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Munce Discovery Burs: Any Real Advantage Over Conventional Burs?

The Munce Discovery Burs (CJM Engineering) look like surgical length contra-angle burs that are readily available in many brands at a much lower cost. I have been using these conventional burs for endo since dental school. Are the Munce Burs any better?

I see that the shafts on the Munce Burs are very slender. Is this any real advantage? I have seen advertisements for ultrasonic tips that do the same thing and are even more expensive. So what is the story here? Are Munce Burs or ultrasonics that much better than the conventional surgical length burs? What is everybody using, especially to trough for the MB2 in maxillary molars?

Editor’s Note:

According to CJM Engineering, the manufacturer of the Munce Discovery Burs:  “Every maxillary molar should be explored for the virtually ever-present MB2 canal, and the isthmus between MB and ML canals of mandibular molars should be troughed to remove necrotic debris. These one-of-a-kind 31mm-long narrow stiff-shafted burs are the ideal instruments for “brushing” away structure on the chamber floor - or just beyond - to debride isthmus areas, to reveal and accentuate hidden orifices and to “dress” the chamber floor and walls.”

D-Fine Shape Burs: Shape and Polish at the Same Time

Dr. B. asks:

Clinician’s Choice has come out with its new D-Fine Shape and Shine Polishers. These are a set of slow speed contra-angle polishing burs that also polish as they shape, so the two processes are completed in one-step. They can be used on all resin composite materials. The polishers are coated with 25 micron diamond particles and come in several different shapes. I am always looking for a way to simplify my operative dentistry procedures and this sounds really good. I wanted to know if anybody has tried these and what your experiences have been.

Editor’s Note:

According to the Clinician’s Choice, D-Fine Shape Polishers are: “Dentistry’s first diamond primary polisher As with the original D FINE polishers, the first step is to “pre”-polish. D FINE Double Diamond Primary Polishers are the first to use proven diamond technology. Each Primary Polisher (purple) is impregnated with diamond particles (average particle size 45 microns) to help you create a smooth surface topography on hybrid composites and porcelain and to get a great initial shine in one easy step. Of course, a clean initial polish is the key to achieving a super gloss result. “

Presence Of Certain Antibodies Helps in Understanding Periodontal Disease

Antibodies present in people with good oral health could become the first tool for dental professionals to assess a patient’s probable response to periodontal disease treatments, say researchers at the University of Michigan.

The antibody is to a protein called HtpG, the bug that makes it is Porphyromonas gingivalis, an important pathogen in periodontal disease. The antibody also has potential as a vaccine candidate, according to Charles Shelburne, assistant research scientist at the U-M School of Dentistry.

Researchers discovered that the HtpG antibodies were present in much lower amounts in people with periodontal disease, and in much higher concentrations in those with healthier teeth and gums. Typically, antibodies are elevated in people with disease, because they help fight the disease.

“What has been seen in periodontal disease over the last 30-40 years is that patients with periodontal disease have higher levels of antibodies to the bacteria associated with periodontal disease, but what we know is that those antibodies aren’t usually protective,” said Dennis Lopatin, principal investigator and senior associate dean of the School of Dentistry. “It’s like being vaccinated against the wrong strain of the flu. The healthy patient makes high levels of the antibodies but to the right part of the bug.”

Not only were the HtpG antibodies present in higher amounts in people with healthier gums, those patients with the antibodies responded better to periodontal treatment, the researchers say.

“We’re in a position now where we have a potential tool that gives insight as to how the patient will respond to treatment,” Lopatin said. “In the United States we spend $8 billion to $12 billion a year caring for people with serious periodontal disease. From a public health standpoint, it’s very important to identify those people who not only need therapy but will actually respond to a specific type of therapy.”

In the long run, this could lead to early interventional therapy to prevent periodontal disease from advancing, or even starting, he says.

The other part of the question is why people with periodontal disease don’t make a good immune response to HtpG, and this could connect back to current thinking that oral health influences general health.

“We want to understand how unique this mechanism is in other types of chronic infections,” Lopatin said. “We’d like to think it’s not a mechanism unique to just this pathogen, if it is a more common mechanism, it makes it even more interesting.”

National Institute of Dental and Craniofacial Research, a division of the National Institutes of Health, funded the project.

The paper, “Serum Antibodies to Porphyromonas Gingivalis Chaperone HtpG Predict Health in Periodontitis Susceptible Patients,” appears online at the Public Library of Science and is available at: http://www.plosone.org/doi/pone.0001984.

Source: Laura Bailey
University of Michigan

Veneer Preparation

Veneer Preparation Clip from Dr. Garber. Demonstrating the use of the LVS-1 Depth Cutters to develop three grooves…

DentCad: A New Computer Aided Design Program

Delcam, a UK company, is set to preview DentCAD, a new computer-aided design program for the dental industry, at the Dental Technology Show to be held in Coventry, UK on 9th and 10th May. On its release later this year, DentCAD will bring to the industry the benefits of speed and accuracy given by CAD software in many other sectors. It will be able to be used for the fast, reliable creation of dental restorations, including copings, crowns and bridge frameworks.

The key benefit of DentCAD is that is extremely easy to use and so is ideally suited to dental technicians that have no previous experience of computer-aided design. The whole process is based on a series of “Wizards” that guide the user through the entire design process.

A wide range of visualization tools are available at every stage, including sectioning, shading and transparency options that allow detailed inspection of the shape being developed. This ensures that the results are exactly as required by the patient.

The system is also very flexible, so allowing different design options to be developed and compared. For example, key parameters like the margin line and the cement thickness can be varied and the computer model will automatically update to reflect the changes. In addition, sculpting tools let the user add or subtract material interactively, while the dynamic editing tools allow the complete model to be reshaped quickly and effectively.

DentCAD offers levels of speed and accuracy that are impossible to achieve with manual methods. Complete restorations can be designed within minutes of importing the scanned data. The complete design can then be supplied to DentMILL or another machining program for the manufacture of the item.

For more information, visit www.delcam.com.

Snap On Smile to Increase Vertical Dimension?

Dr. O. asks:

Snap-On Smile has really created quite a stir. I still have not done any but I took the course and continue to follow the progress in the dental magazines. One use proposed for Snap-On Smile is to open the bite – increase the vertical dimension. I thought these were only for cosmetics? Not for use in actual function. I do not see how these can be used to open the bite. They are relatively fragile. You cannot control the occlusal dimensions of the appliance. So how is this supposed to work? Has anybody tried to use Snap-On Smile to increase the bite? Also, is it true that a dental lab has to be licensed to fabricate these and that only a few labs are licensed for this?

Editor’s Note:

According to the Snap-On Smile: “Snap-On Smile is a patented multi-purpose restorative dental appliance that involves no drills, no cutting down of existing tooth structure, no needles, and it’s removable. It’s non-invasive, meaning it is also reversible. They fit directly over existing teeth and can be applied to a variety of situations. It’s made with a specialized resin which allows the appliance to be made as thin as .5mm without compromising strength. Its simple patent design allows a patient to eat without any impingement into the gums.”

Caries I.D.: An Improved Method of Caries Detection?

Dr. C. asks:

I saw an advertisement in Dentistry Today about a new caries detection system called Caries ID, manufactured by Midwest and marketed by DENTSPLY. According to the advertisement the device, which looks like a high speed handpiece, is held over the tooth surface and a red light comes on if caries is present. It can be used for occlusal and proximal caries. Has anybody tried this and does it work? Is this any improvement over the DIAGNOdent made by KaVo? I am planning to use this primarily to detect occlusal caries. With all the adverse publicity about using a sharp explorer which may puncture an intact enamel surface over a carious lesion, I am looking for an alternative method of caries detection that is reliable.

Editor’s Note:

According to the company: “The Midwest Caries I.D. uses Light Emitting Diode (LED) and fiber optic technologies to accurately detect both occlusal and interproximal caries. The presence of either type of lesion is identifi ed by 2 signals: an audible tone, and a visual signal on the tooth. It requires only a clean tooth surface, free of plaque and calculus prior to use to be effective…Lightweight and cordless for reduced hand fatigue and improved clinician comfort. LED depth penetration of 3mm. Full mouth scan in under 2 minutes. Unit lifespan of over 100 patients. Autoclavable outer housing eliminates the risk of cross contamination.”

Calset Composite Warmer: Does it Improve the Quality of Composite Restorations?

Dr. L. asks:

There is some controversy over the use of flowable composite. I have heard some lecturers say not to use it because of its high polymerization contraction. I have also heard some lecturers talk about warming about the hybrid composite compules to increase its flow and adaptation to the cavity preparation, especially into the line angles. I have seen the Calset Composite Warmer (AdDent) that can warm up the composite compule from 98 – 155 degrees F. I would like to find out if this works. For those of you using this device, does it improve the quality of your composite restorations?

Composi-Tight Matrix Forceps: Does it Make the Removal of the Sectional Matrix Easier?

Anon. asks:

I do a lot of Class II composite restorations. I generally use sectional matrix bands and a ring. I tried out the Composi-Tight Matrix Forceps (Garrison Dental) at a recent dental meeting. It seemed to make placement and removal of the sectional matrix much easier. Of course I tried it out on a mannequin at the exhibit booth. Do any of you use it clinically on patients? Is it worth the cost which is over $100? I have 5 operatories to equip if I buy them so I want to get some feedback.

Editor’s Note:

According to the manufacturer, Garrison Dental:

“Composi-Tight® Matrix Forceps provide the exceptional grip necessary for band removal while their precision tips provide the tactile control needed for placement without distorting the interproximal area of the matrix band. So you can put away your cotton forceps and your hemostats and replace them with the one instrument designed specifically for the job. “

Saliva May Help Diagnose Heart Attack with Aid of Bio-Chip

Early diagnosis of a heart attack may now be possible using only a few drops of saliva and a new nano-bio-chip, a multi-institutional team led by researchers at The University of Texas at Austin reported at a recent meeting of the American Association for Dental Research.

The nano-bio-chip assay could some day be used to analyze a patient’s saliva on board an ambulance, at the dentist’s office or at a neighborhood drugstore, helping save lives and prevent damage from cardiac disease. The device is the size of a credit card and can produce results in as little as 15 minutes.

“Many heart attack victims, especially women, experience nonspecific symptoms and secure medical help too late after permanent damage to the cardiac tissue has occurred,” says John T. McDevitt, principal investigator and designer of the nano-bio-chip. “Our tests promise to dramatically improve the accuracy and speed of cardiac diagnosis.”

McDevitt, a professor of chemistry and biochemistry at The University of Texas at Austin, collaborated with scientists and clinicians at the University of Kentucky, University of Louisville, and The University of Texas Health Science Center at San Antonio.

McDevitt and his collaborators took advantage of the recent identification of a number of blood serum proteins that are significant contributors to, and thus indicators of, cardiac disease.

Leveraging microelectronics components and microfabrication developed initially for the electronic industry, they developed a series of compact nano-bio-chip sensor devices that are biochemically-programmed to detect sets of these proteins in saliva.

Researchers from the University of Kentucky College of Dentistry tested saliva from 56 people who had a heart attack and 59 healthy subjects for 32 proteins associated with atherosclerosis, thrombosis and acute coronary syndrome. They found these proteins were in higher concentrations in saliva of heart attack victims, and that specific salivary proteins were as accurate in the diagnosis of heart attack as those found in blood serum using current testing methods.

“These are truly exciting findings, since use of these tests could lead to more rapid diagnosis and faster entry of patients into treatment scenarios that can save lives,” said Dr. Craig S. Miller, of the Kentucky team.

The test can reveal that a patient is currently having a heart attack necessitating quick treatment. It can also tell a patient that they are at high risk of having a future heart attack.

The new diagnostic test works like this: A patient spits into a tube and the saliva is then transferred to a credit card-sized lab card that holds the nano-bio-chip. The loaded card is inserted like an ATM card into an analyzer that manipulates the sample and analyses the patient’s cardiac status on the spot.

“What’s novel here is our ability to measure all such proteins in one setting and to use a noninvasive saliva sample, where low protein levels make such tests difficult even with large and expensive lab instruments,” McDevitt says.

The new technology is still in the clinical testing phase, but it is a strong candidate for further commercial development through the Austin, Texas company LabNow, Inc., a start-up venture that licensed the lab-on-a-chip technologies from The University of Texas at Austin. LabNow’s first lab-on-a-chip product, now in development, targets HIV immune function testing and can be used in resource poor settings like Africa.

Source:

Dr. John McDevitt
University of Texas at Austin

Fabricating Flexible Removable Partial Dentures?

Dr. T. asks:

I have seen advertisements for Flex Star V (Nobilium/Ticonium) for fabricating flexible removable partial dentures. It looks similar to Valplast (Valpalst International) which I have used with great success. Patients like these a lot better than their old metal framework removable partial dentures. Far more comfortable and much better aesthetics. I am thinking of trying a few flexible removable partial dentures using this material instead of Valplast. Any comments? Have any of you tried it?

Soft-Core HD vs. Thermafil

Dr. A asks,

I have been using Thermafil (Tulsa Dental) – a warm gutta-percha carrier system for years with great results. I have had absolutely no problems with the system. It fills the canals beautifully. But I have been reading about Soft-Core HD (Axis) which is very similar to Thermafil but somewhat cheaper. Really looks to be about the same kind of product. Have any of you switched from Thermafil to Soft-Core HD? Does it work as well? Have you encountered any problems with the system? I wanted to get some feedback from users before I decide to buy the system. Thanks.

Regenerating Tooth and Bone from Autologous Stem Cells

Current strategies for jaw reconstruction require multiple procedures, first to repair the bone defect to offer sufficient support, and then to place the tooth implant. The entire procedure can be painful and time-consuming, and the desired esthetic and functional repair can be achieved only when both steps are successful. Although the patient’s quality of life can be improved significantly, the prognosis is often unpredictable, especially in young patients, whose jaws continue to grow, while the implant remains fixed. The ability to bioengineer combined tooth and bone constructs, which would grow in a coordinated fashion with the surrounding tissues, could potentially improve the clinical outcomes, and also reduce patient suffering.

Under the guidance of Dr. Pamela C. Yelick, a research team at Tufts University (Boston, MA) has examined the feasibility of simultaneously reconstructing both teeth and bone. In 2002, the group first reported the regeneration of tooth crowns, from cultured tooth bud cells seeded onto biodegradable scaffolds and implanted into rat hosts. The morphology of the developing tissue-engineered tooth crowns closely resembled that of naturally formed teeth. Next, they generated a hybrid tooth-bone construct, by combining a bone-marrow-derived stem-cell-seeded scaffold with the previously used tooth model, implanted and grown in the omenta (tissues connecting abdominal structures) of rat hosts. In this case, the formation of not only the tooth crowns but also tooth root and surrounding alveolar bone was observed. However, since the omentum offers an environment quite distinct from that of the natural tooth site, the jawbone, the team examined hybrid tooth-bone construct development using third molar tooth bud cells and bone marrow derived from, and implanted back into, the same minipig.

Their results showed the formation of organized bioengineered dental tissues closely resembling those of naturally formed teeth, including dentin, enamel, pulp, and periodontal ligament, after 12 weeks of implantation. Further analyses confirmed the expression of tooth- and bone-specific markers on the bioengineered tissues. In addition, they observed novel mineralized tissue interface formation, including enamel/bone and dentin/bone interfaces. These results demonstrate the feasibility and therapeutic potential for regenerating tooth and bone from autologous stem cells, for craniofacial reconstructions in humans. This model is currently being modified to improve alveolar bone formation, regenerated dental tissue orientation, tooth root development, and tooth eruption.

Source: Linda Hemphill
International & American Association for Dental Research

Periodontitis HPV Synergy

Persons with periodontitis, or gum disease, who also are infected with human papillomavirus (HPV) are at increased risk of developing tongue cancer, new research conducted at the University at Buffalo School of Dental Medicine has shown.Researchers from UB and Roswell Park Cancer Institute published the first study showing an association between long-standing gum disease and risk of tongue cancer in the May 2007 issue of Archives of Otolaryngology - Head and Neck Surgery. Studies conducted elsewhere have found that HPV is an independent risk factor for a subset of head and neck cancers.

The UB researchers now have shown that the two infections appear to work in tandem to boost the chances of developing tongue cancer.

Mine Tezal, D.D.S., Ph.D., assistant professor in the Department of Oral Diagnostic Sciences, UB dental school, and research scientist at Roswell Park Cancer Institute, presented results of this research at the 2008 American Association of Dental research meeting in Dallas, Texas.

Evidence of periodontitis-HPV synergy has important practical implications,” said Tezal, “because there is a safe treatment for periodontitis, but no treatment for HPV infection. If these results are confirmed by other studies, this has a tremendous relevance in predicting and intervening in the initiation and prognosis of HPV-related diseases, including head and neck cancers.”

The study involved 30 patients newly diagnosed with squamous cell carcinoma on the base of the tongue between 1999 and 2005 at Roswell Park Cancer Institute for whom data was available on both periodontitis and tumor HPV status. Cumulative history of periodontitis was determined by assessing the loss of alveolar bone, the bones that underlie and support the teeth, via X-ray.

Tumor status was identified from paraffin-embedded tumor samples analyzed by polymerase chain reaction. Analysis concentrated on the presence of tumors containing the DNA of two of the most common types of HPV virus associated with oropharyngeal cancers, HPV-16 and HPV- 18.

Results showed that 63 percent, or 19 out of 30 patients, had tumors that were positive for HPV-16 DNA; none of the tumor samples were found to contain HPV-18 DNA. In addition, 90 percent of patients with tumors positive for HPV had periodontitis, and 79 percent of patients whose tumors showed no presence of HPV did not have periodontitis.

“HPV infection is a necessary, but not sufficient, cause of head and neck cancer,” said Tezal. “Although the majority of the population is infected with HPV at least once in their lives, most infections are cleared rapidly by the immune system and do not result in pathology.

“Persistence of HPV infection is the strongest risk factor for carcinogenesis,” she said. “Thus, the identification of factors that influence the persistence of HPV infection is critical to facilitate efforts to prevent head and neck cancers. This study implicates that chronic inflammation and co-infection with oral bacteria may be significant factors in the natural history of HPV infection.”

Source: Lois Baker
University at Buffalo

Coating Dental Implants with Synthetic Bone Material

Research present in a forthcoming issue of the International Journal of Nanomanufacturing from Inderscience Publishers suggests that coating dental implants with a synthetic bone material prior to implantation allows such implant to become incorporated much more successfully into the jaw.

Titanium is the material of choice for many dental and medical implants. However pure titanium has a biologically inert surface, which makes it biocompatible and so it does not trigger an unwanted reaction from the immune system. However, this inertness also means the metal does not initiate new bone and blood vessel growth around the implant, so it is not necessarily incorporated into the implant site as well as it might be.

Researchers have tried to address this dichotomy of the retaining the benefits and avoiding the disadvantages of biological inertness in implant materials. One approach involved the development of various coating materials for the implants that would not trigger an immune response and so lead to rejection but would lead to better incorporation by living tissue at the implant site.

An example of such a coating material is the commercially available composite materials, such as “Bonelike” which is a synthetic bone material, hydroxyapatite reinforced with tiny glass particles. This material can be used to provide a layer on the surface of pure titanium that its developers hoped will lead to better incorporation of any implant.

Now, J.D. Santos of the Biomedical Engineering Institute in Porto, Portugal, and colleagues have investigated how well 27 titanium implants coated with Bonelike were incorporated. The implant rods, 10 mm long and almost 4 mm in diameter were placed in the maxilla (18) and mandible (9) of seven patients, ahead of attachment of an artificial tooth.

X-rays before and after implant at three and six months allowed the team to assess how well the implants had grown in and showed new bone growth around the implants and no bone loss in surrounding regions of the jaws. “The Bonelike-coated dental implants proved to be highly bioactive with extensive new bone formation and attachment,” the researchers say.

Additionally, one implant had to be removed at three months because of bad positioning. This provided the researchers with an ideal opportunity to use light and electron microscopy to study the effects of Bonelike on the implant.

Source:
Jose Domingos Santos
Inderscience Publishers

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