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Marketing “Why My Practice” to Consumers

One of the biggest challenges facing dentists is how to set themselves apart from the competition. Every dentist has met graduating criteria, state licensing, and practice standards. To make matters worse, insurance companies continually market to consumers (who don’t understand quality dental care) that all dentists are the same. To counter the stereotype and attract patients, dentists need an “identifiable” purpose built around what patients really want, and make it their message.

 Identify Your Purpose

Purpose statements aren’t Mission Statements explaining an area of focus. In contrast, a Purpose Statement explains Why we exist, our personal motivation, but not our goals. Without an articulated Purpose, marketing inside and outside the practice lacks a distinct message.

An example of a purpose statement that connects the heart and the head comes from Greg Ellis, former CEO and managing director of REA Group, a leading online real estate ad agency: “…to make the property process simple, efficient, and stress free for people buying and selling a property.” Other examples include the financial company ING: “Empowering people to stay a step ahead in life and in business”, the insurance company, IAG: “To help people manage risk and recover from the hardship of unexpected loss”, and General Electric: “GE people worldwide are dedicated to turning imaginative ideas into leading products and services that help solve some of the world’s toughest problems.”

 

“An Extraordinary Business

Starts with Extraordinary People

Extraordinary People Start with Purpose”

Jesper Lowgren, business author

According to Simon Sinek, continuously sharing our Purpose with like-minded consumers, “Solidifies your brand with whom you share your values. When you share the core beliefs of your business with like-minded people, a natural connection is made. People whose beliefs are in line with your own automatically retain your business as part of their community.  More importantly, because your business feels right, these clients will become walking advocates, sharing your business with other like-minded people in their network. The result is a natural, self-sustaining growth of business. No matter how much technology has entered the marketing world, the most powerful form of advertising will forever be word-of-mouth.”

Putting your Why into Practice

Identifying a purpose that consumers are looking for is the first step to answering the question, “Why?” Extending it through your employees is next. For that to happen, we need employees who not only share our purpose, but execute on it daily: “We provide ‘X’ to more easily help our patients improve and maintain their dental health.”

  • Make sure you have the right employees
  • Have meetings to craft a Purpose Statement about Why your practice is important to patients
  • Collaborate on the best ways to deliver the experience your target market wants
  • Jointly set performance standards for executing your Purpose
  • Meet regularly to objectively assess performance measurements for the practice (you and your employees)

Once your office is clear on what your Purpose is and how to fulfill it, it is time to tell the world who you are and why they need to know. This is the kind of practice differential branding that resonates with those looking for what you offer. Make it stick.

Visit Simon Sinek’s exceptional You Tube video on the topic of “Why” we do what we do, which applies not only to outbound marketing, but also internally.

Molar 3-10-16 W-O B

Facts about Zirconia Degradation and Strength

Full contour zirconia, like the above, is increasingly replacing lithium disilicate as the restoration of choice, even in anteriors. However, according to many dental lab owners, zirconia preparation guidelines provided by manufacturers lost during clinical procedures can place even zirconia at risk of failure. How important is meeting reduction criteria and margin design? In some ways a lot, while in other ways, not as much. Even researchers don’t always agree.

Most often, margins with a chamfer or a rounded shoulder are suggested, with occlusal reduction of 1.5 mm and axial reduction of at least 1.0 mm. But what are the tolerances when we don’t meet these guidelines?

A study by Beuer et al on zirconia axial thickness of 0.4 mm, showed preparation design differences led to significant variations in fracture strength. Vult von Steyern reported that load to fracture for zirconia three unit bridges was much higher with shoulder margins than when a deep chamfer was used. According to some, the data is less clear for single unit monolithic zirconia crowns.

According to Kobayashi et al, “A limiting factor could be the aging of Y-TZP, due to its potential sensitivity to Low Temperature Degradation (LTD).”  When Y-TZP is subject to low temperature degradation (LTD) in the presence of water it undergoes a phase change from tetragonal to a weaker monoclinic structure. This can decrease strength and alter the surface.

A study was conducted to determine the combined effects of margin design and LTD. Three designs were tested with .8 mm occlusal clearance: a shoulderless margin for control was stored dry, a .4 mm chamfer underwent 5,000 TC and mechanically loaded (1,200,000 at 50N), and a .8 chamfer that experienced LTD from 3 hours of autoclave to simulate 10 years at body temperature.  Full zirconia crowns with identical contours and uniform 50 µm cement layer thickness were designed for each preparation.

All crowns were subjected to airborne-particle abrasion with 50 µm aluminum oxide using 0.4 MPa pressure, cleaned with steam and 70% alcohol, then cemented to metal dies with RMGI (KetacCem, 3M ESPE) under a static load of 50 N for 10 minutes.

Preparation form Control group Thermocycling 5-55, 5000 cycles, 60 s per cycle Chewing simulation Autoclave 137, 2 bar for 3 h Chewing simulation
Shoulderless 5712 (758) 5487 (310) 4799 (500)
Slight chamfer 4703 (787) 4613 (626) 4527 (596)
Chamfer 5090 (741) 5138 (328) 3414 (457)

For the above: Chart Link 

The results showed margin design and LTD affect flexural strength. However, although some research has indicated that .5 mm occlusal thickness is adequate, the amount of tooth reduction was substantially less than manufacturer recommendations of 1 mm axially and 1.5 mm occlusally. Minimal reduction can have a negative effect.

In the above study, the shoulderless margin showed highest fracture loads. However, this margin design has been reported to be detrimental to gingival health, since feather style margins always terminate at a point of zero reduction, making them over-contoured. It is advisable, based on the study, to use a small chamfer instead of a feather edge margin.

Not all zirconia is the same. Some have impurities, internal voids, or inconsistent compaction. The affects of LTD will depend on which full contour zirconia is used, prep design, and material management in the lab and chair side. LTD can cause functional wear, and/or lead to micro fractures that may or may not close. This can be especially problematic for weakened zirconia crowns placed in high occlusal stress areas that are made too thin or drilled/adjusted after sintering.

The best thing we can do for patients when using zirconia, is to make sure we follow manufacturer guidelines, refrain from using lower strength “anterior” products in posterior regions, and use smooth diamonds with copious water when adjusting zirconia surfaces.

cemented-vs-screw-retained-crowns

Limitations to Hybridized Implant Restorations

Dentists restoring implants always want successful outcomes. One area of constant concern is the potential for peri implantitis that occasionally leads to implant failure. To help avoid this, many dentists have migrated to screw retained crowns and bridges, eliminating possible complications from cement. However, screw retained crowns also present risks for future complications. The answer might be a blending of the two.

Implant related cement sepsis is a known cause for peri implantitis. However, Korsch found, in 2014, this to be more cement type related that previously thought.  Another complication for cemented abutment crowns is abutment screw loosening. Screw retained implant crowns eliminate complications from cement related risks. However, a problematic lightly cemented implant crown can be removed and repaired or temporarily replaced with an easily fashioned temporary crown holding its position. A problematic screw retained crown is far more difficult and expensive to repair or replace, and its space more complex and time consuming to temporize. This has led some to rely on hybridized screw retained crowns that are cemented and cleaned extra orally with a prefabricated, lab-placed screw access hole.

It is important to understand materials’ strengths and weaknesses before deciding upon a new application, such as a hybrid screw retained implant restoration. In the past, implant crowns have been primarily made from porcelain fused to metal (PFMs). In recent years, there has been a move away from PFMs to cleaner and more esthetic all-ceramic crowns made from lithium disilcate or zirconia. Some dentists have shown a preference for lithium disilicate in esthetically critical cases. However, little is known about the long-term performance of this material as an implant crown with a screw access hole.

Research by Biskri in 2013, noted the brittleness, low elasticity, and unidirectional crystals of lithium disilicate. But the material has also been widely reported to be more fatigue resistant than feldspathic porcelain. Despite its benefits over traditional porcelain, research by Dhima in 2014 showed far more predictable strength when lithium disilicate is at least 1.5 mm thick, occlusally.

Lassle, in his 2015 master’s thesis, described testing the viability of hybridized lithium disilicate screw retained crowns affixed to Nobel conical, 5.5 stock abutments with a 1.5 mm collar. The crowns were digitally designed, mandibular first pre molars, with 2 mm of occlusal thickness and axial walls ranging from .5 mm gingivally, to 1.5 mm near the occlusal table. Occlusal access holes were created in #1 prior to glazing in the “blue” state, #2 after glazing, both using copious amounts of water for cooling. The control had no access hole. The crowns were silanated and cemented with RelyX™ Unicem (3M Espe), and allowed to set 24 hours prior to testing. A control group followed the same protocol, but without an access hole.

 

Results

implant loosen stats

 

It is clear from the results that placement of a screw access hole in lithium disilicate leads to a significant decrease in load bearing strength. According to Lassle’s findings, lithium disilicate would be contraindicated for this purpose.

Despite our potential for bias in selecting screw retained, cemented, or hybridized screw retained, some researchers believe there is inconclusive evidence of clinical significance between them, as reported by Sherif in 2014. Cement retained implant crowns are less expensive, seat passively, and are easier to work with. Screw retained implant crowns eliminate possible cement related complications, and offer retrievability after screw loosening. A deciding factor for the third option should be the material to be used.

The research conducted by Lassle was revealing. However, we should keep in mind that people don’t chew with a constantly increasing pressure of .1 mm per minute against a 3 mm steal ball. Yes, lithium disilicate is definitely weekend by a central fossa hole, as evidenced by the early fractures along the central groove. But that doesn’t mean they will always fail, clinically. However, if we are looking for greatest certainty when using hybridized screw retained implant crowns, zirconia would be a surer bet, according to testing by Hussien et al, in 2016, showing zirconia to be over 3 times stronger than lithium disilicate.

purpose image

Marketing, “Why My Lab”

One of the biggest challenges facing laboratory owners is how to set themselves apart from the competition. Every laboratory has or has access to the same materials and digital technology. To make matters worse, digital technology has made most restorations “good enough” to the point they are often difficult to discern. This has dentists, under consistent fee pressures, asking, “Why pay more when ‘good enough’ costs less, and that is all insurance companies and patients are paying for?” Today, labs can either raise the bar on service & knowledge, or compete on lowest price and turnaround times. In either case, there is so much competition, that no matter the decision, the lab astute lab owner will go one step further and “identify” a business Purpose and its message.

Identify Your Purpose

Purpose statements aren’t Mission Statements explaining an area of focus.  Mission explains what we do and for whom, our Vision is about us, and our Principles speak to how we will conduct ourselves. In contrast, our Purpose Statement explains Why we exist, our personal motivation, not our goals. Without an articulated Purpose, marketing lacks a distinct message.

An example of a purpose statement comes from Greg Ellis, former CEO and managing director of REA Group, a leading online ad agency for real estate: “…to make the property process simple, efficient, and stress free for people buying and selling a property.” His outward focus connects with the heart and the head and emphasizes serving customers and their needs by putting employees in customers’ shoes. Other examples come from giant companies such as the financial company ING: “Empowering people to stay a step ahead in life and in business”, the insurance company, IAG: “To help people manage risk and recover from the hardship of unexpected loss”, and General Electric: GE people worldwide are dedicated to turning imaginative ideas into leading products and services that help solve some of the world’s toughest problems.”

An Extraordinary Business

Starts with Extraordinary People

Extraordinary People Start with Purpose

Jesper Lowgren, business author

The philosophy is simple: continuously share your Why (motivation) with interested, like-minded dentists. Doing so, “Solidifies your brand with whom you share your values. When you share the core beliefs of your business with like-minded people, a natural connection is made. People whose beliefs are in line with your own automatically retain your business as part of their community.  More importantly, because your business feels right, these clients will become walking advocates, sharing your business with other like-minded people in their network. The result is a natural, self-sustaining growth of business. No matter how much technology has entered the marketing world, the most powerful form of advertising will forever be word-of-mouth,” writes Sinek.

Putting your Why into Practice

Identifying a purpose that dentists are looking for is the first step. Having it felt by and extending through your employees is next. For that to happen, we need employees who not only share our purpose, but execute on it daily: “We offer X to help our customers take better care of their patients more profitably,” In considering that the job of a technician is to help their customers restore and maintain health, the Purpose Statement offered above is on target, but can be modified for your lab.

  • Make sure you have the right employees
  • Have meetings to craft a statement about why your lab is important to dentists and patients
  • Collaborate on the best ways to create what your target market wants
  • Jointly set performance standards on how well your Purpose is being executed and experienced
  • Meet regularly to objectively assess performance measurements and that of your employees

Once your lab is clear on what your Purpose is and how to fulfill it, it is time to tell the world who you are and why they need to know. This is the kind of branding that resonates with those looking for what you offer, and your differential. Make it stick.

A Great Video on “Why” 

Visit Simon Sinek’s exceptional You Tube video on the topic of “Why” we do what we do, which applies not only to business marketing, but also internally to employees.

https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?language=en#