the “additive dentistry” specialiststhe “additive ... · multiple approaches to bracketless...

50 January 2008 ■ dentaltown.com

office visit

The “Additive Dentistry” SpecialistsThe “Additive Dentistry” SpecialistsDr. Lou Graham’s group practice of general practitioners and specialists is a patient’s one-stop-shop

for long-term dentistry

by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

Welcome to the newest installment of Office Visit, where we visit a Townie’s office and profile his or her equipment, design or unique

practice philosophy. If you would like to participate or nominate a colleague, please send me an e-mail at [email protected].

This month, we paid a visit to Dr. Lou Graham’s practice, University Dental Professionals, in Chicago, Illinois. Dr. Graham discusses

his new patient process, “additive dentistry,” office layout, team development, working in a group practice and Dental Team Concepts.

51dentaltown.com ■ January 2008

office visit

Office HighlightsBonding Agents

■ 1 Step Plus■ Optibond■ PBnt■ XP Bond

Burs■ Axis■ Fissureotomy■ Komet■ Numerousl Polishing■ Shofu Robots■ SS White

Cements■ Calibra■ Fuji Cem■ Fuji Cem Plus■ G-CEM■ MaxiCem■ MonoCem■ NX3

Implants■ Ankylos■ Neoss■ Nobel Biocare

Impression Materials■ Aquasil■ Flexi Time■ Impergum

Restoratives■ 3M’s Ketac Nano■ Artiste■ Duo CeramX ■ Dyract Flow■ Esthet-X■ Evo Flow■ Filtek■ Fuji 2 LC, Xtra, Miracle Mix■ Gradia X■ Premise■ Riva Light Cure & Self Cure■ Venus■ Vitrebond■ Wave Medium Flow

Technology■ 980 diode laser (KaVo and Sirona)■ A-dec systems with built in Acteon

piezo-electric systems■ Cercon Coach (Dentsply)■ CO2 Spectra & Deka soft tissue laser■ Dentrix Software■ Diagnodent (KaVo)■ Digital pan/ceph (Sirona)■ Digital radiography (Kodak) with

Logicon for caries detection■ Guru (Schein)■ Nobel Guide■ SDI Radi LED light■ Simplant Software■ Velscope (LED)

Name: Lou Graham, DDS

Graduate from: Emory University Dental School

Year graduated from dental school: 1982

Practice Name: University Dental Professionals

Year practice opened: 1984

Practice Location: Chicago, Illinois

Practice Size: 3,500 sq. ft.

Number of Ops: 9 Staff: 14

Your office is located in a university community. How would youdescribe your patient population?

Our patient population is quite unique. With the international reputation of theUniversity of Chicago and all its related graduate programs and hospitals, our patient mix isextremely diversified. We literally see dentistry from around the world and it’s quite interest-ing to observe.

continued on page 52Photos by Pictureboy Creative


office visit

How do you market your practice to this population?

For years we have been the worst at marketing! We followthe adage that internal referrals are the best. Earlier this year westarted a program to send out a $5 Starbucks card with a person-alized thank you note to patients who gave us new referrals. Forthree referrals, we sent out a $50 American Express gift cardwith a personalized note. We just finished a major upgrade withOffice Site by adding customized audio and video to our Website. Now, when you open our site, UDPdentistry.com comesalive. Other projects involve marketing via university publica-tions and working with a direct marketing consultant to buildour specialist referral practice.

You have described your approach as “additivedentistry.” How is this reflected in your treat-ment plans?

Life-spans continue to lengthen and our approach is toalways be as conservative as possible with treatment longevity.Simple answers are a missing lower molar that either requires abridge or an implant. But with more challenging scenarios, like apatient with anterior crowding and discolored teeth, veneers cangive great results, but what would be best long term? If thepatient is 60, veneers can be a great alternative to one or twoyears of ortho, bleaching, and maybe later, more conservativeveneers. On a 22-year-old with aggressive preparations, what islong-term success and how many times will this case requirerepair or retreatment? Add to this, an unstable occlusion andwhether or not veneers are the right answer, long term. The sameapproach goes into perio/restorative treatment planning, dailyrestorative planning and so much more.

You have two offices separated by a lobby.How do you determine which patients are partof each practice? Is there overlap?

From a design standpoint, the 1,000 feet between our officesis absolutely not ideal. The building we were in was built almost100 years ago and the opportunity came about to expand intonew space located on the opposite side of the building. In ourpre-existing space, Drs. Anthony LaVacca, Danielle McCarron,Rauf Yousef, and Michael Alexander practice along with ourhygienists Kierah Robinson and Pam Pennamon. I operate outof the new space with Gwen Smukowski (hygienist) and anorthodontic group, Get It Straight, headed up by Dr. NeilWarshawsky. They sublet the space four days a month and havefull use of the office. Neil is incredibly progressive and the rela-tionship works out incredibly well because we can cross refer andwork together on complex casework with our entire group.

Along with Neil’s group, Dr. McCarron continues to expand herInvisalign practice along with other orthodontic services, includ-ing Red, White and Blue and Raintree Essix’s MTM system.

The overlap in the offices is that our digital panorex islocated on the new side, which allows all of our patients tobecome aware of both offices and the latest technology. Withinour digital panorex room, patients can immediately see the scanand, without question, it is a “wow” for them each and everytime. The same room can be used to have one-on-one patientdiscussions and patient photography. Both offices are linkedtogether in every other manner, so calls or any patient manage-ment can be handled by the front team.

You have a prosthodontist and periodontist in yourpractice. How do you manage this relationship?

Some consider it a challenge to have a general dental group

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see chart on page 54, article continued on page 56

Areas of Expertise

Given where dentistry is going, it is difficult to be excellent at every aspectwithin the field. To create a successful group practice, it is University DentalProfessionals’ belief that it must bring the most out of what each doctor wantsto practice and thus deliver great care under one philosophical mission.

■ Dr. Danielle McCarron focuses on family dentistry/endodontics/ multiple approaches to bracketless orthodontics along with expandingher education in occlusion and TMJ.

■ Dr. Anthony LaVacca’s expertise is in implantology – both surgical andrestorative, sleep apnea, and removable/restorative dentistry.

■ Dr. Lou Graham’s areas include periodontal, restorative, cosmetic, den-tal materials, implants, and geriatric dentistry.

■ Coupled with periodontist Dr. Rauf Yousef, whose expertise is in implantsand surgical periodontics, oral surgeon Dr. Mike Alexander, whose main focus is implants and surgical oral surgery procedures, and Dr. NeilWarshawsky’s orthodontic group, Get It Straight, the practice can pro-vide services that sets it apart, yet works within its collegial community. ■

Dentsply Caulk

Medvisor Guru

Soft tissueLasers

Spectra’s CO2and Kavo’s980 series

Velscope by LED


office visitcontinued from page 52

continued on page 56

Lou’s Top Five

When youstarted to use

2007

2007

2007

2007

2007

Why youcannnot live

without it

The system allowsme to use multiple

different dentalapplications all

within the use ofpiezo electric

technology.

Oral cancer is oursto find and early

detection isdependent on our

profession.

Treating periodon-tal disease is sochallenging and

these lasers havebecome indispen-

sable for us inmaximizing our

therapy.

Instant communi-cation and fun.

B4 allows the userto truly maximize

Aquasil andachieve far more

consistent impressions.

When you use the item

All phases of peri-odontal debride-

ment, endodontics inmulitiple ways, finalmargin preparation,

class 2 boxes inrestorative, cementremoval and more.

Mandatory on everyexam, this includes

every intial exam,and during recall

exams.

Hygienists use themdaily, coupled with

their ultrasonic treat-ments, localized

antibiotics and othermodalities.

My entire team usesthis tool in every

phase of dentistry. Itallows everyone to

interact with thepatients.

For the majority ofmy crown and bridgeimpressions in which

I use Aquasil andother VPS materials.

I do not use thiswhen I use Impergum

which I use for mylarger cases.

If you could changeanything about the

item, what would it be

They are launching an endoirrigation system, which isgreat. I would like some ofthe preparation tips to last

longer, and it would be niceif the implant periodontaltips would be less fragile.

Beyond bleaching lesions,more ways to differentiate

lesions that don’t emit fluorescence.

I am waiting for the GentleRay to add a water system

to their delivery. This willtake the 980 to new heights.

Also fibers that don’t breakand automatically cleave.

For the CO2, just make surethe tubes last.

On the top of my list wouldbe a socket grafting

animation to show ourpatients why.

I would like to buy B4 as astand-alone product.

How you market it to your

patients

We do not market it to our patients.

Patients really appreciate oureffort in screening for cancer.We discuss with our patients

the need to evaluate theiroral tissues and it is the

responsibility of dentists.

It is discussed for any complex peridontal treat-ment in conjunction withscaling and use of othermodalities like Arrestin.

We worked with Office Siteto create audio and videosections and this product

is demonstrated and high-lighted on our Website,

UDPdentistry.com.

We don’t market this product to our patients,

we just smile when we nailour impressions.

Acteon all-in-one built-in

systems withinA-dec unit

coupled with a specialist group. I think weare unique because we also work with localdentists in assisting them with complexcasework. Dr. LaVacca, our prosthodontist,has begun working closely with some neigh-boring dentists in the restorative aspects ofimplants. We are expanding this role byoffering a full-year mini residency inrestorative implant dentistry with DentalTeam Concepts (DTC), along with accred-itation CEUs. This unique relationship willallow our group to surgically plan and placethe casework while working concurrentlywith the referring doctors to coordinate therestorative phase.

What is youradvice for dentistsconsidering a largegroup practice thatwould include spe-cialists as partnersor renting space?

The first step in creat-ing a group practice is todevelop your philosophi-cal mission. My experi-ence would truly advise agreat front office manager,and definitely one clinicalleader. In my case, Mary Beth Reckamp and Daniella Soro weremy front management team, and Zenny Martinez, Gwen andKierah, who have been with me for years, were the key reasons toour growth and success. Associates must be selected so carefullybecause they are your future. Too many times, dentists look uponthem as worker-bees and this only leads to a turnstile office.

What are your tips for picking the great mem-bers of your team?

I go by the adage, “it’s so much easier to hire than fire.” Withtoday’s complexity of laws on dismissal of employees, it becomescritical to hire correctly. For the majority of team members who Ihave let go, there were two essential reasons, they either didn’thave the same work ethic I had, or they just didn’t share the vision.Routinely an interview process involves an initial meeting withme after members of the team have met with the applicant. If theapplicant satisfies all the criteria, we have him or her back for aseries of work appointments in which we evaluate skill level. Theseworking interviews allow us to further observe their interactionswith patients and also for them to see how comfortable they arein our work environment. If we aren’t 100 percent sure, we bringthe applicant back, and sometimes it can take a series of working

interviews to decide. Each and every mistake I have made with ahire who didn’t work out was because we rushed this process.

Describe your approach to team developmentwith your existing team.

Team development is life long. Our goal is to create goals forleadership and development for each team member. This beginswith a written and oral understanding of what the employee isseeking and then it’s up to us to determine the right place withinthe team. An essential ingredient is finding the right job for theright person. All too often you might have the right person inthe wrong job. Our monthly meetings allow the group to inter-act openly with a set agenda and this too leads to leadership/responsibility or the lack thereof.

What are some of the physical ways your officeis different than most?

From the outset of the new build-out, we worked with RonEhlers of Metrotech Design Group who has designed more than100 dental offices. I wanted the office to look like my livingroom. He loved it! As he and Erin McLaughlan worked ondesign and integration, they worked with Dick Ostroski and




The team of

dentists, specialists

and associates at

University Dental

Professionals is

committed to

providing patients

with top-notch,

long-term den-

tistry in a com-

fortable setting.

Rich Landek from Patterson, and a master plan came to life.With today’s options, anyone can build their personality intothe practice and the results can create dental environments thatare truly reflective of their passion.

Our original office had neither space for a consultationroom, nor a panorex, but we had more than enough lab space;we knew what we needed and what we didn’t. As we built outthe new space, we decided not to squeeze four operatories intoa main space but instead create three beautiful rooms. Our goalwas to maximize the “old feel” of the building and maximize the20-foot ceilings, the eight-10 foot windows, the historic mold-ings and so much more.

What dental equipment do most patients noticeimmediately?

The first thing our patients notice is our OrthoPhos digitalpan by Sirona. The moment the panorex is taken, they turnaround and it’s immediately up on the monitor. The fact that thispicture often replaces traditional full mouth X-rays in the officeis both appreciated by patients and the team. Velscope has beenso widely accepted by our patients as an oral health-screeningdevice that this also has a big impact on them. Kavo’s Diagno-dent is a consistent hit with our patients because once the tech-nology is explained, they immediately grasp the reason why.Guru from Medvisor is a great animation resource to explain the“whys” to a patient in a very unique way. It allows the user tostop, draw and point to any part in an animation, along withimporting and exporting files and pictures and allowing users tocreate their own presentations.

Your office seems to have a keen interest instaying current with new dental technology. Isthere any new equipment you’re thinking ofpurchasing for 2008?

The must haves on my list for 2008 begin with the new dig-ital scanner by 3M called Brontes. Imagine scanning a full archin two to four minutes or two quadrants, a crown and being ableto view this all on a monitor. It will show the preparation,occlusal clearance, line angles and so much more. It will allow allof us to create better and proper preparations and replace muchof the traditional impression techniques. It won’t be too longbefore impression materials will be part of the previous genera-tion, imagine all the happy orthodontic patients and beyond!Our offices will be moving into a true CAD/CAM field whereeven traditional articulations will be via computers. In 10 years,who knows where this technology will be? The other must-haveupgrade in our office will be the next generation IntraOralCamera from Acteon. Products that deliver multiple clinicalmodalities are most beneficial. Beyond it being a superb camera,this unit offers a customized lighting system for shade selectionand custom matching of teeth side by side with shade tabs, along

with enhanced lighting for intraoral viewing. Coupled withGuru, case presentations will simply just flow! It’s truly so excit-ing, just take a deep breath and welcome the challenge.

How has Dentaltown impacted your practice? Dentaltown has always been a unique publication to read. I

particularly like the polls and the interactions on the messageboards. This allows me to understand my audiences when I amlecturing and also to see and understand new clinical tech-niques. There are definitely new protocols published and it isvery easy to follow.



United Dental Professionals’ New Patient Process

■ When new patients call the office, they speak directly with Mary Beth

Reckamp, the office manager, who welcomes the patient and gets a

variety of information from the patient.■ New patients will then receive an 8x10 brochure about the office,

reviewing practice philosophy and offered procedures and introducing

staff. Also included is medical history, dental history, and a personalized

letter, hand written from Mary Beth.■ Patients are booked to arrive 30 minutes prior to their appointment to

meet Mary Beth, review office policies, understand more about UDP’s

practice and, if necessary, financial options.■ Prior to any X-rays, the doctor will meet and greet the patients. The

assistant will have briefed the doctor about chief concerns, medical

issues, who referred the patient, etc.■ New patient exams are comprehensive, and require a full review of the

following: medical history; dental history, along with family dental history

(genetics may have key roles); chief concerns; blood pressure; head and

neck exam; full perio, occlusal, restorative exam; review of X-rays: digi-

tal bitewings and digital panorex; digital pictures and diagnostic models

(in cases of any complexity); and a full hygiene review.■ Second appointments are made for all complex treatment presentations. ■




What is Dental Team Concepts? Howoften do you present CE each year?What are your future plans for DTC?

Nearly five years ago we began a continuing edu-cation and consulting company called Dental TeamConcepts (DTC). Our initial premise was to createeducational programs that went beyond the singlemanufacture courses. Through DTC we work withmultiple sponsors throughout the industry that allowus to deliver well-integrated programs. We currentlyhave a dynamic group of 40 dentists who are involvedin many different phases of dentistry. With this as acore group, we consult our client companies to evalu-ate current and future products, market trends and avariety of ways we can interact via the Web, journalsand live lectures. With such a vast speaker pool, wewill be launching a very dynamic Web site that willallow educational entities such as state groups, organi-zations and others to visit our site, select speakers andtheir subjects, and with just a phone call, the event isbooked and DTC handles all of the coordination. Thisproject will also provide our manufacture clientsnumerous innovative alternatives to exposing their products todentists, hygienists, assistants and laboratory technicians. Thekey to all of this is that the speakers as evaluators must utilize the

products in their own practices in order to offer audiences themost honest integrated programs. This is one of the fundamen-tal core values of DTC – teach what you use. ■

University Dental Professionals strives to treat its patients with an individualized and compre-

hensive approach. Its team of dental hygienists are trained in laser dentistry, digital radiography

and non-surgical treatment of periodontal disease.

It feels great to save a tooth.Imagine how it feels to save a life.

Oral cancer kills one American every hour of every day.Fortunately, you can be the key to earlier detection,especially if you have a VELscope® system. When partof a comprehensive oral cancer exam, the VELscopesystem can help you detect suspicious tissue that mightnot be apparent to the naked eye. Just ask DennisPerala. And the VELscope system can also helpsurgeons ensure that all targeted diseased tissue isremoved. No other product has received FDA clearanceto make these statements.

So count on the VELscope system. Because your patients are counting on you.

Get it early. Get it all.™

Call 888.541.4614 or visit www.velscope.com for more information.

“VELscope is trulya lifesaver!” Dennis Perala, DMDVancouver, WA

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