Achieving Aesthetic Dentistry with the Right Tools

You're listening to The Dr. Phil Klein Dental Podcast Welcome to the show.. I'm Dr. Phil Klein. Today we'll be discussing the tools needed to provide excellent aesthetics in your dental practice, as well as how these tools will allow your practice to grow. Our guest is Dr. Sarah Winter, who practices in La Jolla, California. Dr. Winter has taught aesthetic dentistry and has published articles for several dental periodicals. Before we get started, I would like to mention that Dr. Winter's webinar titled Minimally Invasive Treatments for Amazing Aesthetic Results is now available as an on-demand webinar on VivaLearning .com. Simply type in the search field Winter and you'll see the webinar title. Dr. Winter, it's a pleasure to have you on Dental Talk. Hi, Phil. It's a pleasure to be here. Thanks for having me. Definitely. And it was great to hear that you're practicing in La Jolla because I did mention that I lived there for 15 years. Beautiful place to live. If I had to pick one place, there's not many places nicer than that. So we talked offline a little bit about your working environment and you mentioned that you work in a DSO. So from your perspective, we'll be able to talk about some of the aesthetic dentistry that you do and how you can make it profitable using the right products and techniques in that DSO environment. So let's begin by asking, can aesthetic dentistry be profitable in a DSO? Absolutely. Aesthetic dentistry tends to not be bound by the same insurance parameters and fees that a lot of our other services that we provide are. So I feel like both as a private clinician and now as a DSO, the aesthetic dentistry is really what drives our production, at least in our office. I have about... half of my day that's general dentistry, and I have about half of my day that's aesthetic dentistry. But overwhelmingly, that aesthetic dentistry is what drives the profitability of the practice. Yeah, and you established your office as an aesthetic dental practice, I guess, before the DSO purchased you. So you had all those patients coming in under those guidelines of you being an aesthetic dentist. Yes. Yeah. I, I, I worked for years to sort of build my name and my brand, I guess is what they call it these days in aesthetic dentistry, specifically on Instagram by myself, just posting cases, you know, all day long before and afters. And so, yes, I already had built up an aesthetic practice by the time that DSO, I joined the DSO. Wow. So you're like a modern day influencer in the dental space using social media. Wow. That's very cool. It's very important that you're doing this because the younger dentists are looking for new ways of doing things. So let me ask you this. What products would you utilize as a practice builder in the area of aesthetic dentistry in a DSO environment? I believe, and I always say that we need to have a toolkit if we're going to do aesthetic dentistry. So what that means is I need to have a really good understanding of composite, the different types of ceramics that are available, and then the non-invasive. products like resin infiltration or icons specifically when we're talking about composite i want to make sure that i have all of the best polishers i want to make sure that i have the all of the aesthetic shades in different composites the brands that i tend to like are cosmetic for anterior composite but i feel like you can get comfortable with different composites in your hands ceramic i think having a really good understanding and a great lab to be able to offer the different ceramics is a pretty important step as well. So when it comes to CAD CAM, are you doing all of this through a lab and not chair side? We scan everything. I have a trios, but when we're doing aesthetic ceramic, I am definitely sending that out to a lab. The more non-invasive and composite I'm doing all of that, the good old fashioned way, you know, sort of freehand and with my own artistic skills, I guess. So you mentioned resin infiltration. Tell us about that. technique a little bit and what does that do for the patient? I love resin infiltration. I use it a pretty fair amount at the time. It was specifically designed for those white spot lesions like a lot of times after orthodontics or fluorosis that you see what i love about it is oftentimes people have been living with it for years there have been other approaches like you know making a slurry of phosphoric acid etch and pumice and then you know massaging in mi paste or different things like that but we haven't seen those work as effectively as the the icon resident filtration specifically i love it because most patients again have been told that there's not much they could do about it when you ask them you know does this bother you yeah it has bothered me just to be able to give this really really easy non-invasive relatively quick solution to those lesions that have bothered them it can be very rewarding along with that it ends up opening up the conversation about all other forms of aesthetics including whitening including you know aligning the teeth and then further down the road, depending on each individual case, you know, can open that conversation about veneers. And what's the clinical application for the resident infiltration? What defines that case where you say, you know what, this is something I should talk about with the patient? So for me, anytime I see those white spot lesions, I ask the patient if it bothers them. So anytime you see those sort of like hypocalcified areas, those chalky white spots, and they present a little bit differently on everyone. Definitely, post orthodontic you know we've all seen the sort of halo around where the brackets were but sometimes people have had them you know as long as they can remember so anytime i see a lesion like that i will ask has this you know does this bother you oftentimes they'll be like oh no it hasn't i'm like okay well if it ever does you know there's a really non-invasive really simple straightforward approach to to sort of helping it blend in a little bit better if it ever bothered you Going back to social media, when you post your cases a lot, people start to come to you like, oh, I've had that too. I need that on all my teeth. So it becomes a little bit about them finding you. You know, anytime somebody has those white spots, I ask them if it bothers them. If it doesn't bother them, it doesn't bother me. If it does or if it ever did, then there's a really easy approach to helping mask them a little bit better. I never want to overpromise. I never want to say, oh, I can get rid of it completely. But I say, you know, there's a product on the market that. is really non-invasive and we can definitely lessen the contrast. Right. And that's been around a while, that product, and it's proven to work very well, that Icon product from DMG. So you mentioned that it leads to a discussion on whitening. Tell us a little bit about what you do with whitening. Well, so when we start talking about using the Icon product, I do want to point out to them that overall, if I take away the super white spots, One of the things that can happen is your teeth can look less bright. So I recommend whitening your teeth so that you don't lose the white spot and then think, oh no, my teeth look yellower now. That's part of my conversation before I jump in and just setting expectations. And most of the time patients want to whiten their teeth anyway. And so I do recommend whitening their teeth usually before we do the ICON treatment. And if they're not interested before and they want to do it down the road, that's fine too. So you talk about in your title, the correct tools that you want to use to achieve aesthetic dentistry. Talk about some of those tools that you use and how does it increase the credibility of an aesthetic dentist by using those tools? Again, the tools I would use, definitely having resin infiltration in my toolbox. I do offer straightening teeth and clear aligners. Invisalign is sort of the brand name everybody's most familiar with. Having great composite and then... having a lab that does amazing porcelain so what I found is not everybody is a candidate for veneers nor should everybody be a candidate for veneers but if I can talk and make talk to patients and meet them where they're at and make their smile just a little bit better and whitening products again as well. And especially if you can do it in a really non-invasive way, resin infiltration, it's almost like magic. You know, it's under an hour and they're like, oh my gosh, you know, they don't feel anything and it helps blend those lesions much better. All of a sudden they look to you as somebody that knows and understands aesthetics in a way that isn't just veneers for everyone. And so. What I have found is, you know, sometimes it's kids that come in and then the parents start asking me questions or the parents convert to becoming patients, things like that, because you've provided a service that's relatively inexpensive in the grand scheme of dentistry and really quick and painless. And it's given a better aesthetic result. So that definitely in and of itself builds credibility. What advice would you give other clinicians about setting expectations for their aesthetic dental practice? I'm a big fan of setting expectations. So I think having all those conversations on the front end, as we all know in everything that we do in dentistry, can create a much happier patient across the board. When it comes to specifically resin infiltration, I always say, you know, I can probably make this blend better. I know I can make it blend better. I don't know that I can guarantee I can get rid of it. And if this doesn't work, then we can talk about next steps and different options that are going to get you there. oftentimes i have to do a mix of resin infiltration and a little bit of bonding to mask certain color a lot of times like those fluorosis can have that brown alongside the chalky white sometimes if the chalky white has been so porous there for a long time it picks up stain but just being able to let them know like i can make this better you tell me where you're at are we going for perfection are we going for um And the good news is, if this doesn't work, then we know. Then the next steps become a little bit more clear. And we haven't compromised any tooth structure. You haven't spent that much money or time and no pain. So I think it's a really great first step. So your practice is aesthetic, but at the same time, it's minimally invasive. That's a really good way to gain the patient's confidence. Yeah. And I think it's probably a great way to build your practice as well. I'm sure you've seen that success with your practice. Regarding your patient population, do you consider your practice to be a mix of all age groups or is it primarily a younger practice? when i purchased this practice i purchased it in 2016 we had an older demographic i would say it's becoming younger as the years go by when it comes to specifically resin infiltration that tends to be a bit of a younger demographic for sure and um and then you start attracting because it worked you know for one kid at the high school and then those kids friends and parents start asking you start attracting whatever it is that you're doing so i would say that the demographic my demographic these days where i mostly will use resident infiltration is actually like 30s So it's not necessarily high school kids, although I do get a handful, but I would say 30s. And I think that the reasoning for that is that Icon wasn't around until I believe it came out in 2010. Before that. You know, there were other solutions that people brought up to try and people still use them with varying degrees of success. But there wasn't something quite as dependable as DMG's Icon. And I look for other brands. It's the only one on the market that really does this well and dependable. So I think that that 30s demographic is because people have gave up asking about it 15 years ago before Icon came out. Like everything, once you have the tool, you start seeing, you know, where you can use it. And again, it's a tool. But I feel like it's a necessary tool if you want to do aesthetic dentistry to just at least be aware of all the different things that we can offer patients that are starting with as minimally invasive as possible. Really appreciate your input, Dr. Winter. As I mentioned in the introduction, Dr. Winter's webinar titled Minimally Invasive Treatments for Amazing Aesthetic Results is available on VivaLearning.com. Just simply type in the search field winter and you'll find the webinar and certainly recommend it to everybody on the dental team. Thank you very much, and thanks for taking the time out of your evening to be with us. We really appreciate it, Dr. Winter. Thank you for having me, Phil. It was nice chatting with you.