1. Overcome barriers to treatment acceptance GMT 45796. © Nobel Biocare Services AG, 2016. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. For prescription use only. Caution: Federal (United States) law restricts this device to sale by or on the order of a licensed dentist. See Instructions for Use for full prescribing information, including indications, contraindications, warnings and precautions..

2. Agenda Barriers to treatment acceptance Strategies to detect & address the barriers Next steps 2

3. Key barriers to treatment acceptance  Fear  Time  Trust  Value  Cost  Pain 3

4. Fear  Fright of the dentist stems from various reasons e.g. pain, smell and or sound bringing back bad memories.  Most patients are fearful of the process rather than the outcome.  Admitting to fear of the treatment is rare. A patient will point out other reasons e.g. “this treatment is too expensive.” The patient has the money, but does not want to spend it due to fear, lack of trust, wrong value perception, …  Fear can be minimized with a welcoming treatment room and positive atmosphere e.g. music 4 http://www.nhs.uk/Livewell/dentalhealth/Pages/Fearofthedentist.aspxhttp://www.nhs.uk/Livewell/dentalhealth/Pages/Fearofthedentist.aspx accessed 09.02.2015

5. Time  A patient might have certain treatment time expectations for specific reasons e.g. marriage  Time barriers can also relate to the inconvenience of visiting the practice at a certain time of the day.  The treatment team should enquire about particular time constraints that the patient has  Time flexibility for an appointment and for the treatment milestones can help to reduce the barrier to acceptance 5

6. Trust - Clinical credibility A lack of trust is the result of other causes: 1. Clinical credibility In some cases, patients expect to be able to assess the level of professionalism of the clinicians.  Use testimonials e.g. videos on your website, in your practice  Show professional certifications, membership with dental societies  Plan time to explain the treatment and the outcome  Encourage second opinions – it shows self-confidence 6

7. Trust - Price level 2. Price level  The service quality perceived by the patient has to be aligned with the price level  Assure that prices are easy to understand. Patients do not understand when the prices vary without clear rational. An option is to offer standard prices per indication.  Engage in programs that define clear and competitive prices with your lab and other partners e.g. TEM, STEM  Define a good price level, based on:  value perceived by the patient  price points from other practices in the region 7 EUR 3 EUR 50

8. Trust - Conflict of interest 3. Conflict of interest The patient expects that you are going to ‘hard’ sell your treatment. So you and your team should avoid any behavior and message supporting this prejudice:  focus the conversation on clinical aspects  mention potential negative aspects for each treatment option e.g. clinical outcome, function, esthetic, price, time…  NEVER negotiate fees – price negotiation a part of a sale activity; the clinicians role is to provide a solution to an indication  you and your team must show commitment to having happy patients that refer new patients, rather than short-term sales 8

9. Trust - Patient empowerment 4. Involve the patient in making and owning the treatment decision.  Understanding – Illustrate the different treatment options with visual aids, flipcharts, 3D animations (Nobel Clinician communicator), show models  Options – The patient must be able to choose from different treatment options  Contrast – During the dialogue and in the treatment plan, the key is to clearly show pros and cons of each treatment option (function, esthetics, time, cost,…) 9

10. Value Maximize the value perceived by the patient 1 :  Focus on communicating benefits that are tangible for patients e.g. feel free to smile, eat apples, do sports,…  Identify the barriers openly with the patient. These matters are ideally dealt with by the treatment team rather than clinician 10 Price level Money availability Travel time Understanding of the treatment Time Risk of pain Fears … Smile Esthetics Eat apple Phonetics Social contact Longevity of treatment Warranty Peace-of-mind Short timeline Success rate … B ARRIERS B ENEFITS “No more dentures! You can start eating apples and going to the pool again!” 1: adapted from http://www.yourdentistryguide.com/implant-procedures/ accessed April 15, 2013

11. Value  Value is linked to the relevant price level: the price must be set to reflect the amount of benefits the patient will get. 11 $ 100’000 $ 10’000 “Implants are stronger and more durable than their restorative counterparts, such as root canal treatments, or crowns and bridges that are cemented into place, or dentures that are removable.” 1 1: Torabinejad M et al. Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review. J Prosthet Dent 2007;98(4):285-311

12. Cost  You can offer at least two treatment options and let the patient select the one most relevant for their situation  Providing a clear treatment description that the patient can share with their spouse or any other influencer may allow them to find a financing solution  Exploring extra financial resources can be done with the patient 12 Note: A special Study Club module is available on Treatment Price vs. Treatment Acceptance.

13. Pain  Openly or secretly, all patients want to minimize pain.  For some, they will not admit that this is the reason for avoiding treatment; instead they will say that they don’t have the means.  Explain and illustrate, with simple terminology, commonly known pain management solutions:  For serious treatment, it’s full anesthesia  Mini-invasive surgery 13 http://www.nhs.uk/Livewell/dentalhealth/Pages/Fearofthedentist.aspxhttp://www.nhs.uk/Livewell/dentalhealth/Pages/Fearofthedentist.aspx accessed 09.02.2015 “All treatment is done under anesthesia”

14. Agenda Barriers to treatment acceptance Strategies to detect & address the barriers Next steps 14

15. Risk analysis as a communication tool Reasons to carry out such screenings are:  Collaborative situation with the patient  Professionalism  Highlighting problems to be solved  Systematic screening of some potential barriers to treatment  Improve the flow of communication within the team e.g. when the assessment is completed by an assistant/treatment coordinator Source: John Kois (2012) Personal History Gum and Bone Tooth Structure Bite and Jaw Joint Smile Charactrristics Dental History Name____________________________________________________________ Age _________ Referred by ___________________________________ How would you rate the condition of your mouth? Excellent / Good / Fair / Poor Previous Dentist _______________________________ How long have you been a patient? ___________ Months/Years Date of most recent dental exam _____ / _____/ _____ Date of most recent x-rays _____ 7_____ / _____ Date of most recent treatment (other than a cleaning) _____ / _____ /_____ I routinely see my dentist every: 3 mon / 4 mo. / 6 mon. / 12 mo. / 18 mo. / Not routinely WHAT IS YOUR IMMEDIATE CONCERN? ______________________________________________ PLEASE ANSWER YES OR NO TO THE FOLLOWING: YES NO 1.Are you fearful of dental treatment? (How fearful on a scale 1 (least) to 10 (most) 2.Have you had an unfavorable dental experience? 3.Have you ever had complications from past dental treatment? 4.Have you ever had trouble getting numb or had any reactions to local anesthetic? 5.Did you ever have braces, orthodontic treatment or had your bite adjusted? 6.Have you had any teeth removed? 1.Do your gums bleed or are they painful when brushing or flossing? 2.Have you ever been treated for gum disease or been told you have lost bone around your teeth? 3.Have you ever noticed an unpleasant taste or odor in your mouth? 4.Is there anyone with a history of periodontal disease in your family? 5.Have you ever experienced gum recession? 6.Have you ever had any teeth become loose on their own (without an injury), or do you have difficulty eating an apple? 7.Have you experienced a burning sensation in your mouth? 1.Is there anything about the appearance of your teeth that you would like to change? 2.Have you ever whitened (bleached) your teeth? 3.Have you felt uncomfortable or self conscious about the appearance of your teeth? 4.Have you been disappointed with the appearance of previous dental work? Patient’s Signature_______________________________________________________________Date__________ Doctor’s Signature_______________________________________________________________Date__________ 1.Have you had any cavities within the past 3 years? 2.Does the amount of saliva in your mouth seem too little or do you have difficulty swallowing any food? 3.Do you feel or notice any holes (i.e. pitting, craters) on the biting surface of your teeth? 4.Are any teeth sensitive to hot, cold, biting, sweets, or avoid brushing any part of your mouth? 5.Do you have grooves or notches on your teeth near the gum line? 6.Have you ever broken teeth, chipped teeth, or had a toothache or cracked filling? 7.Do you frequently get food caught between any teeth? 1.Do you have problems with your jaw joint? (pain, sounds, limited opening, locking, popping) 2.Do you feel like your lower jaw is being pushed back when you bite your teeth together? 3.Do you avoid or have difficulty chewing gum, carrots, nuts, baguettes, protein bars, or other hard dry foods? 4.Have your teeth changed in the last 5 years, become shorter, thinner or worn? 5.Are your teeth becoming more crooked, crowded, or overlapped? 6.Are your teeth developing spaces or becoming more loose? 7.Do you have more than one bite, squeeze, or shift your jaw to make your teeth fit together? 8.Do you place your tongue between your teeth or rest your teeth against your tongue? 9.Do you chew ice, bite your nails, use your teeth to hold objects or have any other oral habits? 10.Do you clench your teeth in the daytime or make them sore? 11.Do you have any problems with sleep (i.e. restlessness), wake up with a headache or an awareness of your teeth? 12.Do you wear or have you ever worn a bite appliance?

16. Communicate visually with your patient  PowerPoint / Keynote presentations to show the patient where they stand, their options and the potential outcome. Such material can then be used by them to show to their partner and relatives.  NobelClinician and Communicator App to show professionalism and the predictability of the treatment 16 Patient pictures before Medical history summary Dental history summary Gum and bone Tooth Structure 3D form NobelClinician Risk Assessment Diagnostic Periodontal Diagnostic Functional Diagnostic Esthetic Treatment Options Treatment Timelines Questions and call center

17. Communicate visually with your patient Show implant treatment models to help illustrate:  the anatomy of healthy teeth  treatment options e.g. implant, bridge,…  treatment steps 17

18. Dialogue with patient  Create a dialogue situation for the clinical team to collect relevant information about the patient  Help patients to come to a decision by using questions, such as:  Describe different treatment options for easier acceptance of different outcomes (no surprises)  Access the Nobel Biocare courses that address patient communication 18 “Isn’t it a great solution?” “Would that be an affordable budget?” “Should we arrange a follow-up visit?”

19. Patient evening seminars  Patient seminars to educate on pain management, treatment options  Get support from your Nobel Biocare team to organize a seminar  Use patient testimonials and emphasize the benefits of treatment 19

20. Patient data collection and flow Where: Patient calls the practice, medical history review, re-call for follow- up, treatment options, evening seminars for patients, … What:  Get to know the patients background, experience (with dentists and hospitals), expectations (functionality, esthetic, treatment time, …)  Assess patient’s body language, e.g. eye contact for trust signal  Does patient's behavior really reflect reality, e.g. Fear can hide behind “I don’t want to spend that money now” 20

21. Offer patient friendly treatment  Focus on treatment with the least traumatic effect  Favor short time-to-teeth protocols reducing the need for patient visits and manage patients’ expectations  Explain the reason for selecting certain treatment protocols and components 21

22. Help you explain why patients should use original Nobel Biocare components 22 Tell the story… How is the clinician convincing patient to go for a premium restoration. Are your patients increasingly shopping and looking for low prices? How is the science from Nobel Biocare helping you to convince your patients? Are your patients thinking long term when they get a treatment? Are your patients thinking potential treatment needs when they travel or move? Are your patients thinking about the way the treatment evolves over time?

23. Help you explain why patients should use original Nobel Biocare components DISCOVERY of osseointegration in 1952 and the first edentulous patient treated by the Prof. Brånemark in 1965. The implant will be an integral part of the patient’s body and are designed for LIFE-LONG USE. 23 The largest scientific HERITAGE Over 40 years of documented EXPERIENCE Predictable and SAFE solutions The exceptional QUALITY of original products is based on Medical Device standards. Products are TESTED technically and clinically ASSURANCE on life- long follow-up of products WIDE RANGE of evolutive product and solutions Leader for INNOVATION and continual investment in research and development EXPERIENCED clinicians all over the world Assurance to patient of HIGH QUALITY FOLLOW ups wherever the patient lives in the WORLD Tell the story… Wherever, and whenever, patient gets the best product for his treatment today and tomorrow Designing for quality of life Solutions for all indications Worldwide network of experts Pioneer in dental implants Scientifically proven

24. Agenda Barriers to treatment acceptance Strategies to detect & address the barriers Next steps 24

25. Next steps 25 Involve your dental team, assess the actions that can be initiated immediately and others that must be planned Increasing treatment acceptance is a continual improvement process 1.Measure your current treatment acceptance rate and potential root-causes for patients that decline 2.Identify and prioritize areas that can be improved. Which ones have the biggest impact? 3.Plan corrective actions 4.Implement corrective actions with your team and 5.Measure the impact. 1. Assess 2. Identify gaps 3. Develop corrective actions 4. Implement the actions

26. 26