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Disposable Diamonds for Cutting Crown Preps?

Dr. H. asks:

I have always used the expensive, reusable diamonds for cutting crown preps. But the price of these keep going up into the stratosphere. Sometimes I can only use these diamonds once, because they get so clogged up. I have tried various ways of cleaning these out, but the bottom line is that after you use these once and autoclave them, they are not nearly as sharp as they were the first time they were used. I am thinking about switching to disposable diamonds like NeoDiamond [Microcopy Dental] because I have heard these recommended at continuing education courses. What are you all doing out there? Reusable or disposable diamonds? Do the reusable diamonds cut that much better?

RegenerOss Allograft Putty: Grafting Made Easier?

3i has just come out with a new osteoinductive product – RegenerOss. It has a putty like consistency and is mostly demineralized bone matrix. Sounds like this would be very useful for packing around the implant in a case of tooth extraction followed by immediate implant placement. I do not see any downsides to this material. But has anybody used it and how well does it work?

Editor’s Note:
According to 3i, RegenerOss is:

Verified Osteoinductive Potential For Promoting Bone Growth On A Consistent Lot-To-Lot Basis

Demineralized Bone Matrix (DBM) Content Of 40% By Weight Contains Human Growth Factors, Which Enable Bone Growth On The Surface Particles

Moldable Carrier That Resists Movement Under Irrigation And Provides Graft Containment For Ease Of Use In Delivery

Clarity: Useful for Making Transfer Impressions with Implants?

I do quite a bit of implant restorations. Recently, I saw an advertisement for Clarity [Park Dental Research], a transparent impression material. This looked pretty useful for situations like making transfer impressions with implants. I also see uses in making temporary bridges and veneers. I am just wondering if I will actually use this material enough to justify stocking it. I would like to find out if any of you are using it and what you are using it for. Have you found this material useful for implant impressions?

Editor’s Note:
According to Park Dental Research:

”

CLARITY! (with a transparent tray) allows you to clearly see the position of the transfer copings and abutments.

CLARITY! eliminates the guesswork involved in the impression process by permitting clear vision of the implant components.

CLARITY! makes the impression process simple and precise with either an open or closed tray.

”

Licorice extract provides new treatment option for canker sores

Commonly referred to as “canker sores,” recurrent aphthous ulcers (RAU) now can be treated by an extract in licorice root herbal extract, according to a study published in the March/April 2008 issue of General Dentistry, the Academy of General Dentistry’s (AGD) clinical, peer-reviewed journal.

The authors examined the effects of an over-the-counter medicated adhesive patch (with extract from the licorice root) for treatment of RAU versus no treatment. After seven days of treatment, ulcer size in the group who received the adhesive patch with licorice extract was significantly lower, while ulcer size in the no-treatment group had increased 13 percent.

Licorice root extract was used as a prescribed treatment for gastric ulcers until the 1970s, according to the study. In its original form, licorice root extract has a very strong taste. However, when combined with a self-adhering, time-release, dissolving oral patch, the taste is mild and pleasant.

Among the causes of canker sores, a genetic predisposition might be the biggest cause, says Michael Martin, DMD, PhD, lead author of the study. “When both parents have a history of canker sores, the likelihood of their children developing them can be as high as 90 percent,” he says.

The most serious side effect of canker sores is sharp pain in the mouth, which can interfere with an individual’s quality of life and affect their eating, drinking or speech. Dr. Martin revealed that “in addition to speeding healing of the canker sores, the adhesive patch helped to reduce pain after just three days of treatment.”

Those who experience canker sores on a regular basis can visit their dentist for treatment techniques. “Dentists can give patients the proper medication and treatment options to seal the lesions, which will prevent further infection,” says Eric Shapira, DDS, MAGD, AGD spokesperson and expert on alternative medicine. “Also, increasing vitamins and other herbs, such as Vitamin C and zinc, can help treat canker sores because they help to regenerate tissue cells,” Dr. Shapira adds.

Source:
Contact: Stefanie Schroeder
Academy of General Dentistry

Diaroot: Effective Treatment for Repair of Root Perforations?

Dr. D. asks:

I do a lot of my own endo. Every now and then I get a furcal or root perforation. I used to pack these with calcium hydroxide or glass ionomer. I started referring these to my endodontist when ProRoot MTA [Tulsa Dental] came out. ProRoot MTA is supposed to be the most effective treatment for perforations, at least according to what I have read. ProRoot MTA is very expensive and I cannot afford to stock it or use it. DiaDent has now released their new product DiaRoot specifically for treating perforations. Has anybody tried Diaroot? What are the endodontists saying about its effectiveness in treating perforations? Is it as good as ProRoot MTA?

Editor’s Note:
According to DiaDent:

“DiaRoot is a biocompatible pure white powder composed of ceramic particles. Upon mixing DiaRoot with BioA Liquid, the hydrophilic BioAggregate Powder promotes cementogenesis and forms a hermetic seal inside the root canal. Its effectiveness to clinically block off bacterial infection, ease of material manipulation and superior quality make DiaRoot the most innovative and unique root canal repair material.”

Digital Radiography: Diagnostic Information Compared to Conventional Systems?

Dr. C. asks:

I am considering buying a digital x–ray system for my dental practice. Many of the dentists in my area have implemented digital radiography into their practice. I understand there are many benefits to having a digital system, but I am still concerned about how well the digital x–ray machines work. Is the contrast and density clear enough for me to be able to see caries well? Am I going to lose any diagnostic information with a digital system compared to a conventional one? I would like to hear from general practitioners using these systems. Was it worth the investment? Which digital radiography systems do you recommend?

Treating Oral Mucositis: New Data on CAPHOSOL Released

New data show that CAPHOSOL (www.caphosol.com), an advanced electrolyte solution, relieves painful oral mucositis (OM) and improves quality of life for cancer patients undergoing chemotherapy and radiation therapy.

One of the two abstracts including this data, ONS Abstract #2757, “Supersaturated Electrolyte Oral Rinse Aids Quality of Life for Head/Neck Chemoradiation Patients” (Haas, ML), was selected by an ONS Expert Panel as one of the Top Ten Best Supportive Care abstracts at the ONS 2008 Congress.

“Oral mucositis is a painful, common side effect experienced by cancer patients receiving chemotherapy and radiation therapy,” commented principal investigator Marilyn L. Haas, PhD, RN, CNS, ANP-C, Nurse Practitioner, Mountain Radiation Oncology, Asheville, N.C. “As layers of epithelial cells in the oral cavity (cells lining the surface of the throat and esophagus) are eroded during therapy, patients often experience severe pain, are more prone to infection and have difficulty eating and swallowing. Our research concludes that CAPHOSOL, a supersaturated electrolyte oral rinse, should be introduced early in the course of cancer therapy for patients at high risk of oral mucositis because it minimizes the onset and severity of symptoms.”

“Considering that most patients with head and neck cancer experience oral mucositis, any improvements in quality of life for these patients is encouraging,” said Dr. Haas. “CAPHOSOL is useful for oncology nurses and other healthcare practitioners in helping patients with oral pain and related symptoms of chemoradiation-induced oral mucositis.”

Oral Mucositis: A Common and Debilitating Condition

Oral complications including mucositis and salivary gland dysfunction are common and often debilitating side effects of cancer therapy. OM is estimated to affect more than 400,000 cancer patients each year. OM affects approximately 40 percent of cancer patients who receive chemotherapy, more than 70 percent of those undergoing conditioning therapy for bone marrow transplantation, and virtually all patients receiving radiation therapy for head and neck cancer.

Oral mucositis usually manifests itself within seven to 14 days after initiation of therapy. Initial signs and symptoms include redness, swelling and ulceration of the mucosa. Oral mucositis can cause mouth pain, xerostomia (dryness of the mouth or throat), difficulty eating and drinking, as well as difficulty with speech; these effects can significantly impact a patient’s weight, mood and physical functioning. Severe ulceration may cause breaks in the mucosa, which can then become susceptible to oral opportunistic infections, possibly resulting in bacteremia (the presence of bacteria in the blood), sepsis (the presence of pathogenic microorganisms in the blood) or other potentially fatal complications. The economic impact of mucositis can be significant, as the need for prolonged hospital stays, nutritional therapy and treatments for pain and infection can drive up the costs of therapy.

About CAPHOSOL

CAPHOSOL is an advanced electrolyte solution indicated in the U.S. as an adjunct to standard oral care in treating OM caused by radiation or high dose chemotherapy. CAPHOSOL, a U.S. patented prescription medical device, is also indicated for dryness of the mouth or throat (hyposalivation, xerostomia), regardless of the cause or whether the conditions are temporary or permanent. Patients restricted to a low sodium diet should consult their physician before use. Patients should avoid eating or drinking at least 15 minutes after use.

As part of its commitment to advancing the treatment and care of cancer patients, Cytogen launched CARE OM� (www.careom.com) a Web-based education and support center for patients and caregivers seeking to learn more about OM and CAPHOSOL. In addition to oral mucositis educational material and support information, visitors to CARE OM can also download an OM brochure or request it by mail. For more information about CAPHOSOL, visit www.caphosol.com or call (800) 833-3533.

Source:
David Avitabile
JFK Communcations

Styla MicroLaser: A Breakthrough in Soft-Tissue Management?

Any thoughts on the Styla MicroLaser from Zap Lasers? The Styla is being called a breakthrough in soft-tissue management.

The 1.9 ounce Styla combines revolutionary design and proven diode laser technology in a self-contained unit measuring only 6.9 inches long. The handheld Styla has no wires or cables.

According to Zap Vice-President of Sales and Marketing Alex Di Sessa.

“Introducing Styla, Zap continues to break barriers, eliminating the cord and delivering a powerful soft-tissue laser with the freedom to move wherever the doctor does, even between practices, making sure patients in every operatory and office receive the highest standard of care possible.”

Some of the benefits of the Styla include:

Pre-threaded Disposable Tips: Styla’s pre-threaded disposable tips save time by eliminating the need for scoring and stripping, and are ready to use straight from the box. Precisely placed magnets perfectly align and secure the tip for an exact fiber connection every time.

Intelligent Gravity Sensor: Styla’s intelligent built-in gravity sensor automatically detects the microlaser’s orientation and adjusts Styla’s high-contrast display to be read whether operated by a left- or right-handed practitioner.

Wireless Foot Pedal: Styla’s wireless foot pedal uses advanced 2.4 GHz wireless technology to securely communicate with Styla’s main body.

More information at: http://www.zaplasers.com

SensAble Dental Lab System: A New Dimension to Digital Restorations?

Has anyone had any experience with labs that are using the SensAble Dental Lab System, an integrated solution to scan, design and fabricate common dental restorations?

Supposedly, it is the first integrated digital solution to support the production process for partial frameworks, as well as crown and bridge substructures. The solution uniquely incorporates “3D virtual touch” technology so that lab technicians can “feel” the on-screen image — and work as naturally and directly with a computer-based system as they do when using traditional hand-waxing techniques.

Editor’s Note:
The SensAble Dental Lab System is a product from SensAble Technologies and more information is available at www.sensable.com and sensabledental.com.

According to the company, the SensAble Dental Lab Systems:

“Consists of three components that have been tightly integrated to produce accurate, consistent results through scan, design and fabricate. Its software and user interface enable fast, flexible 3D design and modeling; provide case management tracking; and ensure a simple, reliable workflow for producing precise results. In-depth system integration, along with field-proven techniques for investing and casting, ensure a streamlined workflow and consistent results throughout the entire process. Components include:

• 3D Scanner. This creates an extremely accurate digital file from a plaster positive (or “stone”), which is made from a patient impression.
• 3D Modeling and Design System. The design station includes SensAble Dental Lab System software for designing digital wax-ups, as well as SensAble’s patented PHANTOM® Desktop™ touch-enabled device, a high-end computer workstation and monitor. The design software provides a digital approach to traditional steps in the design process, speeding the design process and delivering consistent, digital results.
• 3D Resin Printer. Once the digital wax-ups are complete, the system automatically creates files for the production of resin patterns. These printed partsare then sprued, invested, and cast in metal using traditional methods and materials.”

Cleft Palate: New Research Sheds Light on Optimal Time to Close the Gum Tissue

Research by Dr. Damir Matic, a scientist with Lawson Health Research Institute in London, Ontario is changing the way cleft palate surgeries are performed throughout North America and around the world. Matic has been conducting research to determine the optimal time to close the gum tissue of cleft palate patients. His research suggests that it is best to wait until the child is older.

Matic is a craniofacial/plastic surgeon at London Health Sciences Centre and a professor in the department of surgery at the Schulich School of Medicine & Dentistry at The University of Western Ontario.

Surgical timing has been a controversial topic with various cleft centers around the world opting for early closure at about 3-6 months of age. However, Matic, using research complied over the past 20 years has shown that the best time to close the cleft at the alveolus (gum) in patients with either one or two sided clefts is at eight or nine years of age prior to canine tooth eruption. “We close the lip at three months of age, we close the palate at one year old, but we don’t touch the gum until they are eight or nine, a time that corresponds to when the adult teeth start to appear,” Matic says.

The study represents a significant breakthrough in cleft research involving an unprecedented sample size of 136 children. Matic and his team were able to look at a large group of children who had the cleft repair performed early, and then compare the group to a large group of children who had the repair performed when they were older.

“Cleft is the most common facial anomaly and the second most common congenital anomaly among children,” Matic adds. “Our research is clinically based in terms of looking at how we can make our repairs better in light of our current knowledge and past discoveries. Based on our data, the down-side of early closure is much worse than any potential benefits, and repairing the cleft prior to this time (7-9 years) will damage facial growth.”

Part one and two of the study looked at bone production and facial growth in unilateral clefts and was presented in 2006 and 2007 to the American Cleft Palate Association (ACPA), the largest society dedicated to cleft research in the world. Matic’s research won best paper in the Junior Investigator Competition out of hundreds of submissions from around the world.

Part three of the study looked at how the repair affects bone production and facial growth in patients with bilateral clefts. These findings were presented at the ACPA meeting in Philadelphia last month. At this meeting, Matic was involved in a panel discussion/debate regarding his research where he recommended the later closure. The overall majority of the participants voted with Matic, leading to a change in recommendation in the way cleft palates will be treated in hospitals around the world.

Source:
Kathy Wallis
University of Western Ontario

Twisted File: A New Paradigm in Endodontic Canal Preparation?

I stopped using rotary nickel titanium files a few years ago because of problems with files breaking. I did not break that many, but just enough to make me feel a bit insecure. I went back to using stainless steel files. Recently, though, I was reading about the next generation of rotary nickel titanium, the Twisted File from SybronEndo. According to Mounce – who I consider one of the greatest endodontists – these files are very resistant to breakage if they are used properly. Has anybody used these? How do these compare with other rotary nickel titanium instrumentation? Mounce says you may be able to do a whole endo with only one file. Thoughts?

Editor’s Note:
Richard E. Mounce, DDS published an article in Oral Health. May 2008, discussing the Twisted File. Below are some excerpts. The full article, as well as, other information about Twisted Files can be found at http://www.tfwithrphase.com.

“

The Twisted File (TF) is unsurpassed in its cutting efficiency, fracture resistance, tactile control, and the efficiencies gained from its use…A proprietary process of heating, cooling and twisting makes TF possible. TF is not ground against the material’s natural grain structure to create the cutting edges. Such grinding creates microcracks that can be future failure points due excessive to torsion and cyclic fatigue.

The heating and cooling process that the nickel titanium is subjected to optimizes its molecular phase structure that ultimately gives TF its qualities…many root anatomies will allow a single TF file to create the entire preparation. This is the first instrument ever that has possessed this flexibility and functionality…If used correctly (as described), TF will reduce instrument fracture dramatically, almost to zero…Reduced fracture rates translate to confidence, predictability, ultimately better clinical results and greater profitability…

Because TF cuts efficiently, the number of files needed to reach TWL (i.e. the minor constriction of the apical foramen) is reduced considerably…As a benefit of the heating, cooling and twisting of the metal, TF can negotiate virtually any curvature. It is very difficult to envision the clinical case that would require hand files to be preferred over TF in the apical third…The Twisted File is the first file that can be used Crown Down and/or as a Single File instrument in many cases and do so with unparalleled safety and cutting efficiency…

“

iNterra: Fabricating Nightguards In-Office?

Even though the lab costs for nightguards are not excessive, I would like to save on this and make my nightguards in the office. I would like to train my assistants to do this. In the past we used these suck-down nightguards where we heat-softened a sheet of plastic and adapted it to the models. These are okay but do not last very long. Usually the patient wears through in the molar area. I’m looking for a better alternative. I’ve seen that Caulk Dentsply is advertising their iNterra brand nightguard kit for in office fabrication. They look like lab quality nightguards, but I can’t seem to find much information on this product . Anybody using this system? What has been your experience?

See also:
Enterra VLC light curing unit for fabricating nightguards.

ERA Implants: Easier System for Implant Supported Overdentures?

I have been using conventional dental implants for my overdenture cases. I would like to try the ERA Implants (Sterngold) because they are far less expensive and seem easier to use. The system can correct for misangled implants by using an angled housing that can be cemented into the one-piece implant/abutment. Seems to be a pretty simple protocol. Also it has one-piece implant/abutments that are straight and can easily be torqued into implant channels that are straight and do not need correction. Anybody using the ERA implant system? What have your results been?

Editor’s Note:
According to Sterngold:”The ERA Implant consists of a micro ERA prosthetic head on a 2.2 mm diameter self-tapping implant which may be used for immediate stabilization of a complete denture. A wider 3.25 mm diameter self-tapping implant is also available.
The entire micro ERA Implant procedure takes about 90 minutes and the patient leaves the chair with their denture snapped into place.”

QwikStrip Serrated Strips: A Solution for Veneer Problems?

Dr. M. asks:

I do a lot of veneers. One of the problems I occasionally have is when cement hardens interproximally before I can remove it. What I like to do is remove the cement when it enters its gel state. If I am not fast enough, this turns into a real nightmare sometimes where I have to use very narrow diamonds and finishing strips. I saw the advertisements for the QwikStrip Serrated Strips (Axis) and I am wondering if this is the answer to this problem. It looks like the plastic bow that holds the strip will limit cervical penetration so I do not have to worry as much about tearing up the interproximal papilla. What have you found with this product?

Editor’s Note:

According to Axis: “QwikStrip™ Serrated Strips are designed to make crown and bridge clean-up quick, safe and simple after cementation of crowns, veneers, bridges, inlays or onlays…The depth limiting design prevents soft tissue irritation, while the unique handle provides a comfortable grip for optimal tactile control, giving easy access to interproximal spaces. No more cutting of the patients’ lips or gums with the firmly embedded strips.”

Culprit found for Jaw Decay Linked to Bisphosphonates

A group of University of Southern California School of Dentistry researchers says it has identified the slimy culprits killing the jawbones of some people taking drugs that treat osteoporosis.

Microbial biofilms, a mix of bacteria and sticky extracellular material, are causing jaw tissue infections in patients taking bisphosphonate drugs, said Parish Sedghizadeh, lead researcher and assistant clinical professor at the USC School of Dentistry.

Sold under brand names such as Fosamax, Boniva and Actonel, bisphosphonates are prescribed to millions of patients to combat osteoporosis, a bone-wasting disease that increases the risk of fractures.

Sedghizadeh said there have been increasing reports of osteonecrosis (bone death) of the jaw in patients who have been taking the drugs for osteoporosis or for treatment from the bone-wasting effects of cancer. He said he decided to investigate further after seeing patients in USC dentistry clinics who had the unusual jaw infection.

“This is the first study that identifies microbial biofilms in the bone of bisphosphonate patients who have osteonecrosis of the jaw,” Sedghizadeh said.

Jaw osteonecrosis occurs when bacteria-laden biofilms infect the jaw after the bone is exposed, typically because of a tooth extraction or injury.

The USC research team includes renowned biofilm expert J. William Costerton, director of the Center for Biofilms at the USC School of Dentistry.

Pioneered by Costerton, biofilm theory has moved scientists beyond thinking of bacteria as free-floating organisms. Instead, bacteria build biofilm communities, attaching to surfaces and communicating and defending against antimicrobial invaders.

The team used powerful scanning electron microscopes to study patients’ jawbone samples. The images revealed biofilm bacteria sprawling over pitted tissue.

The scientists are now trying to determine why bisphosphonate drugs seem to open the door for biofilm-associated infections of the jaw.

“Now that we’ve know biofilms are behind the infection of the jaw, we are studying ways to effectively treat or prevent the osteonecrosis,” Sedghizadeh said.

Source:
Contact: Angelica Urquijo
University of Southern California

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