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

May 14, 2008

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

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Twisted File: A New Paradigm in Endodontic Canal Preparation?

May 12, 2008

tf-175×175.jpgI 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…

“

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iNterra: Fabricating Nightguards In-Office?

May 11, 2008

nightguard.jpgEven 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.

Written by admin · Filed Under Caulk, TMJ, What's New | 1 Comment 

ERA Implants: Easier System for Implant Supported Overdentures?

May 5, 2008

era.jpgI 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.”

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QwikStrip Serrated Strips: A Solution for Veneer Problems?

May 5, 2008

Dr. M. asks:

qwikstrips-fades.jpgI 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.”

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Culprit found for Jaw Decay Linked to Bisphosphonates

May 4, 2008

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

Written by admin · Filed Under Restorative, What's New | 3 Comments