Monday, December 31, 2007

Happy 2008


Wishing everyone a happy, healthy and prosperous 2008

Sunday, December 30, 2007

NADL To Be Featured In Public Television Documentary Educating Viewers About The Origin And Materials Used In Dental Restorations, USA

The National Association of Dental Laboratories (NADL) and GTS Education Inc. announced that "The Global Learning Series," an education-focused television program distributed to public television, has invited NADL to be featured in an episode called "Understanding Dentistry."

The program will educate viewers about a patient's right to know where their dental restoration was manufactured and the credentials of the manufacturer. Nearly 25 percent of all dental restorations used by U.S. patients are made in foreign countries by dental technicians who likely lack recognized certifications. The show will be distributed this winter and spring to public television stations and cable television stations throughout the country as well as abroad through VOA Television.

Saturday, December 29, 2007

Brain Abscess Secondary to Dental Braces.

I guess this is true but I wonder if its not a reach just like the MVP and dental treatment, and this was an undiagnosed at risk patient. MJ

Brief Reports
Pediatric Infectious Disease Journal. 27(1):84-85, January 2008.
Wolf, Joshua MBBS, BA *+; Curtis, Nigel FRCPCH, PhD *+++

Abstract:
We report a case of Haemophilus aphrophilus brain abscess presenting 6 weeks after application of dental braces in an adolescent patient with a formerly undetected patent foramen ovale. Neither brain abscess nor invasive H. aphrophilus infection has previously been associated with dental braces. Application or tightening of dental braces may cause bacteremia and invasive disease from oral commensals.

(C) 2008 Lippincott Williams & Wilkins, Inc.

Friday, December 28, 2007

American Dental Partners Transfer Assets In Settlement

American Dental Partners Inc. said it agreed to transfer leases and assets to a Minneapolis dentists group two weeks after a local jury hit American Dental with about $131 million in damages seen as having far-reaching implications for clinics and hospitals.

Read the rest at the Wall Street Journal Site.

Tuesday, December 25, 2007

In Kentucky’s Teeth, Poverty and Neglect Take Toll

An interesting NY Times article on why there is dental neglect in KY ( this is the same for many states) Not a lot of answers but an interesting read.

NY Times Dental Neglect Article

Sunday, December 23, 2007

Dental Stocks Look For More Bite

BY STEVE WATKINS

FOR INVESTOR'S BUSINESS DAILY

Posted 12/21/2007

People don't typically wait for the economy to get better before they go to the dentist.

Maybe that's why many took notice when Patterson (PDCO) Chief Executive James Wiltz blamed the economy for disappointing sales.

Dental supply firms have long been thought of as resistant to the economy's slumps. To a large extent that's still the case, says Jeff Johnson, analyst at Robert W. Baird & Co.

Read the whole article on the Investors Business Daily site.

"I still see dental as a great place to be in the next 24 months," he said. "These stocks do well in a slow economy. Dental tends to be recession-resistant."

A lot depends on which part of the dental business you're talking about.

Johnson did an in-depth study and found that spending on dental services has held up through recessions the past 40 years. That spending tends to bottom out 12 to 18 months after the recession's midpoint. And that dip in spending growth is only 1 to 2 percentage points.

"Even in recession, there's a very modest change in dental spending," Johnson said.

That takes care of the 75% of the dental supplies market that is in consumable items. These include toothpaste and other products that dentists use for routine treatments and checkups. Sales link closely to consumer dental spending.

"Demand for consumable supplies is really insensitive to the economy," said Derek Leckow, analyst at Barrington Research Associates.

Tighter Purse Strings

The other one-fourth of the market is in equipment. These are bigger-ticket items such as chairs, stands and lights, as well as high-tech gadgets like 3-D imagers.

Those sales are tied to dentists' spending rather than consumer spending.

The two aren't always the same. Dentists' economic outlooks can affect how much they invest in their business.

"That could cause them to temporarily delay spending," Johnson said.

That's the part of the dental market in which Patterson's sales are slumping.

While sales of core equipment such as chairs have stayed strong, high-end products have been hit. Dentists might hold off on items that run $150,000 or more.

Tighter credit is also affecting dentists' willingness to spend, Leckow says. Think of dentists as small businesses. If they're concerned that money could become tight, they'll slow their spending.

Read the entire article on the Investors web site.

Saturday, December 22, 2007

Sampling Water from Chemically Cleaned Dental Units with Detachable Power Scalers

Authors: Coan, Lorinda L1; Hughes, Elizabeth A1; Hudson, Joyce C1; Palenik, Charles J1
Source: Journal of Dental Hygiene, Number 4, Fall, 1st Oct 2007 , pp. 80-80(1)

Publisher: American Dental Hygienists' Association
Purpose.This study's purpose was to determine the effect chemical cleaning had on the microbial quality of water emitted from dental unit waterlines (DUWL), 3-way syringes, and power scalers.

Methods. Ten randomly selected dental units with attached self-contained independent water reservoirs filled with deionized water were used. An ultrasonic scaler was paired with each of the ten units. This combination was retained for the duration of the study. Water samples were collected at the beginning of the fall semester and again after two weeks. Analysis indicated unacceptable levels of microorganisms and the need for a shock treatment, which included cleanings on 3 consecutive days. Water samples were collected following the initial shock treatment and for the following 4 weeks. Weekly cleanings were performed as part of routine equipment maintenance. Water specimens from the 3-way syringes and scaler handpieces were spiral plated on R2A agar plates. Incubation was at room temperature for 7 days. Plates were examined and the number of colony-forming units per milliliter (CFU/mL) was determined for each specimen.

Results.The first sampling showed that none of the 3-way syringes and one of the power scalers produced potable water after sitting unused for 6 weeks and receiving only one chemical cleaning. Improvement was noted after the second cleaning with specimens from 8 units having bacterial levels <500 CFU/mL. Three power scalers emitted potable water. Improvements in the bacterial levels of the power scalers were noted following the shock treatment; all of the power scalers emitted potable water.

Conclusions. Practitioners should routinely treat dental units and power scalers with products that will maintain acceptable microbial water quality. Administration of a shock treatment may be necessary prior to beginning a weekly maintenance protocol. Shock treatments are beneficial if units or power scalers have not been used for an extended period of time.

Friday, December 21, 2007

Guardian One of the First Major Dental Insurers to Cover Cosmetic Teeth Whitening

I hope this is an insurance company "covering" a procedure but not just reducing the fee to a PPO level but providing no money.MJ

NEW YORK, Dec. 17 /PRNewswire/ -- If you are tired of the rituals involved in using over-the-counter teeth whitening products, and would prefer to receive professional dental treatments to achieve or maintain your movie star smile, then you'll be happy with The Guardian Life Insurance Company of America's (Guardian) new dental plan enhancements. Guardian, a leading provider of employee and voluntary benefits for small and midsized companies and the second largest dental network in the nation(1), today announced that it now covers cosmetic teeth whitening and has expanded its coverage of periodontal maintenance cleanings.

Dental insurance companies usually do not cover cosmetic procedures, but demand from clients and brokers supported Guardian's decision to offer teeth whitening as a covered benefit. According to the American Academy of Cosmetic Dentistry (AACD), teeth whitening is the number one requested cosmetic service today, and they expect its popularity to soar.

"Guardian is committed to helping small and midsize employers attract and retain the best talent," said Jim Pogue, vice president, Group Dental, Guardian. "Research shows that dental insurance is a popular benefit and can bolster a company's overall benefits package. Guardian's focus is on wellness and preventive procedures. But we believe that there is value in offering cosmetic teeth whitening because it will encourage employees to visit their dentists and seek not only the treatments that will improve the look of their smile, but also their oral health and overall health."

In addition to the new teeth whitening feature, citing the connection between oral health and overall health, Guardian has also expanded the number of periodontal cleanings in its dental plan. An estimated 80 percent of American adults have some form of periodontal disease, according to a 2006 National Institutes of Health report. This prevalent disease can lead to high blood sugar, heart disease and premature births.

Guardian's new plan gives employers the option of offering their employees up to four periodontal maintenance cleanings per year, regardless of medical conditions. Traditionally, a physician's certification that the employee has a disease with a known correlation to periodontal disease is required to qualify for more than 2-3 cleanings in a year.

"Americans realize that there is a link between oral health and overall health," said Dr. Richard Goren, 2nd vice president, Group Dental, Guardian. "In fact, 89 percent of respondents in a 2006 survey conducted by Guardian, 'Benefits & Behavior Spotlight on Dental', indicated that consumers recognize a connection. With the relationship between oral and overall health in mind, we have expanded our periodontal coverage so that plan holders can offer their employees as many as four routine or periodontal cleanings per year."

The cosmetic teeth whitening and enhanced gum cleanings complement existing Guardian Group Dental programs including discounts on Xylitol products, coverage for dental implants, adult fluoride treatments and ViziLite(R) Plus oral cancer screenings and a dental account rollover program that allows members to save up their annual maximums for costly procedures as part of its standard coverage. Many of these types of programs are not widely available in competing dental plans.

Name Change For Clinical Research Associates (CRA)

CRA (Clinical Research Associates) Foundation in Provo, Utah is changing its name to CR (Clinicians Report) Foundation effective January 1, 2008. In addition, its monthly clinical newsletter will be renamed the Gordon J. Christensen Clinicians Report.

Thursday, December 20, 2007

New Video Network Targets Dental Waiting Rooms

by Erik Sass, Tuesday, Dec 11, 2007 8:00 AM ET
AT LONG LAST THERE'S SOMETHING to take your mind off the fear of dentists: a new place-based video network operated by Creative Marketing and Media Solutions. It's set to go live in the waiting rooms of 200 dental offices nationwide by the end of 2007, with plans to add an additional 1,200 in 2008. The C3MS NobelVisionT Network is the result of a partnership with Nobel Biocare, which manufactures and distributes dental supplies to 160,000 practicing dentists in the United States. It will broadcast entertainment and educational content, as well as news, weather, and sports updates.

In addition to promotional content focusing on dental care products offered by Nobel Biocare, the IP-based network also offers space to advertisers in the health-care and healthy lifestyle categories. Advertisers can purchase spots on the network or exclusively sponsor a 10-minute video package, taking advantage of the system's touch-screen and SMS text-messaging features.

The place-based video category is booming, and networks are keen to break into medical waiting rooms, which attract a relatively well-off audience with long "dwell" times. For example, Healium--a video network serving waiting rooms in doctors' offices--will include 120,000 medical practices by the end of 2008, delivering 3 million viewers per month. Healium features video content from CBS.

Wednesday, December 19, 2007

Dentalcast- Sleep Apnea

Episode 35: Dr Kent Smith, co-founder and co-director for the Dental Organization of Sleep Apnea discusses recognizing possible sleep apnea patients in your practice, and possible methods of treating them with a dental sleep appliance.


You can get this episode via iTunes, or download from the website; http://www.dentalcast.net

Tuesday, December 18, 2007

LAWYER SUES INSURANCE - FAILURE TO PAY FOR WHITE FILLINGS

December 15th, 2007

Henry Gottlieb
New Jersey Law Journal
December 14, 2007

A New Jersey lawyer who won a $45 million class action settlement last year from Horizon Blue Cross is suing the carrier in small claims court for not paying his $462 dental bill.

And the carrier, saying it fears the suit may be a prelude to another class action, has hired McCarter & English, the state’s largest firm, to make a federal case out of it.

A dentist charged Eric Katz $600 to fill a decayed tooth with composition bonding, but Horizon Blue Cross told him his coverage under his ex-wife’s family policy permitted reimbursement for an inexpensive silver filling only. The carrier pegged the benefit at $138, leaving the rest of the bill to Katz.

Katz appealed to the carrier, armed with a statement from dentist Fred Teschemacher that bonding was required because Katz’s teeth were “severely eroded.”

Teschemacher also wrote that dentists have reduced their use of silver fillings — metal amalgams that include mercury — “due to concerns about mercury exposure.” New Jersey has strict rules on amalgam disposal because of the mercury.

The American Dental Association, the Food and Drug Administration and the U.S. Public Health Service say amalgams are safe for patients, but Katz says his dentist’s concern adds weight to his demand for more coverage.

In October, when he received no satisfaction, Katz sued the carrier in Special Civil Court in Essex County, N.J.

Katz usually has larger sums in mind when he sues Horizon Blue Cross. In an October 2006 settlement of a class action suit on behalf of the state’s doctors, a judge approved a package of billing and claims processing reforms worth $39 million to the class.

On top of that, Horizon Blue Cross paid $6.5 million in legal fees to Katz’s firm, Mazie Slater Katz & Freeman in Roseland, N.J.

He represents dentists in a similar class action against Horizon Blue Cross and is seeking class certification for patients with eating disorders who allege the carrier denied legitimate claims. He also represents individuals in benefit-denial cases.

Given Katz’s history, it’s not surprising that the insurance company is making a mountain out of a molar.

The company hired McCarter & English partner Andrew Bunn. On Dec. 6, he filed a removal petition in federal court, which has jurisdiction over benefits cases of any size under the Employee Retirement Insurance Security Act. The law also gives federal judges the power to send such matters back to state court.

Thomas Rubino, a spokesman for Horizon Blue Cross, says the suit is “a little crazy.”

“Katz is just forum shopping to develop more class actions,” Rubino says. “It has to be seen in that context because he has filed a lot of class action lawsuits.”

He says the federal court is a better forum for the company than state court, but declines to say how much the company is paying McCarter & English to defend a case worth $462.

Katz denies he had anything more than a small claims court matter on his mind when he filed the suit.

But he says that at his firm, “we’ve now had some internal discussions here about whether we should take a closer look at this particular issue. I have no idea how many people are impacted by this.”

He says his case can’t morph into a class action because a lawyer representing a class can’t be a member of the class.

He says he sued rather than do what a typical patient would do — complain, shrug and pay — because suing is easy for a lawyer, especially a lawyer with his experience.

“This sort of thing goes on hundreds if not thousands of times a day,” he says. “Horizon receives between 4,600 and 4,700 dental claims a day. Most people are not lawyers of course, and what lawyer would ever take a $500 case?

“The issue here, more than anything, is that Horizon apparently is so afraid of me that they hired McCarter & English,” he says.

A lawyer outside the case, Keith McMurdy, a corporate benefits lawyer at Fox Rothschild in New York, suggests a company in Horizon Blue Cross’ position would have a reason to petition for removal.

“If it was a $400 claim and that was the only exposure associated with it, I might say to the client, a state court judge is competent to hear it,” he says.

“But the other side is if you’ve got thousands of claims out there and you’re doing it over and over and if you feel someone is trying to challenge your mechanism and you need to define your mechanism, what you are going to do is fight in federal court,” McMurdy says.

The final question is, why would Katz, whose lawsuits have alleged that Horizon Blue Cross mistreats doctors and patients, continue to be covered by the company, under COBRA, from his ex-wife’s policy?

The answer: His firm doesn’t pay his dental coverage, he says

Monday, December 17, 2007

Interplak Video Unboxing

Here is a short video of the unboxing of a new Interplak toothbrush.
For more information call the Interplak hotline at 800-633-6363

Sunday, December 16, 2007

Jury awards $130 million to Twin Cities dentists

A jury has awarded a group of Twin Cities dental clinics more than $130 million over charges that a Massachusetts company had overstepped its legal authority by interfering with patient care.

Read the rest on the Star Tribune web Site

Saturday, December 15, 2007

Search Engine Rankings

Just found this interesting and thought you might also. Lots of money in searching. You might not know that the browser you use gets renumeration from the search companies.

Google’s (GOOG) share of the U.S. search query market improved to 65.1% in November from 64.49% in October, and and 61.84% a year ago, according to data release today by Hitwise.

Yahoo’s (YHOO) share slipped to 21.21%, down from 21.65% in October, and 22.43% a year ago.

Microsoft’s (MSFT) share dropped to 7.09%, from 7.42% a month ago, and 9.82% a year ago.

Ask.com’s (IACI) share declined to 4.63% from 4.76% a month ago, but up up from 4.23% a year ago.

The other 46 search engines tracked by Hitwise had a combined 1.96% share.

Friday, December 14, 2007

Burns From Electric handpieces

Electric dental handpieces used by dentist and oral surgeons have been leaving many people with severe burns. The culprit in many of these dental handpiece injuries, says the Food & Drug Administration (FDA), are poorly maintained devices.

According to an FDA warning issued yesterday, patients have been severely burned when poorly maintained electric dental handpieces were used during dental procedures. Some patients even suffered third degree burns which required plastic surgery. The FDA said that the burns are often not apparent to the operator or the patient until after the tissue damage is done, because the anesthetized patient cannot feel the tissue burning and the dental handpiece housing insulates the operator from the heated attachment. The FDA warning said that while all of the reported burns have so far occurred during cutting of tooth and bone, tooth extraction and other dental surgical procedures, overheating could occur during any dental procedure.

The burns have only been reported in relation to the use of electric dental handpieces, and not with the air-driven variety. With high and low speed air-driven handpieces, sluggish handpiece performance will alert the dental practitioner to maintenance issues such as a dull bur or worn or clogged gears or bearings. But a poorly maintained electric handpiece does not provide a similar warning that maintenance is needed. Instead, if an electric handpiece is worn or clogged, the electric motor sends increased power to the handpiece head or attachment in order to maintain handpiece performance. This increased power can rapidly generate heat at the head of the handpiece attachment. Because the heat buildup is so rapid, and is efficiently conducted through the metal handpiece, a burned patient may be the first indication of handpiece problems that the practitioner receives.

The FDA recommended that dentists and other practitioners who use the electric dental handpieces be aware of the burn risk associated with them, and take steps to insure that they are properly maintained according to manufacturer’s instructions. Users of these devices should also verify with the manufacturer the appropriate routine service interval for their dental practice based on the actual use of the electric dental handpieces. Personnel should be trained to properly clean and maintain the electric dental handpieces and to follow specific device maintenance requirements. The FDA also recommended that practitioners develop a method for tracking maintenance and routine service for each handpiece used. Dentists were also cautioned to examine all dental handpiece attachments prior to use. Finally, the FDA warned that worn drills or burs and poorly maintained electric dental handpieces should never be used.

This is not the first time the FDA has reported on burn problems related to hand held medical devices. In 2003 the FDA warned that rotary surgical handpieces can cause patient burns during orthopedic procedures, as reported in the July 2003 edition of FDA Patient Safety News

Thursday, December 13, 2007

gumEase- Drug Free Anesthesia

I have not tried this but it does look interesting. Go check out the gumEase web site for more information and watch the video.


Dental pain relief in seconds without drugs? The FDA says yes, recently certifying the first cryoanesthetic dental mouthpiece for the US OTC market. Used standalone or in conjunction with conventional anesthesia, gumEase provides pain relief without the side effects or complications of drugs. It's a tempting solution for clinicians plagued with patient needle phobia, sharps and the complex issues of hypodermic delivery.

The easy-to-use, disposable device is a breakthrough in pain management - as effective as it is inexpensive. Inserted easily into the upper and lower sulci, the latex-free device delivers a soothing, cool temperature to the maxillofacial nerves, quickly diminishing pain across a wide area of the mouth. In patient tests the new gumEase diminished pain by 90% in 2 to 3 minutes for the average participant. Patients can apply them post-operatively as needed, and reuse without side effects by storing in a household freezer.



"It gives dentists an option they didn't have before", says Tay McClellan, BioMeDevice CTO, "they can manage patient pain easily in a wider range of situations. Now it's not a problem to have a patient who can't use drug-based anesthesia." The device also holds promise for situations where needle use is limited; such as Brazil, whose interest in the gumEase is spurred by HIV initiatives there.

The Class 2 gumEase G-100 is prepared by storing in a conventional freezer until freezing temperature is reached. Proprietary solutions inside the mouthpiece prevent it from freezing, allowing it to form comfortably within the patient's mouth for several minutes. Pain reduction lasts for up to twenty minutes, and the process can be repeated as often as needed.

Developed in Laguna Hills, California by BioMeDevice, the gumEase is manufactured in Ireland. The company's plans for the device include establishing a global supply network to meet current demand, and emphasis on the US OTC market. For more information on the gumEase, please visit www.biomedeviceltd.com

Wednesday, December 12, 2007

Proper Care Needed For Safety Of Mouthguards

Fractured teeth, neck injuries and abrasions in the mouth, also known as sports-related dental injuries, are ever present among athletes. According to the U.S. Centers for Disease Control, sports-related dental injuries account for more than 600,000 emergency room visits each year.

One may assume that mouthguards should serve as a preventive measure. In some 200,000 cases annually, mouthguards have been known to avert oral injuries and cut the risk of concussion by 50 percent. However, while a mouthguard may be popular for its ability to prevent the injuries that may temporarily and sometimes permanently disfigure a person's appearance, what many may not be aware of is the importance of proper maintenance, cleanliness and care to prevent disease transmission and infection.

According to a study that appeared in General Dentistry, the AGD's clinical, peer-reviewed journal, mouthguards harbor large numbers of bacteria, yeasts and molds that can possibly lead to life and/or health-threatening infectious/inflammatory diseases.

"Everything that a microorganism needs to survive, including food and water, can be found in a mouthguard," says Thomas Glass, DDS, PhD, lead author of the study. "While mouthguards appear solid, they are very porous, like a sponge, and with use, microorganisms invade these porosities."

"These concerns are similar to using an infected toothbrush repeatedly or using silverware that has not been cleaned properly," says AGD spokesperson Bruce Burton, DMD, MAGD, ABGD. "Although a mouthguard is recommended to prevent permanent damage to the mouth and teeth, we know it also has the potential to be a reservoir for bacteria that can cause gum infections or the bacteria that help promote tooth decay."

There are warning signs that can alert athletes that he or she may be suffering from a contaminated mouthguard. Those include "difficulty breathing, wheezing, diarrhea and nausea to the point of vomiting," says Dr. Glass.

As a high school football coach for 25 years, Dr. Burton witnessed many poor habits athletes practiced when handling their mouthguard. "Chewing on the mouthguard until it no longer serves the purpose of protecting the dentition is one poor habit," says Dr. Burton. "In addition, some athletes throw the mouthguard in with dirty, sweaty gear and never clean it."

----------------------------
Article adapted by Medical News Today from original press release.
----------------------------

Mouthguard maintenance:

* Brush teeth before wearing a mouthguard.
* Never share a mouthguard with teammates.
* During sporting events, have a backup mouthguard.
* Purchase disposable mouthguards.
* Clean mouthguards before storing them.

The Academy of General Dentistry is a non-profit organization of more than 35,000 general dentists dedicated to staying up-to-date in the profession through continuing education. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management and overall coordination of services related to patient's oral health needs. Learn more about AGD member dentists or find more information on dental health topics at http://www.agd.org/consumer.

Source Stefanie Schroeder
Academy of General Dentistry

Article URL: http://www.medicalnewstoday.com/articles/91324.php

Tuesday, December 11, 2007

Cavities - Nature Or Nurture? $1 Million Grant To Pitt Dental School To Study Causes

Dental caries, also known as tooth decay or cavities, remains the most common chronic affliction of childhood, five times more common than asthma and seven times more common than environmental allergies. Four out of ten children have caries when they enter kindergarten. To identify the genetic and environmental risk factors that cause dental caries, the National Institutes of Health (NIH) has awarded a $1 million grant to the University of Pittsburgh School of Dental Medicine researcher Mary L. Marazita, Ph.D., director of the Center for Craniofacial and Dental Research, associate dean for research and professor and chair of oral biology. Dr. Marazita and colleagues will study the interaction between genes and environmental factors that lead to tooth decay. The results of these studies will allow a better understanding of the disease, which in turn will lead to earlier identification of children at risk and improved and targeted interventions.

"As prevalent as tooth decay is in everyday life, there are many gaps in our scientific knowledge about its causes," said Dr. Marazita. "It is striking that some people will have many teeth affected with decay while other people in the same environment will not. Our study is the first to apply a comprehensive approach that will allow us to tease out what's in our genes and what's in our environment that is causing tooth decay."

The grant is part of the Genes, Environment and Health Initiative (GEI). In addition to the grant, NIH will provide genetic services of approximately $2.5 million to Dr. Marazita. She is one of only eight scientists selected to receive these grants during this funding cycle.

In 2005, dental health care costs reached nearly $84 billion, of which 60 percent or about $50 billion was related to treatment of cavities. Childhood caries is a serious public health issue because of associated health problems and because disparities in oral health have led to substantially higher average disease prevalence among children in poverty and in underserved racial and ethnic groups.

The genome-wide association studies will be led by the National Human Genome Research Institute (NHGRI), part of NIH. First-year funding for the studies was contributed by all NIH institutes and centers, including an extra investment by NIH's National Institute of Dental and Craniofacial Research (NIDCR). NHGRI is one of 27 institutes and centers at the NIH, an agency of the Department of Health and Human Services. The NHGRI Division of Extramural Research supports grants for research and for training and career development at sites nationwide.

The NIDCR is the nation's leading funder of research on oral, dental and craniofacial health. NIH is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases.

Additional collaborators from the University of Pittsburgh include Robert Weyant, D.M.D., School of Dental Medicine; and Eleanor Feingold, Ph.D., Daniel Weeks Ph.D., and Michael Barmada, Ph.D., Department of Human Genetics at the University of Pittsburgh Graduate School of Public Health. Other collaborators include Steven Levy, D.D.S., and colleagues of the University of Iowa; Rebecca Slayton, D.D.S., Ph.D., University of Washington; and Richard Crout, D.M.D., and Daniel McNeil, Ph.D, West Virginia University.

The School of Dental Medicine has been an integral part of the University of Pittsburgh's growth for nearly a century. Established in 1896 as an independent institution named the Pittsburgh Dental College, the school was incorporated into the University in 1905. Like the five other Schools of the Health Sciences, the School of Dental Medicine is affiliated with the internationally renowned academic medical center, the University of Pittsburgh Medical Center, which provides the region's largest network of tertiary, specialty and community hospitals. Collectively, these facilities provide one of the nation's greatest, most complete health centers for teaching, patient care and research in the health sciences.

School of Dental Medicine, University of Pittsburgh

Monday, December 10, 2007

Visible Body



Argosy's Visible Body is the most comprehensive
human anatomy visualization tool available today.
This entirely Web-delivered application offers an
unparalleled understanding of the human body.
The Visible Body includes over 1,700 anatomical
structures, including all major organs and systems
of the human body.

Go check out the human body

Saturday, December 08, 2007

Survey Confirms Americans Prefer Root Canal Treatment By Endodontists

Here is an interesting article I came across. No discounting the need for endodontist as I routinely will refer difficult root canals to them. I would really have liked to have seen the questions in this AAE study. I think this is just another of those self serving polls.


There may not be a more feared dental procedure than a root canal, but the key to ensuring a positive experience is choosing the right professional to perform the procedure. Painful root canal treatment is a thing of the past thanks to advances pioneered by endodontists, the root canal specialists. In a just released L.C. Williams & Associates poll, 89 percent of individuals who previously underwent a root canal by an endodontist would return to the specialist for future procedures.

Nearly half of overall respondents would choose to have an endodontist perform their root canal procedure. Even certain dental professionals would prefer an endodontist perform their root canals, with four out of five dental educators surveyed saying they would seek root canal treatment from a specialist.

"I trust my general dentist and make an effort to see him on a regular basis," says Sande Gioia, a 61 year-old patient from Newark, Delaware. "When my dentist told me I needed a root canal, he recommended that I see an endodontist who specializes in the procedure. My teeth are important, so when I need root canal treatment, I see a specialist who has the expertise in performing it."

Just as it is commonplace to see a cardiologist for a heart condition or an oncologist for a cancer diagnosis, consulting a specialist is equally important for maintaining your dental health. Routinely seeing a general dentist is the cornerstone of sustaining a healthy mouth, but for more complex and challenging procedures, such as a root canal, a visit to an endodontist may be preferable. Endodontists complete four years of dental school followed by two to three years of advanced training in endodontics. Their specialized training in administering anesthesia and use of leading-edge technologies can make root canal treatment more effective and predictable and result in a more positive patient experience. Endodontists also are experts in diagnosing and treating facial pain as it relates to dental problems.

"Endodontists are really micro-surgeons trained to navigate the intricate canals inside the tooth," says Shepard S. Goldstein, D.M.D., president of the American Association of Endodontists (AAE) and an endodontist from Framingham, Mass. "Our specialized training paired with the latest dental technologies helps us to accurately and effectively eliminate tooth pain and ultimately allow the patient to keep the natural tooth."

The advanced technology often found in the endodontist's office, such as digital radiography and operating microscopes, has dramatically improved the precision and success of every step of the root canal procedure. By harnessing this technology, endodontists are able to save teeth that would have been pulled -- all while making root canals virtually painless.

General dentists are trained to perform basic root canal treatments in dental school and on average they perform about two a week. Endodontists' advanced training makes them true experts in root canal procedures and especially adept at handling complex cases. Endodontists perform an average of 25 root canals per week.

For more information on endodontists or to find a local specialist, visit the AAE Web site at http://www.rootcanalspecialists.org.

Friday, December 07, 2007

Clean Machine-A Small Business IT Solution

Here is a good idea if you cannot keep up with your computers and need a remote IT guy or gal


Most Brand-New PCs and Laptops are Compromised by “Junkware”
And Vulnerable to Virus and Spyware Attacks


Far Hills. NJ – December 06, 2007 - This year, many PC and laptop computers will be given as holiday gifts. However, most of these nice gifts will have something naughty inside that can seriously compromise their performance. It’s appropriately named junkware.

Junkware is the trial software, games and so-called efficiency tools you didn’t ask for, but nonetheless came pre-loaded on your new PC or laptop. Computer manufacturers market junkware as free, extra-value programs. But in reality, they profit from companies who pay to have these programs bundled with new computers. While the computer manufacturers count the cash, you’re left to fend off the constant pop-ups reminding you to renew your expired trial software.

According to Larry Gordon, CEO and Founder of PC security and performance management services company Clean Machine, Inc., “Junkware is not only annoying, it can seriously impair the performance of your new computer. That’s because junkware uses valuable disk and memory resources, which in turn slows processing speeds and raises the potential for system crashing. If this wasn’t bad enough, much of this junkware is integrated into the computer’s operating system, which makes it tricky to remove without also removing vital system files by accident. Plus, it’s just clutter.”

There are ways to remove junkware. One way is to use a multitude of system cleaning tools. One leading computer magazine recommended 20 different tools to do the complete job; but this is can be complicated and time consuming. A computer consultant or the service department at your computer store can do the job as well but for a hefty fee.

Clean Machine will be offering a superior alternative globally in January when it launches its unique and powerful PC Concierge Service, which for $19.95 a month assigns a highly trained technician to remotely scan your PC or laptop to effectively remove virtually all junkware, spyware and viruses.

The PC Concierge Service technician is armed with an extensive arsenal of the latest system optimization and security tools. Clean Machine also provides the customer with the most secure environment. It is more secure than onsite or other remote access solutions, including, for example, those offered by Geek Squad. The company has a unique, patent pending, 5 stage security process based on their proprietary software and processes.

“Our PC Concierge Service is the most complete, cost-effective and secure way to remove junkware from your brand new PC or laptop and then continuously protect it from the constant onslaught of viruses and spyware,” explains Gordon. “You don’t have to learn anything, talk to anyone, know how the software or computer works, or do anything. You don’t even have to be at your computer! We can do everything to help keep your computer optimized and secure for as long as you own it.”

The PC Concierge Service is also the perfect system optimization and security solution for small businesses of 5-10 computers, such as dental practices which generally don’t have a dedicated IT staff. Clean Machine's remote PC support offers a very cost effective solution for supporting a dental practice’s critical business systems and avoiding downtime that can severely impact their bottom line.

About Clean Machine

Clean Machine is a NJ-based and incorporated company that helps consumers and small business owners easily manage and protect their computing environments safely and cost effectively. The company is has a unique, powerful and inexpensive PC Concierge Service. Specifically, for $19.95 per month (discounts available for multiple computers), each customer is assigned a highly-trained tech concierge who remotely examines their computer system on a scheduled and very secure basis. The tech concierge will immediately fix software-based problems and prevent new threats to the customer's computing environment including offensive pop-ups, browser redirects and slow performance, and then provide a detailed report. Clean Machine's proprietary Radar™ technology (Remote Access Detection Audit and Repair) allows its expert technicians to remotely resolve any problems, eliminating the need for customers to go through the frustrating process of speaking with a tech support expert, and still having to do the work themselves. In other words, the Clean Machine PC Concierges do it all. For more information on Clean Machine, its PC Concierge Service, and how to become an authorized reseller, please visit www.pccleanmachine.com

Thursday, December 06, 2007

Solar Powered Toothbrush



"Soladey‐J3X" is a toothbrush that can remove accumulated plaque completely through the workings of minus electrons. The electronic power is upgraded with the double power of a semiconductor + solar panel, attaining a high plaque removal level.

More on the Soladey on their web site.

Wednesday, December 05, 2007

The New Oral B Triumph


New Oral-B® Triumph™ with SmartGuide™ is the most technologically advanced toothbrush on the market. It is the first toothbrush to combine best-in-class cleaning and gum care with wireless technology that promotes better brushing in real time. Triumph with SmartGuide features a wireless display – the first in the category – that helps you brush better, longer and gentler.


Brush Better. Oral-B Triumph with SmartGuide’s oscillating-rotating technology has been clinically proven to remove significantly more plaque than the next best performing toothbrush, healing and reversing gingivitis for healthier teeth and gums.
Oral-B’s FlossAction™ brushhead with patented MicroPulse™ bristles gently removes plaque between teeth and along the gum line.
Oral-B’s dentist-inspired PowerPolisher™ brush head erases 60 percent more stains, for whiter teeth.
Features clean, massage, soft and polishing brushing modes.

Brush Longer.
The wireless display tracks brushing time, taking the guess work out of brushing to help you brush as dentists recommend.
Notifies user every 30 seconds to brush another area of the mouth and when user has brushed for two minutes.
With Triumph with SmartGuide, you are four times more likely to brush up to the dental-recommended two minutes than with a manual brush.

Brush Gentler. A visual pressure alert sensor on the wireless display ensures that the user is brushing with the right pressure, to reduce the risk of gum recession and promote healthier gums.

Brush Smarter. The newest innovation from Oral-B features Smart Technology, in which the brush head, handle and visual display work together to provide instant interactive feedback to help you brush your best every day.
Tracks usage and alerts user when it’s time to change the brushhead (approximately every 3 months).

Handle synchronization ensures there will be no wireless interference if another Triumph with SmartGuide is used in the same area.
Feedback is available in 13 languages via the wireless display.

Oral-B Triumph with SmartGuide is available at department, retail and specialty stores at a suggested retail price of $149.99.

Tuesday, December 04, 2007

Treating Your Periodontal Pockets May Benefit Your Pocketbook

Study suggests that preventing periodontal diseases can positively impact health care expenses

CHICAGO—November 27, 2007—A new study in the November issue of the Journal of Periodontology (JOP) found that prevention of periodontal diseases may lead to savings on not only dental costs, but also medical care costs. Periodontal (gum) diseases have been linked to systemic health conditions including diabetes, cardiovascular disease, and respiratory problems.

The JOP study, conducted in Japan, examined the effect of periodontal diseases on medical and dental costs in 4,285 patients over a 3.5-year time span. The patients were between the ages of 40-59. Researchers found that cumulative health care costs were 21% higher for those patients with severe periodontal disease than those with no periodontal disease. Severe periodontal disease (periodontitis) involves bone loss and diminished attachment around the teeth.

“While previous studies have evaluated the potential link between periodontal diseases and other systemic conditions, this study provides an interesting analysis of total health care costs and the financial impact of having periodontal diseases,” explained JOP editor Kenneth Kornman, DDS. “The research suggests that patients with sever periodontal diseases incur higher overall health care expenses as compared to those patients with no periodontal disease. Prevention of periodontal disease may be very important in overall health, and this study suggests that it may also indirectly translate into lower total health care costs.”

“Everyone is looking for ways to reduce health care costs,” said Susan Karabin, DDS, President of the American Academy of Periodontology, “especially those who are in an age category where they are more susceptible to periodontal diseases. Because of the relationship between the mouth and the rest of the body, treating periodontal disease may be one simple way to decrease total health care costs. If caught early, periodontal diseases can be treated using simple non-surgical techniques which can restore your mouth to a healthy state.”

Monday, December 03, 2007

The American Dental Education Association And Colgate-Palmolive Announce Partnership To Create A Dental Plaque Biofilm Curriculum

The American Dental Education Association (ADEA) and Colgate-Palmolive have partnered to create a curriculum on dental plaque biofilm (commonly known as dental plaque), gum inflammation, and treatment options for dental and allied dental programs. The curriculum will provide educators with the latest research in a rapidly evolving field tailored to first-year students in dentistry, dental hygiene, and dental assisting. With funding from Colgate-Palmolive, ADEA will lead the working group of dental academics and clinicians that develops the curriculum.

"Colgate-Palmolive, the global leader in oral care, is extremely pleased to be partnering with ADEA to have this curriculum produced," said Fotinos S. Panagakos, D.M.D., Ph.D., Director of Professional Relations for Colgate Palmolive. "Our hope is that once completed, this curriculum will become a valuable addition to the existing dental and dental hygiene program, and lead to future curriculum projects with ADEA."

Plaque biofilm was identified as a topic because it bridges the basic and the clinical sciences. By examining plaque biofilm from both of these scientific perspectives, students will be able to easily synthesize how the complex nature of plaque biofilm connects to treatment options and preventive education. The curriculum will also provide a foundation for more advanced coursework in periodontal therapy that occurs later in the programs.

"We were pleased to be approached by Colgate-Palmolive to lead the project. ADEA looks forward to leading the design of a curriculum that brings together science, theory, and practice to better educate future dental professionals," said ADEA President James Q. Swift, D.D.S.

The curriculum will include a syllabus, DVD supplemental program, and content for lectures and seminars. A dental professional from Colgate-Palmolive will also give guest lectures to students as part of the course. The final curriculum will be announced in November 2008 at the 50th Annual ADEA Deans' Conference.

Sunday, December 02, 2007

New CT Scanner


From the BBC News web site. Go check out the video

A new scanner has been unveiled which can produce 3D body images of unprecedented clarity while reducing radiation by as much as 80%.

The new 256-slice CT machine takes large numbers of X-ray pictures, and combines them using computer technology to produce the final detailed images.

It also generates images in a fraction of the time of other scanners: a full body scan takes less than a minute.

The Philips machine was unveiled at the Radiological Society of North America.

Because the images are 3D they can be rotated and viewed from different directions - giving doctors the greatest possible help in looking for signs of abnormalities or disease.

All images also can be accessed on any computer in a hospital or by colleagues and researchers remotely, to make it easier for the whole team to share information.

Saturday, December 01, 2007

Fosamax Users Seek Class-Action Status

Fosamax Users Seek Class-Action Status

By LARRY NEUMEISTER
Associated Press Writer

NEW YORK (AP) -- Lawyers for Fosamax users who believe their jaws were damaged by the osteoporosis drug on Friday asked a federal judge to order Merck & Co. to provide a dental monitoring program for the drug's users.

The lawyers made the suggestion to U.S. District Judge John F. Keenan as they argued for the case to be certified as a class-action, in order to pursue claims by users who believe the drug caused osteonecrosis of the jaw, a condition in which portions of the jaw bone die, sometimes leaving the bone exposed.

Timothy M. O'Brien, a lawyer for plaintiffs, said hundreds of thousands of patients would benefit from a dental monitoring program that would include regular dental screenings, X-rays and lab tests, all aimed at preventing the need for dental surgery.

Paul Strain, a Merck attorney, called Fosamax a "life altering and life saving drug" that helps to prevent the kind of bone fractures that can hasten the deaths of people as they age. He said the drug was a pioneer 11 years ago.

Strain also said there was no proven link between degeneration of the jaw bone in some patients and Fosamax.

Damage to the jaw bone can result in many ways, including from using steroids, from diseases or weaknesses in the body and from poor dental hygiene.

O'Brien said as many as one in every 296 patients who use Fosamax develop the severe damage to the jaw, though Merck disputed the figure. O'Brien said jaws were more susceptible to damage because they are used so frequently and are under greater stress than most bones.

Keenan did not immediately rule after hearing arguments.

Vance Andrus, another lawyer for the plaintiffs, argued a class-action certification would allow for a trial where a jury could decide whether Fosamax is toxic and hazardous and whether Merck was negligent and should have warned users of dangers.

http://hosted.ap.org/dynamic/stories/F/FOSAMAX_LAWSUIT

Kavo GENTLEray 980 Diode Laser Gets FDA Clearance

The Kavo Gentleray 980 diode laser has received FDA clearance so it is now available for sale. This laser has a nice touch screen with lots of information for preforming many different soft tissue procedures. This is a 6 Watt laser and has the ability to add water cooling through the tip. More information is available from Kavo

Friday, November 30, 2007

Cruise ship sails into storm over whitening botch

From the Times Online


A woman’s teeth looked as though they had been dipped in acid after she had whitening treatment aboard a cruise ship, a dentist said yesterday.

Carla Regan, 47, was on a two-week cruise in the Eastern Mediterranean with her husband and two children when she decided to treat herself to the £130 treatment. But she was left with yellowing, easily stained and dry teeth after a chemical typically used for disinfecting swimming pools stripped away the top layer of tooth enamel on her front eight teeth. The treatment, using chlorine dioxide, was of a kind increasingly being offered to consumers wishing to brighten up their smile, despite evidence that it causes harm. Mrs Regan is now facing a £5,000 bill to restore her mouth’s appearance.

The General Dental Council has determined that only a registered dentist can carry out teeth whitening, yet the cruise ship treatment was provided by beauticians in an onboard spa, with no dentist even to supervise, she said.

Mrs Regan said yesterday: “The beauty salon on the ship was offering teeth whitening and I thought to myself, why not? It seemed like an appropriately indulgent thing to do on holiday – they promoted it as nontoxic and safe. However, a week later I noticed my teeth were starting to look stained, and with time they only got darker. I also constantly had a ‘dry mouth’ feeling, so I decided to see a dentist to tell me what could be wrong.”

Mrs Regan declined to name the cruise operator involved as she has lodged a formal complaint against the company.

“I had never considered whitening procedures before, and on the ship I had no chance to do any research into the treatment,” she said. “I thought it would be perfectly safe, but in the end it permanently damaged my teeth.”

James Goolnik, a dentist and vice-president of the British Academy of Cosmetic Dentistry, said he was shocked at the surface harm on Mrs Regan’s teeth. “Her teeth look like they had been dipped in acid,” he said. “It may not be immediately visible to the untrained eye, but her front teeth clearly have no surface shine when compared with the rest of her teeth. The damage is permanent and we are currently assessing whether repair will involve more complex cosmetic procedures, such as bonding or porcelain veneers.” Despite a lack of clinical evidence or official trials that justify the use of chlorine dioxide on teeth, the chemical is being offered as an alternative to hydrogen peroxide treatments by a growing network of franchises around the country.

Its use has caused problems in other patients, including 23-year-old Stephanie Ramezan, whose teeth were left darkened after a session at a City spa, as The Times reported in February.

Dr Goolnik said: “The rise in these problem cases illustrates why dental care, even purely cosmetic procedures, should only be provided by dentists with the proper training.”

Thursday, November 29, 2007

Lantis Laser Wins Coveted Popular Science Magazine Award

Company’s Breakthrough Optical Coherence Tomography (OCT)
Dental Imaging System™ Named in “Best of What’s New” 2007

Denville, N.J. – November 29, 2007 – Lantis Laser Inc. (Other OTC: LLSR.PK - News) (http://www.lantislaser.com), a New Jersey-based company specializing in the commercialization of advanced dental technology, recently won a Popular Science Magazine 2007 Best of What’s New award for its newly developed Optical Coherence Tomography (OCT) Dental Imaging System™. Lantis’ proprietary OCT System is a diagnostic aid that provides real-time, high-resolution chairside imaging of dental tissue for the early detection of tooth decay and other oral diseases.

”For 20 years, Popular Science’s Best of What's New awards have honored the innovations that make a positive impact on life today and change our views of the future,” says Mark Jannot, Editor-in-Chief of Popular Science. “PopSci’s editors evaluate thousands of products each year to develop this thoughtful list; there’s no higher accolade Popular Science can give.”

Lantis Laser’s OCT Dental Imaging System™, which is scheduled to launch in August 2008, was a winner in the Personal Health Category because it provides up to 10 times the resolution of a standard x-ray, which enables much earlier detection of tooth decay than is currently possible. Importantly, unlike x-rays, which emit harmful radiation, the OCT Dental Imaging System™ utilizes an innovative, safe, non-invasive light that is passed over the tooth surface using a small, pen-like handheld scanner to capture images of the teeth. It can be used safely on children (and pregnant women), enabling the dentist to diagnose and implement a program to safeguard the oral health of mother and child alike.

“We’re very pleased and honored to be recognized by the editors of Popular Science Magazine,” said Lantis President & CEO Stan Baron. “Up to this point, the support and interest among dental professionals and the dental trade media have been extremely positive. However, Popular Science Magazine’s Best of What’s New award validates on a larger scale how the capture of reflected light can immediately and accurately reveal on a chairside monitor the earliest stages of cavities, gum disease, and microstructural deficiencies. Lantis Laser’s OCT Dental Imaging System™ will give the dental profession a significant upgrade in chairside dental imaging as it meets important diagnostic needs and helps the dentist provide a much safer and superior level of care than what is now available.”

BrytonPick


Not all things new have to be high tech. Here is a cool new device I saw at the GNYDM for getting food out from between teeth. Click on the link for more information.


BrytonPick is a cool and hygienic solution for discreet and effective removal of food from between teeth. It is a string-free, portable and reusable dental space cleaner, a great floss substitute for on-the-go. Designed to be used by Teens, Adults and Seniors after every meal anywhere and anytime.

• Use requires one hand only, no mirror or water therefore it can be used in a restaurant, car, office, school, home, etc.
• Flexible stainless steel edges makes BrytonPick germ resistant and re-usable for up to 30 days
• Between uses cleanse with tissue, napkin or hot water
• Plastic holder comes in 7 different colors
• BrytonPick is stored in a credit card size carrying pouch
that fits into any wallet
•BrytonPick will replace all unhygienic improvised tools used to remove food debris from between teeth such as: paper clips, hair, business cards, finger nails, pens or worse!
• BrytonPick is also FDA registered, Pre-Sterilized and 100 % Made in USA (QS-9000 / ISO9001 Certified)

Wednesday, November 28, 2007

Humanoid robot teaches dentists to feel people's pain


A group of robot and computer makers presented the high-tech dental patient in Tokyo at the 2007 International Robot Exhibition, a four-day technology showcase that opened Wednesday.

The medical simulation robot, named "Simroid," is designed to be used for clinical training at dental schools, said Tatsuo Matsuzaki, an official at robot maker Kokoro Company Ltd., which developed the body and control system.

The 160-centimeter (five-foot-three) robot can say "it hurts" and frown when it feels uncomfortable from the dental drill.

"Because it's so real, dental trainees can see patients' feelings and will be able to develop good skills as they treat it, not as an object, but as a human being," Matsuzaki said.

Read more on the Phyorg web site

Tuesday, November 27, 2007

EWOO Technology CBCT, Pan, Ceph


One of the larger booths at the GNYDM was from Ewoo Technology. They were displaying a number of imagining products including the Picasso Trio which is a CBCT, Panoramic, Cephlametric unit. You can get the unit without the Cephlametric. The images looked good and they were offering $20K discount with the trade in of your old Panorex machine. The EzImplant 3D software looked easy to use and the images were very good.

Check out more and the videos on the EWoo Technology website.

Sunday, November 25, 2007

GNYDM

A busy day at the Greater NY Meeting. Not a lot of new things to report on but I will post some things when I get the chance this week. It does look like the Chicago Mid-Winter meeting should produce some new equipment announcements.
Marty

Saturday, November 24, 2007

Good For Business

Wondering around NYC. Hershey is on one side of the street and M&M is on the other.

Just what a dentist needs for patients... More candy!

Greater NY Dental Meeting

I just checked into my hotel room with a nice view of Time Square. Above the Discover sign is where the ball drops to ring in the New Year.

The Greater New York Dental Meeting starts tomorrow. I will be on the floor all day checking out the latest gadgets. A full report in the next few days.

Marty

Dentist kicks late patient off NHS register

Here is my 500th post to the blog. I never thought that I would be doing this almost daily. This is a fun post. Something we have all experienced in our practices. Make sure you click the link and read the comments after reading the conclusion of the article. Marty

Here is a great article about a patient turning up late. The best part is the comments after the article . Read the whole article on the Scotsman.com website and enjoy all the puns that people wrote in the comments section.

A WOMAN was de-registered by her NHS dentist because she was 15 minutes late for an appointment. Now the Scottish Public Services ombudsman has upheld her complaint against Marchmont Dental Care.

Since the complaint, the practice has changed its procedures so patients will be warned in advance and not de-registered after just one late appointment.

The incident came after the practice had suffered repeated problems with new patients failing to turn-up for appointments.

The ombudsman, Professor Alice Brown, said the woman, referred to only as Mrs C, had arrived 15 minutes late for a 35-minute appointment to mend a broken tooth in January.

She told the ombudsman she had been late for reasons outwith her control - she was caught in traffic on her way to the dentist's because of a road accident.

The patient claimed that after being de-registered, she was then forced to spend several weeks trying to find a new dentist and could not be treated before July.

Friday, November 23, 2007

A 4-Year Prospective Clinical and Radiological Study of Maxillary Dental Implants Supporting Single-Tooth Crowns Using Early and Delayed Loading Proto

Ilser Turkyilmaz DDS, PhD, Mehmet Avci DDS, PhD, Serkan Kuran DDS, Esma Nida Ozbek DDS (2007)
A 4-Year Prospective Clinical and Radiological Study of Maxillary Dental Implants Supporting Single-Tooth Crowns Using Early and Delayed Loading Protocols
Clinical Implant Dentistry and Related Research 9 (4), 222–227.
doi:10.1111/j.1708-8208.2007.00045.x


Background: Recent studies have showed that immediate/early loading of dental implants is a clinically feasible concept with results similar to those for standard two-stage procedures, especially in the mandible. However, there are only a few studies regarding the immediate/early loading of maxillary implants supporting single-tooth crowns.

Purpose: The aim of this study was to compare the clinical and radiological outcomes of early- and delayed-loaded dental implants supporting single-tooth crowns in the maxilla.

Materials and Methods: Twenty-nine patients were consecutively treated between 2000 and 2002 with 59 Brånemark System MK III TiUnite implants (Nobel Biocare AB, Göteborg, Sweden) in the maxilla. Two groups were formed according to the loading protocols. In the test group, definitive implant-supported single crowns were delivered to 19 patients 6 weeks after the implant placement. In the control group, definitive implant-supported single crowns were delivered to 10 patients 6 months after the implant placement. Clinical and radiographic parameters were recorded at baseline, 1 to 4 years. Implant stability measurements have only been performed at 4-year follow-up recall.

Results: Overall, three implants were lost during the study period. Two implants were lost in the test group including 36 implants, which indicated a survival rate of 94.4%. One of the lost implants was replaced and then osseointegrated successfully. One implant was lost in the control group during the healing period, which indicated a survival rate of 95.7%. The average marginal bone loss was 1.11 mm for 56 implants after 4 years. There were no significant differences in marginal bone levels, insertion torque, and resonance frequency values between the two groups.

Conclusion: The results of this study indicate that 6 weeks of early loading period for TiUnite-surface titanium implants in the maxilla is reliable and predictable for this patient population and may offer an alternative to the standard loading protocol.

Thursday, November 22, 2007

Happy Thanksgiving

I hope everyone in the USA enjoys a wonderful Thanksgiving Day with their family. I am especially thankful for the men and women of our country’s arm forces and their families and friends who know sacrifice first hand. Travel safe and don't eat too much.

See some of you at the Greater NY Dental Meeting this weekend.

Marty

Wednesday, November 21, 2007

Health and Disability Natural teeth and cognitive function in humans

MAUD BERGDAHL, REZA HABIB, JAN BERGDAHL, LARS NYBERG, LARS-GÖRAN NILSSON (2007)
Natural teeth and cognitive function in humans
Scandinavian Journal of Psychology 48 (6), 557–565.
doi:10.1111/j.1467-9450.2007.00610.x

A number of neurobiological, psychological and social factors may account for cognitive impairment. In animal studies a relation between dental status and cognitive performance has been found. It is unclear whether such a relation exists for humans. In a first step we compared the performance of 1,351 participants (53% women, 47% men; age M = 54.0) with natural teeth to 487 edentulous participants (59% women, 41% men; age M = 71.3) on 12 cognitive tests. The natural teeth group had a lower mean age, fewer women, more years of education, higher mini-mental state (MMSE), and performed significantly higher on several cognitive tests. In a subsequent analysis, the cognitive performance of a subset of the participants (50–85 years) was examined. In this analysis, 211 had natural dentition and 188 were edentulous. The groups were matched for gender, age, social variables, diseases, stress and MMSE. The cognitive disadvantage of the edentulous group was still apparent. The results suggest that functional natural teeth relate to relatively preserved cognitive functioning in older age.

Tuesday, November 20, 2007

Technology has extracted much of the pain from dental work.

I saw this article in my local newspaper. I use the newer version of the wand called the STA (Single Tooth Anesthesia) and like it very much.

Posted by the Asbury Park Press on 11/20/07

BY MICHAEL RILEY
STAFF WRITER


Zaire Riley of Long Branch was about to get a tooth pulled last week. And the 10-year-old in the dentist's chair had a big smile on his face.

Someone asked him if he was scared.

"No," he said.

His mother, Mirta Colbert, was right by his side at the Monmouth Medical Center Dental Clinic in Long Branch. She's not afraid of a trip to the dentist either, she says.

And that's a good thing. Anxious parents have a way of passing along that anxiety to their kids, says Dr. Michelle Ziegler, program director for the Dental Residency at Monmouth Medical Center.

The way to overcome a fear of the dentist is never to have that fear in the first place, she says.

"If those first and second trips to the dentist are pleasant experiences," she says, "then fear doesn't have to be a part of it."

Nevertheless, some people still get scared.

Dr. Robert McTaggart, attending and faculty dentist at Monmouth Medical Center, says that studies say the number of people afraid of a visit to the dentist has come down, but . . .

"Somewhere between 12 to 17 percent of people describe themselves as "very anxious' when facing the prospect of sitting in that chair. I've had to talk patients in from the parking lot," he says.

Ziegler understands where that fear comes from.

There's the pain factor, she says.

And then the procrastination factor — "people sometimes keep putting off the trip to the dentist," she says.

You put those together long enough, Ziegler says, and then people are afraid to go the dentist because they are worried that the dentist is going to scold them for not having come in sooner.

At that point, she says, "there's definitely an embarrassment factor." But a lot of that fear is misplaced, dentists say.

"Things have come a long way," Ziegler says. "For one thing, our hand pieces are a lot faster now."

"Hand pieces" is dentist talk for drills.

The faster those instruments spin, she explains, the less likely patients in the chair are to feel pain.

And if it is the very sound of the drills that sets patients' nerves askew, well, the drills are getting quieter.

"The electric drills are almost silent," says McTaggart, who is in private practice at General Dentistry and Advanced Dental Sedation, both of Toms River. Even given the more efficient drills, some of them moving at up to 300,000 rpm, the numbing medicines have improved, he says, providing more efficient ways to block pain signals from getting to the brain.

And so have the instruments used to inject the medicine.

"We have what's called "The Wand' — it doesn't even look like a syringe," Ziegler says. "It's a way to provide a slow, consistent injection that is less painful. Dentists use them especially, but not always, for children."

Zaire got what the dentists called his "tooth sleep juice" with just such a wand.

All of that, though, is not enough to calm some people down. This is why the phenomenon of sedation dentistry is gaining in popularity.

It's not quite accurate to say that sedation dentistry "knocks patients out" says Sally-Jo Placa, chairman of the Department of Dentistry at Jersey Shore University Medical Center in Neptune and in private practice in Woodbridge.

"It is not general anesthesia," says Placa.

Dentists need special training and special permits to administer either type of sedation — a pill or an IV drip."

Patients can still respond to commands, she says, and generally have little or no memory of the event.

Sedation is used on apprehensive patients, the disabled and those facing complex procedures, such as having all four wisdom teeth out at once.

McTaggart says that about 15 percent of his patients request sedation dentistry, which mirrors the percentage of Americans nationwide who are very nervous about a dentist poking around their mouths.

"Dentists really invade your personal space," Placa says. "But as a dentist, it is never my intention to cause you pain. It's easier for me to work on you if you're not in pain."

As for scolding patients who have neglected their dental health, she doesn't do it, she says.

"Some dentists feel that with some patients with whom they've developed a relationship, scolding might be a way of motivating them," she says. "But we know who's not flossing."

Fear of the dentist might not be a thing of the past, but it's getting there, says McTaggart.

"Teeth are getting better," he says. "With fluoride, better education and more diligent parents, people have less reason to be anxious now."

EDITOR'S NOTE: Zaire Riley is not related to the author of this article, Michael Riley.

Monday, November 19, 2007

AFP Imaging Corporation Receives Canadian Government License to Market Newtom(TM) VG 3D Cone Beam Computed Tomography Scanner

I don't have a NewTom but do have one of their EVA sensors...MJ

AFP Imaging Also Receives a Prestigious 'Technology Impact Award' for its EVA(TM) and EVA+(TM) Digital Dental Sensors

ELMSFORD, N.Y.--AFP Imaging Corporation (OTCBB: AFPC.OB ) announced today that it has been granted a medical device license from Health Canada, the federal regulator of drugs and health products, to market the company’s NewTom™ VG 3D Cone Beam Computed Tomography (CBCT) Scanner in Canada. The NewTom VG provides clinicians with detailed three-dimensional, radiographic images of the teeth and jaws while allowing patients to stand, sit, or remain in their wheel chairs while being scanned. The unit’s small footprint makes it ideal for in-office examinations when space is limited. The primary applications are for diagnosis and treatment planning in dentistry and otolaryngology (ENT), including dental implants, orthodonture, and maxillo-facial surgery, as well as ear, sinus, and airway imaging.


NewTom VG uses the same technology and proprietary software as AFP Imaging’s NewTom™ 3G, which provides a horizontal support table to accommodate elderly, infirm or trauma patients and children. AFP Imaging is the only CBCT scanning supplier to provide both vertical and horizontal configurations of this exciting technology for dental and ENT markets. The products are manufactured by AFP Imaging’s wholly owned subsidiary, Quantitative Radiology, srl (QR) in Verona, Italy.

Gary Lee, Executive Vice President, Sales and Marketing of Genexa Medical Inc., the exclusive Canadian distributor for NewTom VG and NewTom 3G, said, "We are extremely excited that Health Canada has approved the latest 3D CBCT scanner from the company that actually invented cone beam scanning. The NewTom VG is a culmination of the key advances of previous generations of NewTom scanners. It produces images with better resolution, contrast and clarity in a package whose footprint is no larger than a traditional panoramic X-ray scanner.”

AFP Imaging Receives ‘Technological Impact Award’

AFP Imaging also announced that Polytechnic University’s Center for Advanced Technology in Telecommunications (CATT) presented the company with a prestigious “Technology Impact Award” for successfully commercializing CATT research in the company’s EVATM line of digital dental sensors. The award was given at Polytechnic University in Brooklyn on November 8, 2007. CATT’s mission is to assist New York State companies with basic research that companies can apply commercially.

EVA digital dental systems expose patients to significantly less radiation than film X-rays, but “low radiation produces only a low level of signal per pixel. The rest of what you get is noise,” explains Jim Johnson, Director of Engineering at AFP Imaging. The challenge AFP Imaging faced was to get the clearest image while using the smallest amount of radiation as possible. To improve the process, AFP Imaging collaborated with Professor Ivan Selesick of CATT. “Dr. Selesick’s research team developed an algorithm to recognize the geometry and movement of the signals, pick out the relevant signals, and ignore the noise,” notes Mr. Johnson. “Now, EVA sensors are clearly the clearest digital dental sensors on the market.”

For additional information about AFP Imaging and its products, please visit www.afpimaging.com, www.dent-x.com and www.newtomdental.com.

Sunday, November 18, 2007

Back From El Paso



I spent the past few days in El Paso, Texas with Paul Feuerstein doing a Dental Technology Solutions lecture for the Thunderbird Dental Study Club. The lecture was in the beautifully restored Plaza Theater. We had a very nice visit and got through a lot of information in a very limited time. We also made a short dash across the border into Juarez Mexico. A place like many with a dentist on every corner.

So if your group is looking for a Technology CE event check out the DTS web site
www.dentaltechnologysolutions.com

Saturday, November 17, 2007

Erase Your Office Hard Drive


Are you upgrading computers and worried about HIPPA? Then this little device maybe what you are looking for. WiebeTech's newest hardware solution completely erases all data from a hard drive quickly and easily. Stand-alone operation. No computer required! Faster than software.

More at the WiebeTech web site

Friday, November 16, 2007

Why some people's teeth crack while others stay strong

By Chris Emery | Sun reporter
November 15, 2007

The closest thing China has to a tooth fairy might be Dwayne Arola, an engineering professor from the University of Maryland, Baltimore County who has a thing for Asian choppers.

Not long ago, Arola returned from a trip to Shanghai with a plastic lunch box containing a dozen prime specimens from Chinese dental patients - large, cavity-free wisdom teeth - destined to endure a regimen of abuse that he once reserved for aircraft parts.

How the Chinese molars hold up under Arola's stress tests may explain why Chinese teeth are more brittle than American teeth. Ultimately, that knowledge might lead to a dental Fountain of Youth: a high-tech process to make old teeth young again, and less prone to cracking under pressure.

Read the entire article on the Baltimore Sun web site

Thursday, November 15, 2007

UCLA dentist school scandal

Cheating on licensing exams is probed, and a highly competitive program is accused of giving preferential treatment in admissions.
By Louis Sahagun, Los Angeles Times Staff Writer
November 14, 2007
The UCLA School of Dentistry was hit by separate scandals Tuesday involving allegations of favoritism toward relatives of deep-pocket donors and student cheating on licensing examinations, university authorities acknowledged.

The American Dental Assn. is investigating allegations of cheating by at least a dozen UCLA students as well as students from USC, Loma Linda University and New York University, UCLA officials said. The students were alleged to have improperly obtained questions to a test that is a step toward fulfilling qualifications for a license to practice dentistry.

"The ADA is looking into alleged improprieties by UCLA students associated with testing," said Lawrence Lokman, UCLA's assistant vice chancellor of communications. "We would certainly hope any ADA investigation provides adequate due process to the students, and whatever matter they are looking at would be resolved quickly and fairly."

A detailed account of alleged preferential treatment given large financial donors to the dental school's highly competitive orthodontics residency program appeared in Tuesday's edition of the Daily Bruin, the campus newspaper. There are about only six positions offered each year in the residency program, and the positions are highly sought because careers as orthodontic specialists can be lucrative.

It was not the first time the university has been accused of favoring major donors and other influential people with VIP admission treatment. In 1996, The Times published a five-part series that underlined how seeking generous donors had become a "team sport," in the words of one UCLA fundraiser.

In the aftermath of The Times series, UCLA officially prohibited influencing admissions with donations.

The Daily Bruin's months-long investigation, coupled with an independent audit conducted this year, has prompted changes in the School of Dentistry's admissions policies and procedures, university authorities said. For example, admission to coveted program positions must now be reviewed by a special admissions panel to resolve potential conflicts of interest.

But No-Hee Park, dean of the School of Dentistry, said in a prepared statement that the program was fair and merit-based.

"While an independent investigation requested by Acting Chancellor Norman Abrams found no credible and convincing evidence to support allegations of a legacy program in the orthodontics admissions process," Park said, "it did provide us with an opportunity to review our admissions policies and procedures and make improvements in the areas of oversight and transparency."

(Abrams was acting chancellor until Gene D. Block assumed the top post at UCLA this summer.)

The Daily Bruin article, which it said was based on examinations of hundreds of pages of e-mails and internal documents, said the program's high admissions standards were relaxed for children or relatives of donors who pledged hefty financial gifts, one as high as $1 million.

Amid a university probe, John Beumer III in February resigned as chairman of the faculty executive committee of the School of Dentistry.

"The selection process for residents in orthodontics amounts to nothing less than an affirmative action program for the wealthy and well-connected," he wrote in a resignation letter posted Tuesday on the Daily Bruin's website. "Preferential treatment has been given to children of donors and students who have worked in the research laboratories of orthodontics faculty."

In an interview Tuesday, he said, "UCLA students in particular have been disadvantaged by this policy. I don't think this represents the best of the university. But I think it will change because, fortunately, this incident has precipitated a review of the issue."

Michael McDonald, a dental school alumnus, agreed, saying in an interview, "It's horrible, just horrible, what's going on."

According to McDonald, a dental school official told him that giving large donors and their relatives an edge in the competitive admissions process was a way to increase revenues.

"When I heard that, I called the office of admissions about it," McDonald recalled, "and the rats started jumping off the ship.

"People should be getting in because of their hard work and qualifications, not because of how much money their mom and dad gave the school," McDonald said. "I studied my brains out, but I would have accomplished nothing under these circumstances because my father worked in a grocery store and our family bank account was empty."

As for the investigation by the American Dental Assn., Lokman declined to elaborate.

However, two members of the School of Dentistry who asked that their names not be used out of fear of retribution, said the alleged cheating involved the sharing of compact discs that contained improperly obtained questions that appear in American Dental Assn.'s National Board Dental Examinations.

"I love UCLA, and I've donated a lot of money to the university," McDonald said. "But I'm distraught. The fact we have some bad apples in the dental school really bothers me."

louis.sahagun@latimes.com
http://www.latimes.com/news/local/orange/la-me-ucla14nov14,1,5609807.story?coll=la-editions-orange

Wednesday, November 14, 2007

Ivoclar Invests In Sirona

Ivoclar Vivadent AG announced today that it has made an investment in Sirona Dental Systems, Inc., one of the world's leading manufacturers of high-technology dental equipment. Sirona's CEREC System today is the world's only CAD/CAM system for chairside dentistry, and their inLab technology is a market leader with dental laboratories. Ivoclar Vivadent is the market leader in all ceramic metal free materials for esthetic dentistry and is a material partner for Sirona's CEREC System and inLab Technology. "This investment represents our commitment to the growth of CAD/CAM systems and our belief that this technology provides benefits to the dental industry, the dental profession and to the patient", said Robert A. Ganley, Chief Executive Officer of Ivoclar Vivadent AG. "Sirona has been a very valuable partner with Ivoclar Vivadent and we look forward to building the growth of CAD/CAM together in the future." CAD/CAM dentistry represents one of the fastest growing sectors of dentistry with expectations for continued rapid growth. "We have had a long lasting relationship with Ivoclar Vivadent and we are very excited about this investment and our mutual success in the future. This year we are celebrating our 20 year anniversary of CEREC and this investment is further evidence of our established success and growth potential", said Jost Fischer, Chairman, President and Chief Executive Officer of Sirona Dental Systems, Inc.

Tuesday, November 13, 2007

MATERIALISE LAUNCHES U.S. LAWSUIT AGAINST NOBEL BIOCARE

Follows Similar Action In Germany Where Court Agreed With Materialise; Contends that “NobelGuide” Drilling Templates Violate Materialise’s Patented “SurgiGuide” Technique



GLEN BURNIE, Md. ; LEUVEN, Belgium (November 12, 2007) --- Materialise N.V. and Materialise Dental N.V., manufacturer of 3D implant planning systems for accurate and predictable treatment planning of dental implants, have launched a U.S. patent infringement lawsuit in the Central District of California against Nobel Biocare, AB and its U.S. subsidiary Nobel Biocare USA. LLC.

Specifically, Materialise contends that Nobel Biocare’s manufacture of “NobelGuide” drilling template violates a Materialise U.S. patent that was issued in 1998 relating to Materialise’s “SurgiGuide” techniques.

The lawsuit in the U.S. is effectively an extension of a similar action in Europe where this past August the District Court of Dusseldorf ordered Nobel Biocare AB and Nobel Biocare Deutschland GmbH to stop offering the NobelGuide drilling templates in Germany, finding that they infringed Materialise’s analogous European Patent No. 0 756 735. This decision, which is preliminarily enforceable, is subject to an appeal of Nobel Biocare pending at the Düsseldorf Court of Appeals. Materialise’s U.S. lawsuit is also a response to a recent Nobel Biocare civil action (also filed in the Central District Court of California) that seeks declaratory judgments that Materialise’s U.S. patent is both not infringed by Nobel Biocare’s products and is invalid.



Bart Swaelens, CEO of Materialise Dental, said:

"With this lawsuit, we are protecting our technology. Our “SimPlant” software was launched in 1991, and was followed by our “SurgiGuide” drill guides in 1999. The introduction of NobelGuide by Nobel Biocare, on the other hand, did not occur until 2005. "

Materialise Dental has been promoting Computer Guided Implantology for many years, and our products, based on extensive Research & Development, have greatly contributed to the success of the implant dentistry field.

Fortunately, the German court agreed that Nobel Biocare was infringing on our European patent, and we’re now hopeful that the U.S. courts will follow suit.

The Evolution Of SurgiGuide
Dental drill guides transfer surgical implant planning to the actual surgery. The litigations in the U.S. and in Germany concern methods for making medical models, including guides for dental surgery, which involve the use of grey value images and rapid prototyping.

Over the last decade, Materialise Dental has gathered considerable clinical experience in this area. Research yielded groundbreaking results leading to the 1999 introduction of the first (bone-supported) version of SurgiGuide. This was followed in 2001 by a SurgiGuide version for zygomatic implants, in 2002 by a mucosa-supported SurgiGuide, and in 2003 by a tooth-supported SurgiGuide version. Dental experts and opinion leaders in the industry were well aware of the development of the SurgiGuide drill guides, which were presented at open conferences for clinicians.



Timeline

* April 19, 1994 – Materialise files its first patent application (in Belgium) for a “Method for Making a Perfected Medical Model on the Basis of Digital Image Information of a Part of the Body,” followed in April, 1995, by patent applications in the European Patent Office and the United States. Materialise Dental subsequently releases SurgiGuide drill guides in 1999.
* June 16, 1998 – Materialise is awarded a U.S. Patent (No. 5,768,134) for same method as above.
* August 5, 1998 – Materialise is awarded a European Patent (No. 0.756,735) for the same method as above.
* June 5, 2005 – Nobel Biocare launches its NobelGuide product.
* November 23, 2006 – Materialise files a patent infringement action asserting its European patent No. 0 756 735 against Nobel Biocare in the Dusseldorf District Court (Germany).
* June 25, 2005 - Nobel Biocare files a nullity action in Germany against the German part of EP 0 756 735 (pending)
* July 24, 2007 – Nobel Biocare files a request to stay the German infringement action. The Dusseldorf Court denies this request.
* August 3, 2007 – Nobel Biocare files a declaratory judgment civil action in the Central District of California seeking a declaration of patent non-infringement and/or invalidity of Materialise’s U.S. patent, and a declaration of authorization to produce by a patent licensee.
* August 14, 2007 – The District Court of Dusseldorf rules that Nobel Biocare is indeed infringing on Materialise’s European patent No. 756 735 by its unauthorized use of a method for producing guides for dental implant surgery.
* September 28, 2007 – Nobel Biocare files an appeal against the decision of the District Court of Düsseldorf with the Düsseldorf Court of Appeals (pending)
* October 15, 2007 – Materialise files a counterclaim for U.S. patent infringement against Nobel Biocare AB and Nobel Biocare USA in the Central District Court of California.

About Materialise Dental



Materialise Dental focuses on 3D Digital Dentistry and offers a range of products and services to aid dental professionals in the treatment of their patients. Materialise Dental is the manufacturer of SimPlant and SurgiGuide internationally. SimPlant software, one of the most recognized names in computer guided surgery, is the world's first interactive 3D implant planning system for the most accurate and predictable treatment planning of dental Implants. As the industry leader, SimPlant software is available in six different languages and is utilized by thousands of clinicians all over the world.

Materialise Dental is one of the independent market leaders in dental implantology simulation software and one of the worldwide leaders in medical modeling technology. Materialise Dental provides surgeons with the most detailed and precise virtual 3D models available. Clinicians around the world use medical models and templates created by Materialise Dental software to assist them in the most complex surgical cases. Materialise Dental is a trusted partner worldwide for the largest hospitals and research institutions.

Materialise Dental is based in Leuven, Belgium, with its U.S. operation headquartered in Glen Burnie, Md.

Monday, November 12, 2007

Patients' self-perceived impacts and prosthodontic needs at the time and after tooth loss.

Teófilo LT, Leles CR.

Department of Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil. Braz Dent J. 2007;18(2):91-6

Studies on self-perception have demonstrated that tooth loss is associated with esthetic, functional, psychological and social impacts for individuals. However, not all subjects seek treatment immediately after tooth loss, even when desire for replacement is strongly expressed. The aim of this study was to evaluate the perception of patients submitted to tooth extraction about factors associated with tooth loss and prosthodontic treatment, at the time and after extraction. A convenience sample of 211 consecutive patients were clinically evaluated and answered to a questionnaire about perceived impacts and prosthodontic treatment needs. Data were collected at the time of extraction and after a 3-month time interval. Perceived impacts were high (21 to 76% at the time and 35 to 87% after extraction). From 72.5% patients who expressed intention of immediate replacement of edentulous spaces, only 8.1% had actually been treated. Financial limitation was considered the most important factor that restricted access to treatment. Bivariate statistical analysis showed association between immediate dental replacement and anterior tooth loss (p=0.00) and extension of edentulous space (p=0.01). Position of lost teeth was associated to perceived functional limitation (p=0.03). Worsened appearance was associated to tooth loss in the maxillary arch (p=0.02), and desire of prosthodontic treatment was associated to the extension of edentulous space (p=0.05). Perceived impacts were more frequent in women than men. It was concluded that although patients usually expressed prosthodontic treatment needs, clinical and financial issues are determinant factors for tooth replacement.