IRA plan, are typically moderate with a 401(k) plan, and can be significant with a defined benefit plan. As we contemplate these plans, we can employ cost/benefit analysis to compare your tax savings to the associated staff and administrative costs.

Simple-IRA vs. Safe-Harbor 401(k)
For example, in a SIMPLE-IRA plan, the maximum staff cost is a 3% match—and the match is only for eligible staff members who participate by deferring their own dollars. This generally makes a SIMPLE-IRA plan cost effective for the owner. Safe Harbor 401(k) plans are similar to SIMPLE-IRA’s—but the staff cost can be slightly higher—either a 3% guaranteed contribution on behalf of all eligible participants or a maximum (up to) 4% match.

Choosing the Right Profit-Sharing Funding Method
When you begin adding in profit sharing, participant costs can jump up and, in some cases, depending on the demographics of your practice, might not be cost effective—but in many cases, choosing the right profit-sharing funding method can make the cost benefit quite advantageous.

Part of your ongoing financial planning should be to determine if your current retirement plan type and features (or lack thereof) are optimizing your cost benefit. We review this issue each fall and help clients determine if they have the right plan and plan features in place for the coming year.


Cost Segregation
If you have built-out or remodeled your office in the past 10-15 years, you will want to make certain that a cost segregation study has been completed. Generally, your contractor’s bill for the construction process defaults into the commercial real estate asset classification and will be deductible over either 39 years, or in more recent years, may qualify for the 15-year write-off. Either way, it is a lengthy or very lengthy time-period to recover your investment for tax purposes. A cost segregation study allows you to reclassify a significant percentage of the build-out

or remodel into much faster write-off classifications—five-year and seven-year, and in turn, qualify for first year bonus depreciation.

Retroactive Cost Segregation
With a retroactive cost segregation project, you determine the depreciation that should have been taken compared to the slower method depreciation you have taken and make a “catch-up” deduction in the current tax year. These can lead to significant one-time deductions—saving tens of thousands of dollars. To determine if applicable, have your detailed federal tax depreciation scheduled reviewed by your dental CPA. (Note: Our firm provides depreciation review on a complimentary basis).

Build-out or Remodel
Contemplating a build-out or remodel? Address the cost segregation aspect up front. This allows you and your cost segregation provider the ability to organize and capture relevant costs with your contractor before you break ground. Cost segregation also applies to buildings.

S Corporations
If you are not currently operating as an S Corporation, you should have your dental CPA prepare an analysis of the pros and cons for electing this status. For higher income dentists, S Corporations have traditionally been valuable in limiting the total amount of FICA tax paid. With the new Medicare taxes mentioned above, the savings have grown substantially.

In short, when you operate as an S Corporation, you have two types of taxable income as a result: Salary, which is subject to income and FICA taxes, and S Corporation income (profit) which you take from the corporation as a distribution (draw). S Corporation income is subject to income tax, but is not subject to FICA taxes, and is exempt from the 3.8% net investment income tax.

Paying Yourself a “Reasonable” Salary
The salary you pay yourself must be “reasonable” in the eyes of the Internal Revenue Service. This means you must pay “enough” to reasonably compensate yourself as a dentist. There are a number of ways to estimate this level of “reasonable.” One might take the U.S. Department of Labor Bureau of Labor Statistics national average general dentist salary (2015) of $158,310 and perhaps tack on a bit for management responsibilities. Or you might take 28% of your personal net production. In any case, you cannot pay too low or you risk additional tax, interest and penalties.

So, for example, if you are making $200,000, and paying a “reasonable” salary of $175,000, your potential savings are not much and would not warrant the added cost of filing an S Corporation return and the annual planning required to properly maintain an S Corporation. But at $300,000 plus, the savings nicely outweigh the added cost and hassle. (The higher the S Corporation income after deducting salary is the greater the amount of income you are receiving that avoids FICA tax and net investment income tax.)

Note: When contemplating a change to S Corporation status, you must also consider legislative risk (i.e. these rules could change in the future). Forming and/or electing S Corporation status should be undertaken with the guidance of your dental CPA and professional practice attorney.

Deducting What You Already Spend
Although some dentists are aggressive with their income tax deductions, most are not. In fact, most new clients that we encounter fail to document and deduct legitimate expenses they already incur. These fall into categories such as automobile, meals and entertainment, continuing education and travel. Knowing the rules for these deductions and keeping the appropriate documentation could be worth a few hundred to a few thousand dollars kept in your pocket each year. Even the occasional meal with your spouse where you update him or her on practice matters and plans can be 50% deductible—including a fine bottle of merlot—but you must follow the documentation rules.

Spend some time with your dental CPA after tax season to map out what potential deductions you are missing out on. Also develop a plan for how you will capture and store the required documentation to sustain the deductions if audited.

Spend Time to Plan Tax Savings
Those are a sample of the 40-some items we (and most likely other dental CPAs) look at when considering tax opportunities for dentists. The real point is—it’s well worth spending the time to plan your tax savings and after-tax returns. Keeping more of your hard-earned money in your pocket and out of the hands of the government, along with a strong cup of French roast, is what gets me out of bed in the morning.

Thanks For Asking


Kathy Edwards, RDH, Margaret Boyce-Cooley and Dana Morano of the Practice Support Team


Burkhart’s Practice Support Team provides support to doctors by answering hundreds of questions that come in through our toll free number and email. It is our pleasure to provide answers and resources—at no fee—to all of our Burkhart clients. Consider it a value-added service from Burkhart. We’ve compiled the most frequently asked questions and shared some insight on those here:

Q. I’m leaving a practice as an associate to start up my own practice. Do you have any resources I can use to make sure I have my bases covered?
A. We are able to work with doctors on a number of support areas. The first thing we need to know is if this is a new build with Burkhart or an existing practice purchase. If it is a new build, we like to find out:
• Will the practice be a general or specialty practice?
• Have you owned a practice prior to this?
• Will you be doing your own hygiene to start?
• Is the practice fee for service, or will you be contracting with insurance companies?
• How many days a week will the practice be open?
• Are you actively working with a marketing firm on logos, web page and social media presence?

Support Available
Below is a list of specific areas where we can lend support. We want to find out YOUR main areas of focus and develop a “course of action” from there.
• Business Planning: Manage your cash flow, your patient experience, and develop a productive and happy team.
• Marketing: Differentiate your practice by presenting a memorable image backed-up with an exceptional patient experience.
• Operations & Leadership: Create a positive work environment with a clear vision and goals. Get best practices in place to ensure compliance.
• Communication Protocols: Provide the best possible dental care with your patients’ best interests at heart.
• New Patient Checklist: Burkhart Dental can also provide a New Practice Checklist to get you started. Ask your Equipment Specialist for this and other valuable resources.

Q. I just hired a front office person with little to no dental experience. Do you have any tools to help get her started?
A. We offer a recorded three-part webinar series, Front Office Essentials; however, our webinars assume knowledge and experience for the most part. We do recommend the purchase of Dr. Charles Blair’s Coding with Confidence book (which can be ordered through your Burkhart Equipment Coordinator). We also recommend two sets of “Dental 101” level webinars:

Dental Trade Alliance

AADOM Resources
(There are some great resources here)
We feel strongly that most practices benefit from hiring someone with dental front office experience, especially if yours is a start-up practice. If the candidate doesn’t have dental experience (or at least medical experience), you’ll need to be prepared to invest in the new employee’s education and understand the costs involved to the practice through:
• Time and productivity lost by training the new employee on your own
• Time and productivity lost by having another team member train the new hire
• Revenue lost through trial and error at the front
• Online and additional training resources for the new employee

The Importance of I.T. in Your Multi-location Equation

By Dawn Christodoulou, President, XLDent

As a dental software development and services company, XLDent has seen more private dental practice owners expand to two or more locations in the past nine months than we have in the past nine years. This emerging trend is exciting to say the least! It means our small business community is overcoming the challenges of over-regulation and rising costs. They are seeing opportunity in consolidation of business systems and expansion of service offerings. They are taking control back! Our private practice owners are doing what all small business owners do. They provide needed services, employ people in their communities, and work to grow their businesses.

The Vehicle in Your Expansion Plans
As with all expansions, there is a lot to think about. This article is intended to highlight the importance of information technology (IT) in a multi-location growth strategy. It’s often over-simplified by the belief that what is working for the current location will work for a small enterprise. It very well may work, but will it give you the records consolidation, performance and continuity that you need to be efficient and productive? Will the software and infrastructure you are using be the headache or energizer in your trek to grow your business? Your IT solution needs to be the vehicle in your expansion equation that gives you and your team flight, not the boat anchor that brings you down.

Consider How to Manage Your Database
If you are considering the purchase of a second (or third, or more) location, also consider how you want to manage your EDR and business systems – your databases. Consider whether or not patients will travel between locations. If this is a likelihood, a single patient database will be necessary if you want to maintain a single dental chart for each patient. It is also an important consideration if you intend to consolidate patient billing and insurance functions. If not, stand-alone databases at each location may be a better option, especially if you build up the location and patient goodwill to sell it off someday.

Software to Service Multiple Dental Specialties
If you also intend to expand by offering multi-disciplinary services, keep in mind that you will need software that serves multiple dental specialties to maintain continuity in not only patient delivery and communication systems, but business systems. And again, consider whether or not it will be necessary to maintain a single patient database.

Help from I.T. and Software Partners
As you set up your business structure or “shell” with your accountant and lawyer, it will be important for you to know the ins and outs of your database configuration, software capabilities, and how production, collection and profitability numbers will be reported. This will require the aid of your IT and software partners. Don’t count on your accountant or lawyer to know any of these details. They can help you build your accounting, incorporation and tax equations based on your variables, but only if you do your homework so you can explain all of them, including your database configuration and software capabilities.

Single or Multiple Databases?
Ultimately, evaluation of your database and software needs begins with identifying whether you will run your operation with a single or with multiple databases, with a single or with multiple software solutions, and understanding how these locations need to be connected. An experienced IT partner will complete a thorough needs assessment, help you answer these very important questions, and also provide you with options when selecting a solution.

IT Team That Specializes in Dentistry
Because the technology landscape today includes so many options like VPN, RDP, clouds and hybrid clouds, it’s important to choose an IT team that specializes in dentistry. Your technology needs truly are specialized and unique, so don’t settle for anything less than experts in the field. XLDent, for example, has been serving the dental community since 1971. We offer a software solution that is scalable for single practitioners, group practices, multi-location, and multi-specialty practices. We provide computer hardware and network services, as well as partner with NSPs that specialize in dental practice installations across the country.

Growth and prosperity await you! Work with all of your trusted partners—accountant, lawyer and IT professionals—to build a successful equation that is productive and efficient to maintain.

The 5 Most Commonly Asked Questions About CBCT

Dr. Louis Kaufman answers five of the most popular questions he gets asked about imaging equipment.

By the Dental Products Report PR Editorial Team

Dr. Louis Kaufman is a Chicago dentist who lectures nationally on CBCT and implantology for imaging equipment from Planmeca USA, Inc. Like all lecturers, he gets dozens of questions from other dentists who attend his lectures. Dental Products Report decided to explore some of the most common questions he receives about CBCT.

What is the return on investment or how do I justify this amount of capital?
When you purchase a cone beam, I suggest that you look at the ability of the machine to generate images in different formats. You need to ask yourself, besides taking a three dimensional image, can this machine create panoramic images? If it can take panoramic images, ask yourself, “How many panoramic images do I take in a year?” Then ask yourself, “What do I charge for those images?” For example, if I charge $100 and I take 400 panoramic images a year, then I just billed out $40,000. If this machine cost you $120,000, dollar for dollar, you recoup the expenditure in three years. Realistically, you pay for it over four years.

Remember, it’s just not about the X-rays. It’s about the amount of undiagnosed dentistry and implant planning we can do with this technology. It generates better comprehensive treatment planning and ultimately better dentistry for the patient.

How has communication improved with your patients using CBCT?
Patients are blown away when they see a three-dimensional image of their jaw. When I can show patients where I can place an implant in their jaw using their own anatomy and a chairside model, patients can visualize and comprehend the procedure more clearly.

I would encourage the use of videos that all the major dental implant companies produce. Check with their marketing departments and incorporate a video into your website. While the patient is in the chair, you or your team can pull it up on your website for the patient to view. This serves two purposes. First, patients can visualize it more clearly. Second, when they go home to their significant others, they can pull up your website and explain the procedure to them.

Do you need a dental radiologist to review all your scans?
It’s extremely important to have a working relationship with a dental radiologist. Of course, then the question becomes, “Do I need to send every scan to the radiologist?” In my opinion, when a large field of view is taken, I recommend sending the scan to the radiologist. The beauty of this technology is that it allows us to take small fields of view or limited fields view. Therefore, it is not necessary to send every scan to a dental radiologist. I can’t stress enough the importance of reviewing all your scans even after the patient has left the office.

The more we review and educate ourselves on the normal anatomy, the better we become at identifying the obscure. I also encourage taking classes that are continually being offered throughout the country on how to review a cone beam.

Do I need an intraoral scanner and CBCT?
Having an intraoral scanner and a cone beam is the perfect marriage. Both are completely independent of each other. The scanner focuses on teeth and tissue and the cone beam addresses the bony architecture. When the STL files are joined in the lab, there is complete harmony. Like a great marriage, they make each other better.

From my understanding and speaking with different vendors, one can take a DICOM file obtained from the CBCT, convert it, make a virtual model, 3D printed model and fabricate a crown. So, in theory, you could prep a tooth and have an edentulous area. Plan the implant and make the crown or partial all at the same time. And then there are times we just need to take an intraoral scan and make a crown inlay or onlay.

What’s your opinion on the obsolescence of a machine you purchase today?
The most important question to ask the equipment sale rep is, “Is the hardware upgradeable?” Also, is there a fee for upgrading to a newer version of the software? Many companies have software version updates, so you should ask what is included with your purchase.

Like any other technology, there are advances in how it’s delivered. Going with a company that’s one and done is not the way to go. I want to do business with a company (and there are many out there) that wants a long-term relationship with the buyer.

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