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

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…

“

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

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.”

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.”

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

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.”

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. “

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