Saturday, February 27, 2010

Successful Treatment of Early Implant Failure: A Case Series

Successful Treatment of Early Implant Failure: A Case Series
Ali Saad Thafeed AlGhamdi, BDS, MS, FRCD(C)*

Clinical Implant Dentistry and Related Research

Published Online: 11 Feb 2010


Background: The aim of this longitudinal study was to evaluate the effect of combined treatment on early progressive bone loss around dental implants.

Methods: The study sample consisted of 18 implants presenting at 4–6 weeks post placement with early progressive bone loss. Clinical examination indicated the presence of a fistula in the soft tissue covering the implants in most cases. Defects around the implants were curetted, exposed implant surfaces were mechanically debrided and treated with tetracycline solution, and the defects were filled with bone graft and doxycycline powder. Bioabsorbable membranes were used. Final crowns were placed after 6 months. The patients were followed for an average of 30 months.

Results: The surgical sites healed without complication. At the time of loading, the defects were completely restored. At 12 months postloading, there was crestal bone loss to the level of the first thread (average, 1.3 mm). Pocket depths ranged from 3 to 5 mm (average, 3.6 mm) with no bleeding. No further changes were noticed throughout the remaining follow-up visits. All implants were successful according to the criteria proposed by Albrektsson and colleagues.

Conclusions: Early detection and treatment of early progressive bone loss around dental implants are the key to saving early failing implants. The author recommends reevaluation visits 4–6 weeks postimplant placement to detect any signs of early failure so that immediate treatment can be undertaken if needed.

Friday, February 26, 2010

Replacement versus repair of defective restorations in adults: resin composite.

Cochrane Database Syst Rev. 2010 Feb 17;2:CD005971.

Replacement versus repair of defective restorations in adults: resin composite.

Sharif MO, Catleugh M, Merry A, Tickle M, Dunne SM, Brunton P, Aggarwal VR.

School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.

BACKGROUND: Composite filling materials have been increasingly used for the restoration of posterior teeth in recent years as a tooth coloured alternative to amalgam. As with any filling material composites have a finite life-span. Traditionally, replacement was the ideal approach to treat defective composite restorations, however, repairing composites offers an alternative more conservative approach where restorations are partly still serviceable. Repairing the restoration has the potential of taking less time and may sometimes be performed without the use of local anaesthesia hence it may be less distressing for a patient when compared with replacement. OBJECTIVES: To evaluate the effectiveness of replacement (with resin composite) versus repair (with resin composite) in the management of defective resin composite dental restorations in permanent molar and premolar teeth. SEARCH STRATEGY: For the identification of studies relevant to this review we searched the Cochrane Oral Health Group Trials Register (to 23rd September 2009); CENTRAL (The Cochrane Library 2009, Issue 4); MEDLINE (1950 to 23rd September 2009); EMBASE (1980 to 23rd September 2009); ISI Web of Science (SCIE, SSCI) (1981 to 22nd December 2009); ISI Web of Science Conference Proceedings (1990 to 22nd December 2009); BIOSIS (1985 to 22nd December 2009); and OpenSIGLE (1980 to 2005). Researchers, experts and organisations known to be involved in this field were contacted in order to trace unpublished or ongoing studies. There were no language limitations. SELECTION CRITERIA: Trials were selected if they met the following criteria: randomised or quasi-randomised controlled trial, involving replacement and repair of resin composite restorations. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. MAIN RESULTS: The search strategy retrieved 279 potentially eligible studies, after de-duplication and examination of the titles and abstracts all but four studies were deemed irrelevant. After further analysis of the full texts of the four studies identified, none of the retrieved studies met the inclusion criteria and all were excluded from this review. AUTHORS' CONCLUSIONS: There are no published randomised controlled clinical trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled clinical trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement ( Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, anxiety and distress, time and costs.

Thursday, February 25, 2010

Notes From OralDNA press conference.

Notes From OralDNA press conference.

OralDNA saliva tests helps patients acknowledge their disease state and accept treatment.
Salivary diagnostic tests enable accurate, easy and biological diagnosis of disease. A 30 second oral rinse of saline is all it takes to produce a sample for analysis.

My PerioPath test determines the cause of perio infections providing personalized treatment options. MyPerioPST test looks at the suseptibility traits of individuals for periodontal disease. 35 to 40% carry the trait and are more likely to have more aggressive perio disease.

Human HPV virus is transmited via sexual contact. Oral HPV can lead to oral cancer. The OraRisk HPV test screens for the presence and type of HPV. The test results identifying the risk of HPV and risk of developing oral cancer. 

Test results can be obtained via the web in about 4 days. The cost for 12 sample collectors is $199. The cost for the HPV test is $70 and perio tests are $99.

Children's understanding of and motivations for toothbrushing: a qualitative study

P Gill, K Stewart, D Chetcuti, IG Chestnutt

International Journal of Dental Hygiene

Published Online: 18 Feb 2010


Objective: To explore children's understanding of why they do or do not brush their teeth and their motivations for toothbrushing.

Methods: Individual semi-structured interviews were conducted with 66 children aged 6–7 years and 10–11 years in four purposively selected primary schools in Cardiff, UK. Data were analysed using a constructive process of Thematic Content Analysis and techniques of open and selective coding.

Results: While a routine activity, toothbrushing was prompted rather than monitored by parents and easily fell by the wayside because of tiredness, excitement or distraction. Rationalizations for toothbrushing were poorly formed in the children's accounts and related to 'doom scenarios' such as teeth falling out, or to issues of personal grooming and cleanliness rather than caries prevention. Electric (powered) toothbrushes were popular and had engaged the children's interest. Social and domestic circumstances, such as when children stayed with different parents at different times, impacted on toothbrushing routines.

Conclusion: This study has revealed information that is of value in directing oral health education messages, oral health promotion programmes and has identified issues that potentially affect compliance with toothbrushing that merit further investigation.

Wednesday, February 24, 2010

Institute of Medicine (IOM) to exclude private practice dentists from two panels

Dear Members,

The American Dental Association is very concerned over a recent decision by the Institute of Medicine (IOM) to exclude private practice dentists from two panels it is convening to study oral health care delivery in the United States.

At the behest of the U.S. Department of Health and Human Services, IOM will begin studies (one on a national oral health initiative and one on access to services) in March. These studies could help drive national policies on improving access to oral health care.

ADA leaders met Friday with IOM representatives, including Tracy Harris, the director of the studies, to discuss the aims and makeup of the panels. We made it clear that the ADA supports the IOM's efforts to examine access issues in general and that we wish to work positively with the IOM as they conduct the studies. We stressed that including private practice dentists on both panels was essential if the reports were to have any credibility with the practicing dentists who ultimately deliver the vast majority of care. Also, IOM representatives were informed that the ADA accumulates vast amounts of data, some published, some not on both the public and private delivery systems that the IOM may find quite useful in their study. The IOM emphasized that both committees will be impartially evaluating published data in order to reach their conclusions. However, we urged the IOM to include private practice dentists on the panels, as they will be deeply involved in the implementation of any IOM recommendations.

Ms. Harris offered the ADA and the American Dental Education Association the opportunity to meet with the president of IOM to further discuss the two studies. Staff in the Washington Office is pursuing this meeting and writing a formal letter to the panels asking them to reconsider the membership composition of the panels. I will keep you abreast of developments.

Below are links to the two IOM studies. Within these links, you have the opportunity to email comments to IOM about the need to include the private practicing perspective on both committees.

Study on an Oral Health Initiative

Study on Oral Health Access to Services


Ronald L. Tankersley, D.D.S.

Tuesday, February 23, 2010

Oral health coordinators in long-term care—a pilot study

Special Care in Dentistry

Published Online: 16 Feb 2010

Gilda J. Pronych, DDS, FAGD ; Elizabeth J. Brown, RDH, MS ; Karen Horsch, MEd ; Karen Mercer, RDH, MPH


This pilot project tested a curricular and systems approach to improving the oral health care of nursing home residents in three facilities in New Hampshire. An oral health coordinator (OHC) was appointed in each facility to act as a liaison between nursing and dental staff, provide resources for nursing assistants, and ensure staff delivery of residents' daily oral care. During the study, residents' oral health status was assessed at four intervals and ongoing training was provided to nursing staff. At the conclusion of the pilot study, an evaluation of the results indicated an improvement in oral hygiene in all facilities. The role of the OHC showed promise when that person was active in holding nursing staff accountable for daily oral care of the residents.

Monday, February 22, 2010

Oral sex-related cancer hits an all-time high

A dental charity is hammering home its call on the government to include boys in a planned vaccination programme to guard against the sexually transmitted HPV virus.

The cancer virus is transmitted through oral sex, and is thought to contribute to the doubling of mouth cancers.

The British Dental Health Foundation's demand is in response to a recent large-scale study in the US of 46,000 mouth cancer cases.

It found that the number of deaths caused by the sexually transmitted HPV virus has increased by a third in the last 30 years and is now the highest it has ever been.

The DoH has already agreed to introduce the HPV vaccine for all 12 and 13-year-old girls, which was rolled out in September 2008 and aims to guard against cervical cancer in the future.

Dr Nigel Carter, chief executive of the Foundation, said: ‘It is admirable that the government is taking such positive steps to reduce the number of cervical cancer cases for the women of the future but, with mouth cancer killing more people than cervical cancer and testicular cancer combined, it is clear that this little-known condition also needs to be addressed.

‘By expanding its HPV vaccination programme to include boys as well as girls, the government would be able to address the problem of rising HPV-related mouth cancer deaths in a simple, fair and effective manner.

‘With young people becoming progressively more sexually active this problem is not going to go away.

‘It needs to be addressed and sooner rather than later.'

Mouth cancer kills one person every five hours in the UK and affecting more men than women.

‘People need to take steps to reduce their risk of developing the condition; whether that be by cutting out smoking, by reducing their alcohol consumption or by taking a HPV test along with their partner,' said Dr Carter.

Saturday, February 20, 2010

Velscope Screening Olympic Athletes

LED DENTAL INC in White Rock, British Columbia, Canada reported that its VELscope Oral Cancer Screening System is being used to screen around 800 Olympic athletes for oral cancer in Vancouver.

Friday, February 19, 2010

GlaxoSmithKline announced today that it will stop selling three versions of Poligrip because of concerns about health risks.

February 18, 2010

Dear Dental Professional:

Since there is much news coverage about today's GlaxoSmithKline announcement, we wanted to make you aware of this news, as it may result in questions from your patients, your colleagues or members of the media in your area.

According to GlaxoSmithKline Consumer Healthcare, this action affects three Poligrip products: Super Poligrip Original, Ultra Fresh and Extra Care. GlaxoSmithKline says it will remove zinc from its denture cream, following reports that excessive use has caused neurological damage and blood problems in consumers.

The company said it plans to reformulate the product without zinc, and that the words "Zinc Free" will appear on the new packaging. In a consumer advisory on its Web site, the company said it had "become aware of potential health problems associated with the long-term excessive use of our zinc-containing denture adhesive products." To download a copy of the complete advisory, please click here (168kb PDF).

Glaxo's voluntary action follows dozens of lawsuits filed against the company alleging Poligrip caused nerve damage, resulting in symptoms such as weakness and numbness, as well as blood problems like anemia. The company says its products are safe when used as directed, but some consumers use the cream excessively to help make their dentures fit.

Thursday, February 18, 2010

In vitro analysis of human tooth pulp chamber temperature after low-intensity laser therapy at different power outputs

Laerers In Medical Science
February 11, 2010

Márcio de Alencar Mollo, Lucio Frigo, Giovani Marino Favero, Rodrigo Álvaro Brandão Lopes-Martins and Aldo Brugnera Junior

Published online: 11 February 2010

Abstract In vitro studies have provided conflicting evidence of temperature changes in the tooth pulp chamber after low-level laser irradiation of the tooth surface. The present study was an in vitro evaluation of temperature increases in the human tooth pulp chamber after diode laser irradiation (GaAlAs, λ = 808 nm) using different power densities. Twelve human teeth (three incisors, three canines, three premolars and three molars) were sectioned in the cervical third of the root and enlarged for the introduction of a thermocouple into the pulp chamber. The teeth were irradiated with 417 mW, 207 mW and 78 mW power outputs for 30 s on the vestibular surface approximately 2 mm from the cervical line of the crown. The highest average increase in temperature (5.6°C) was observed in incisors irradiated with 417 mW. None of the teeth (incisors, canines, premolars or molars) irradiated with 207 mW showed temperature increases higher than 5.5°C that could potentially be harmful to pulp tissue. Teeth irradiated with 78 mW showed lower temperature increases. The study showed that diode laser irradiation with a wavelength of 808 nm at 417 mW power output increased the pulp chamber temperature of certain groups of teeth, especially incisors and premolars, to critical threshold values for the dental pulp (5.5°C). Thus, this study serves as a warning to clinicians that “more” is not necessarily “better”.

Tuesday, February 16, 2010

New DNA therapy for advanced mouth cancer

Author: staff

A research team has been awarded a patent after developing a new DNA therapy for head and neck cancer sufferers. Researchers from the University of Pittsburgh School of Medicine in the US, aims to develop a safe and effective alternative to standard chemotherapy treatments which cause debilitating side-effects.

Based on a form of genetic therapy called ‘antisense’, the new DNA therapy injections target the epidermal growth factor receptor (EGFR), blocking the growth of a protein which is found on the surface of many types of cancer cells.

During the initial Cancer Institute study, led by Dr Jennifer Grandis, the injections were well-tolerated, and the tumours which were being targeted by the treatment disappeared or shrank considerably in more than a quarter of the patients.

The British Dental Health Foundation has welcomed the latest development in treating this deadly disease. Chief executive Dr Nigel Carter said: ‘These new findings show that this new DNA therapy can have the potential as both a safe and effective advanced cancer treatment.

One of the major problems with mouth cancer is that it often presents in late stages, significantly reducing survival – so a late stage treatment is particularly welcome.

‘Head and neck cancers have a strong association with environmental and lifestyle risk factors including smoking tobacco, alcohol consumption and the sexually transmitted human papilloma virus (HPV).

‘Research has recently suggested that the HPV virus, transmitted via oral sex, could soon become the most common cause of mouth cancer.’ Cancers caused by viral infections can also be prevented by making positive lifestyle changes to reduce these risks.

World Cancer Day was marked around the globe yesterday (Thursday 4 February) in an effort to highlight the link between infections and cancer.

Dr Carter said: ‘Thirty per cent of mouth cancer cases have been linked to a poor diet. Eating a balanced diet with plenty of fruit and vegetables, quitting smoking and cutting down on alcohol consumption lowers the risk of mouth cancer.’

The British Dental Health Foundation’s Mouth Cancer Action Month campaign, which runs each November in the UK with the message of ‘If In Doubt, Get Checked Out’, stresses the importance of following this advice by undertaking regular dental visits and self-examination.

Case study of linking dental and medical healthcare records

Am J Manag Care. 2010 Feb 1;16(2):e51-6.

Case study of linking dental and medical healthcare records.

Theis MK, Reid RJ, Chaudhari M, Newton KM, Spangler L, Grossman DC, Inge RE.

Group Health Center for Health Studies, 1730 Minor Ave, Ste 1600, Seattle, WA 98101. E-mail:

OBJECTIVE: To link the administrative data of a large dental carrier and an integrated health plan in Washington State to conduct an observational study of diabetes and periodontal disease. STUDY DESIGN: Evaluation of variable suitability, testing of linkage variables, and performing an n - 1 deterministic linkage strategy. METHODS: We examined a variety of administrative data variables for their consistency over time and their information richness to use as matching variables. After choosing social security number, date of birth, first name, and last name, we tested their reliability as linking variables among a population with dual dental and medical insurance. Lastly, we performed four n - 1 deterministic linkage steps to obtain our study population. RESULTS: With a success match rate of more than 96% with the 4 test variables, we extracted the entire population who met the study criteria with the understanding that only a subset would successfully link. We linked 78,230 individuals (55.2% of the Group Health Cooperative population). Of these matches more than 50% occurred within a last name-first name-birth date deterministic match. CONCLUSIONS: Employer groups who provide dental-medical benefits for their employees send identical administrative data to dental and healthcare plans. The n - 1 deterministic linkage was accomplished by using a relatively straightforward approach because these data were fairly homogeneous and of high quality. Until medical care and dental care are integrated, it is possible to link these data to assess the impact of oral disease on overall health.

Monday, February 15, 2010

SoundBite: Hearing Aid on Your Teeth

SoundBite hearing system is the world’s first and only non-surgical and removable hearing solution designed to imperceptibly transmit sound via the teeth to help people who are essentially deaf in one ear regain spatial hearing ability and rejoin the conversation of life. It employs a well-established principle called bone conduction to deliver clear, high quality sound to the inner ear. Nearly invisible when worn, the SoundBite system consists of an easy to insert and remove ITM (in-the-mouth) hearing device – which is custom made to fit around either the upper left or right back teeth – and a small microphone unit worn behind the ear. No modifications to the teeth are required.

Sunday, February 14, 2010

Deformation of Stereolithographically Produced Surgical Guides: An Observational Case Series Report

Deformation of Stereolithographically Produced Surgical Guides: An Observational Case Series Report

Clinical Implant Dentistry and Related Research

Published Online: 11 Feb 2010

Lambert J. Stumpel, DDS
Private practice, 450 Sutter Street, Suite 2530, San Francisco, CA 94108

This material was partially presented at the 2009 San Diego, CA, annual meeting of the Academy of Osseointegration.


Background: Template-based computer-guided implant placement holds the promise of more precise and less traumatic placement of dental implants. Errors in the fabrication process of the surgical guide may lead to unfavorable clinical outcomes.

Purpose: This report discusses the potential of unintentional volumetric deformation of stereolithographically (SLA) produced surgical guides (NobelGuide, Nobel Biocare AB, Göteborg, Sweden) compared with the original scan denture.

Materials and Methods: Three-dimensional radiographic data acquired by medical computerized tomography (CT) or cone beam CT (Newtom 3G, AFP Imaging Corporation, Elmsford, NY, USA) can be utilized in specialized software to develop treatment planning for dental implant placement.

This information can then be transferred to the patient via a surgical guide. Stereolithography is a rapid prototyping process that can be used to create such a guide stent. Three cases are shown describing different levels of deformation of SLA-produced surgical guides.

Results: Unintentional deformation of SLA-produced surgical guides is possible. Deformation of surgical guides can create dissimilarity between the virtually planned position and the actual position of the implants.

Conclusion: Incorrect setting of the ISO values for the segmentation of the scan denture has been found to be a factor in the deformation of SLA-produced surgical guides, although more, at this time known but also less understood, issues appear to be involved. Only one manufacturer's product is discussed; further research is warranted to determine if the discrepancies are process or product based. It might be prudent to closely evaluate the volumetric congruence of SLA-produced surgical stents before their clinical use to prevent undesired clinical outcomes.

Saturday, February 13, 2010

Dentinogenic potential of the dental pulp: facts and hypotheses

Endodontic Topics

Volume 17 Issue 1, Pages 42 - 64

Published Online: 4 Feb 2010



The aim of the present article is to discuss observations and hypotheses from different experimental approaches on the biological mechanisms underlying initiation of tertiary dentin formation and therapeutic control of pulp–dentinal regeneration. The specific dentinogenic potential of dental pulp cells in up-regulating the biosynthetic activity of primary odontoblasts (reactionary dentinogenesis) and differentiation into odontoblast-like cells (reparative dentinogenesis) is described. The role of biologically active matrices and molecules as signaling factors in the expression of the dentinogenic potential of dental pulp cells, in numerous ex vivo and in vivo models, is reviewed. Data are focused on the mechanisms by which the signaling molecules, in the presence of the appropriate pulp microenvironment and specific mechanical support, can induce competent pulpal cells in the acquisition of odontoblast-like cell phenotype and reparative dentin formation. The ability of tissue engineering to stimulate reconstruction of the amputated pulp–dentin complex offers exciting opportunities for the future. Advances in molecular biology and bioengineering research might thus be integrated into the clinical problems of endodontology.
Received 13 February 2009; accepted 2 September 2009.

Friday, February 12, 2010

Safer Hip, Knee And Dental Implants With Smart Coating

Researchers at North Carolina State University have developed a "smart coating" that helps surgical implants bond more closely with bone and ward off infection.

When patients have hip, knee or dental replacement surgery, they run the risk of having their bodies reject the implant. But the smart coating developed at NC State mitigates that risk by fostering bone growth into the implant. The coating creates a crystalline layer next to the implant, and a mostly amorphous outer layer that touches the surrounding bone. The amorphous layer dissolves over time, releasing calcium and phosphate, which encourages bone growth.

"The bone grows into the coating as the amorphous layer dissolves, resulting in improved bonding, or osseointegration," says Dr. Afsaneh Rabiei, an NC State associate professor of mechanical and aerospace engineering, associate faculty member of biomedical engineering and co-author of a paper describing the research. This bonding also makes the implant more functional, because the bonding helps ensure that the bone and the implant do a better job of sharing the load.

"We call it a smart coating because we can tailor the rate at which the amorphous layer dissolves to match the bone growth rate of each patient," Rabiei says. This is important because people have very different rates of bone growth. For example, young people's bones tend to grow far faster than the bones of older adults.

The researchers have also incorporated silver nanoparticles throughout the coating to ward off infections. Currently, implant patients are subjected to an intense regimen of antibiotics to prevent infection immediately following surgery. However, the site of the implant will always remain vulnerable to infection. But by incorporating silver into the coating, the silver particles will act as antimicrobial agents as the amorphous layer dissolves, Rabiei says. This will not only limit the amount of antibiotics patients will need following surgery, but will provide protection from infection at the implant site for the life of the implant. Moreover, the silver is released more quickly right after surgery, when there is more risk of infection, due to the faster dissolution of the amorphous layer of the coating. Silver release will slow down while the patient is healing. "That is another reason why we call it smart coating," Rabiei says.

The research was funded by the National Science Foundation, and was accomplished with assistance from the Center for Nanophase Materials Sciences and Shared Research Equipment User Facilities at Oak Ridge National Laboratory.

The research, "Functionally graded hydroxyapatite coatings doped with antibacterial components," was co-authored by Rabiei, former NC State Ph.D. student Xiao Bai, and Oak Ridge National Laboratory researchers Karren More and Christopher Rouleau. The research is published online by Acta BioMaterialia.

The study abstract follows.

"Functionally graded hydroxyapatite coatings doped with antibacterial components"

Authors: Xiao Bai, Afsaneh Rabiei, North Carolina State University; Karren More, Christopher M. Rouleau, Oak Ridge National Laboratory

Published: Online January 2010, Acta BioMaterialia

Abstract: A series of functionally graded hydroxyapatite (FGHA) coatings incorporated with various percentages of silver were deposited on titanium substrates using ion beam-assisted deposition. The analysis of the coating's cross-section using transmission electron microscopy (TEM) and scanning transmission electron microscopy equipped with energy dispersive X-ray spectroscopy has shown a decreased crystallinity as well as a distribution of nanoscale (10-50 nm) silver particles from the coating/substrate interface to top surface. Both X-ray diffraction and fast Fourier transforms on high-resolution TEM images revealed the presence of hydroxyapatite within the coatings. The amount of Ag (wt.%) on the outer surface of the FGHA, as determined from X-ray photoelectron spectroscopy, ranged from 1.09 to 6.59, which was about half of the average Ag wt.% incorporated in the entire coating. Average adhesion strengths evaluated by pull-off tests were in the range of 83 ± 6 to 88 ± 3 MPa, which is comparable to 85 MPa for FGHA without silver. Further optical observations of failed areas illustrated that the dominant failure mechanism was epoxy failure, and FGHA coating delamination was not observed.

Thursday, February 11, 2010

If Parents Visit The Dentist, Children Probably Will, Too

Are studies really necessary for somethings? MJ

Dental caries is one of the most prevalent chronic diseases of childhood in the U.S., yet more than half of children don't see a dentist on an annual basis. A new study suggests programs trying to improve access to dentists for children should also target their parents' use of dental services. In the study, "Association Between Parents' and Children's Use of Oral Health Services," published in the March issue of Pediatrics (appearing online Feb. 1), children were more likely to have visited a dentist in the previous 12 months when their parents also had a dental visit. Of 6,107 child-parent pairs, 77 percent of children and 64 percent of parents had a dental visit in the previous 12 months.

Among parents who had seen a dentist, 85 percent of their children also had a dental visit. Among parents who had not seen a dentist, 62 percent of their children had a dental visit. Children whose dental care was deferred due to cost were more likely to have parents whose dental care was deferred for the same reason. Researchers suggest parental oral health behaviors have an important impact on their children, and that comprehensive strategies to enhance awareness of the importance of oral health and to eliminate financial barriers could improve children's oral health.

Wednesday, February 10, 2010

Survey of United States dental schools on cementation protocols for implant crown restorations

Journal of Prosthetic Dentistry
Volume 103, Issue 2, Pages 68-79 (February 2010)
Diane Yoshinobu Tarica, DDS, Veronica M. Alvarado, DDS, Samantha T. Truong, DDS
Statement of problem

With conflicting results in the literature and various manufacturer recommendations, it is not known what cementation protocols are currently being used for implant restorations in US dental schools.


The purpose of this survey was to determine what dental cementation protocols are taught and recommended by 62 US dental schools and postgraduate programs.

Material and methods

From February to September 2008, 96 questionnaires consisting of 8 questions were sent to the chairperson or director of restorative departments, advanced prosthodontics programs, and implant programs. The questionnaire asked recipients which implant manufacturers provided the products used at their dental schools. Additionally, recipients were queried as to the choice of material and techniques for abutment and restoration preparations prior to definitive cementation. Data were analyzed with descriptive statistics.


A total of 68 (71%) surveys were returned, and 52 (84%) of the 62 predoctoral and postgraduate programs were represented. After deleting duplicate responses, 31 surveys were returned from restorative department chairpersons, 29 from advanced prosthodontic program directors, and 2 from implant program directors. Frequency of responses to each question was tabulated, and results are presented in 3 sections. For all 3 types of programs, Nobel Biocare was reported to be the most widely used implant system, followed by Biomet 3i, Straumann, Astra Tech, and Zimmer Dental systems. The most commonly used technique prior to definitive cementation is to airborne-particle abrade the intaglio surface of the restoration. Resin-modified glass ionomer is the most frequently used luting agent for cementing implant restorations. The 5 most commonly used materials to fill screw access openings are cotton pellets, composite resin, rubber-based material, gutta-percha, and light-polymerized provisional composite resin. Most predoctoral and postgraduate programs teach students to fill the screw access opening completely to the occlusal surface.


There are a wide range of implant cementation protocols and materials used; however, some common trends were identified among predoctoral and postgraduate programs.

Tuesday, February 09, 2010

The expert's guide to healthy teeth

Dental surgeon Lance Knight recommends products for healthy teeth...

If a crown or filling falls out, make a temporary plug to prevent pain and sensitivity by chewing a piece of sugar-free gum and then gently nudging it into the space.

You could also try Toofy Peg, an over-the-counter product that does the same job.

  • Choose a waxed dental floss such as Colgate Total, which has been impregnated with an antibacterial substance called chlorhexidine. This will kill any bugs tha thave settled between the teeth. (Waxed floss makes it easier to slide between the teeth.)
  • It's also worth keeping some mouthwash containing chlorhexidine in the cupboard if you cut your gum or have a mouth ulcer, as it'll speed up the healing process. But don't use it every day - it can dissolve teeth if used too often and cause staining. For an everyday regular mouthwash, choose something that is fluoridated but non-alcoholic, such as Colgate Fluorigard Alcohol Free Mouthwash.
  • Invest in a tongue scraper and use twice daily to remove bacteria that causes bad breath. Choose one that doesn't feel too abrasive or too soft such as the OraSweet Tongue Cleaner.
  • If food gets stuck between the gaps in your teeth, get an interdental brush. TePe makes a range of them and your hygienist will be able to recommend the size to buy. Never use a toothpick, as you run the risk of cutting your gum, which can be sore and lead to infection.

Monday, February 08, 2010

Join me and learn about Kerr's new Vertise Flow composite

enter classroom Simplifying Restorative Dentistry Using Self Adhesive Flowable Composites
Presenter: Dr. Martin Jablow CE Credits: 1
Webcast Begins: 2/10/10 7:00 PM ET, 4:00 PM PT

Learn how to use this new composite technology in your office. As every dental practitioner knows, time is valuable and the use of self adhesive composites combines the benefits of adhesive and restorative technology into one product. Learn about the varied procedures that self adhesive flowable composites can be used for thus reducing the time the patient spends in the dental chair.

Click here to register

Saturday, February 06, 2010

Most people think of a career in the medical field as being a doctor or a nurse. However, while these jobs are certainly important, there are plenty of other jobs available in the medical field that can provide you with a career that is fulfilling and interesting. A number of jobs also require less education than becoming a doctor or nurse, while at the same time allowing you to make a difference in others’ lives. Here are 50 medical blogs that can help you learn about every medical career.

Go check it out on Online LPN to RN

Friday, February 05, 2010

Relationship between the size of patency file and apical extrusion of sodium hypochlorite

Indian Journal of Dental Research
Year : 2009 | Volume : 20 | Issue : 4 | Page : 426-430

Background: Sodium hypochlorite (NaOCl) is the most widely used endodontic irrigant because of its excellent antimicrobial, organic tissue dissolving, and lubricating properties. However, it is highly cytotoxic to the periapical tissues.
This study evaluated in vitro the extrusion of 5.25% NaOCl through the apical foramina of mesiobuccal (MB) root canals of maxillary first molars in two experimental conditions: Before apical debridement and after apical debridement with different instrument sizes to ensure direct access to the apical foramen (apical patency).
Materials and Methods: Coronal accesses were prepared in 17 teeth and the apical foramina of the distobuccal and palatal root canals were sealed. The teeth were held in acrylic receptacles with the roots turned upwards to reproduce their position in the maxillary dental arch. The receptacles were filled with a starch/KI solution (a reagent that changes its color to blue after contacting NaOCl) covering the roots. The experiment had two phases: P1: Irrigation of the MB canals with 5.25% NaOCl without previous establishment of apical patency; P2: Canal irrigation after use of size 10 K-file and size 15 Flexofile as patency files. Only specimens with no NaOCl extrusion in P1 were assigned to P2. NaOCl was delivered pressureless at the canal entrance. The moment that the starch/KI solution contacted NaOCl was captured on digital photographs.
Results and Conclusions: There was no NaOCl extrusion in nine specimens in P1, but all of these teeth had irrigant extrusion in P2. The 5.25% NaOCl used as an endodontic irrigant showed great capacity to extrude beyond both intact and small-sized apical foramina of MB root canals of maxillary first molars.

Thursday, February 04, 2010

Tooth regeneration: Current status

Dadu SS. Tooth regeneration: Current status. Indian J Dent Res [serial online] 2009 [cited 2010 Jan 30];20:506-7. Available from:

Regeneration of a functional tooth has the potential to be a promising therapeutic strategy. Experiments have shown that with the use of principles of bioengineering along with adult stem cells, scaffold material, and signaling molecules, tooth regeneration is possible. Research work is in progress on creating a viable bioroot with all its support. A new culture needs to be created that can possibly provide all the nutrients to the stem cells. With the ongoing research, tissue engineering is likely to revolutionize dental health and well-being of people by regenerating teeth over the next decade.

Tooth loss, commonly seen due to a variety of oral diseases and physiological causes, leads to physical and mental suffering that markedly lower an individual's quality of life. Presence of teeth also helps to prevent dementia as mastication stimulates the brain. [1]

Dentistry has taken the same approach to tooth decay-filling cavities-for decades, but new techniques for rebuilding teeth from inside out could transform the profession over the next decade. [2] Although dental implant therapies have achieved long-term success in the clinic for the recovery of tooth function, dental implants require preexisting high quality bone structures for supporting the implants. Reconstruction of teeth in patients without adequate bone support would be a major advance. [3] Regeneration of a functional and living tooth is one of the most promising therapeutic strategies for the replacement of a diseased or damaged tooth.

Gradually, there seems to be greater convergence between clinical dentistry and bioengineering with which it is possible to regenerate tooth in humans in the near future.

Now the question arises whether the techniques presently available are sufficient to design and fabricate tooth for replacement in clinical dentistry? The present article reviews current research into tooth regeneration.

Techniques of Tooth Regeneration Top

Currently, there are two major approaches to tooth regeneration: [1]

  1. The first is based on tissue engineering involving regeneration of tooth by implanting cells on scaffolding biomaterials.
  2. The second approach involves reproducing the developmental processes of embryonic tooth formation.

Tissue regeneration using tissue engineering

Tissue engineering, according to National Institute of Health definition, is an emerging multidisciplinary field involving biology, medicine, and engineering that is likely to revolutionize the way we improve the health and quality of life for millions of people worldwide by restoring, maintaining, or enhancing tissue and organ function, [2] Tissue engineering requires a combination of cells, biodegradable materials, and signaling molecules. This technique has already been applied to the regeneration of the periodontium.

Yelick's group have used dental epithelial and pulpal mesenchymal tissues and seeded the mixture of heterogeneous single cells onto a tooth-shaped biodegradable polymer scaffold, mainly consisting of polyglycolic acid and polycoglycolide copolymer [4] The cell-scaffold constructs were implanted into the body of animal host to receive sufficient blood supply, nutrients, and oxygen. By 25-30 weeks after implantation, tiny tooth-like tissues (such as enamel, dentin, and pulp) were observed within the implants, which resembled the crowns of natural teeth. [4] Although most dental tissues are regenerated using a combination of scaffold materials and dissociated single cells, the success rate for achieving the correct arrangement of a natural tooth is only 15-20%. Further studies are, therefore, required to consistently achieve reconstituted and structurally sound teeth.

Tooth regeneration by reproducing developmental process of tooth formation

This requires an understanding of the basic principles that regulate early tooth development. The natural processes involved in embryonic tooth development were replicated by Sharpe's group. [5] They have placed nondental mesenchymal cells, rather than dental mesenchymal cells (adult bone marrow stromal cell), in contact with embryonic oral epithelium and cultured it for 12 days. The explants containing adult bone marrow stromal cells formed a tooth crown structure comprising enamel; dentin and pulp in few cases, while explants derived from embryonic stem cells or neural stem cells did not form teeth, and only expressed odontogenesis-related genes. These results suggest that stem cells derived from adult bone marrow can take the place of dental mesenchyme for future clinical use, however, no suitable source of epithelial components has yet been found to replace the embryonic oral epithelium.

Hu B et al. have shown that, under experimental conditions, bone marrow cells can give rise to ameloblast-like cells that form enamel [5] , while Sharpe's group reported that bone marrow cells possess the potential to differentiate into dental mesenchymal cells forming dentin and pulp. [6]

These approaches to tooth reconstitution using developing tissues are far from ready for patient application because it would be impractical to use human embryonic tissue. Strategic improvements are also needed prior to clinical application to prevent immune rejection and to overcome ethical issues. [1]

Root generation

Current understanding of the cellular and molecular mechanisms of tooth root development is still in its infancy, although a number of genes involved in tooth crown development have been identified. From a clinical perspective, the most important part of the tooth is the root that supports the crown. Recent technological advances have made possible regeneration of murine tooth, encouraging efforts to regenerate whole human teeth. [3] However, human tooth root development that involves dentin formation, cementum generation, instruction of epithelium, and tooth eruption is a far more complex process which may not be possible with presently available biotechnologies. [3]

Stem cell-mediated root regeneration offers opportunities to regenerate a bioroot and its associated periodontal tissues, which are necessary for maintaining the physiological function of teeth. Sonoyama et al. have explored the potential for reconstructing a functional tooth in miniature pigs in which a bio-root periodontal complex is built up by postnatal stem cells including stem cells from root apical papilla and periodontal ligament stem cells to which an artificial porcelain crown is affixed. This hybrid strategy of autologous dental stem cell engineering may be applicable to human tooth root regeneration. [3]

Limitations in Tooth Regeneration Research Top

Even though biotechnology has lead us to regenerate the various components of the tooth, there are certain limitations, which are listed below as suggested by Nakahara and Ide. [1]

  1. Whether the principles of tissue engineering related to tooth regeneration can mimic correct tooth morphology?
  2. Though adult bone marrow cells can replace dental mesenchymal cells, there is no suitable substitute for the embryonic oral epithelium which has a unique set of signals for odontogenesis.
  3. At present there is no embryonic environment that enables bone marrow cells to differentiate into tooth germ cells.
  4. There is concern over host immune rejection and ethical issue on use of human embryo.

Conclusion Top

Using the principles of bioengineering, tooth regeneration is going to become a realistic possibility within the next few decades.

References Top

1.Nakahara T, Ide Y. Tooth regeneration: implications for the use of bioengineered organs in first wave organ replacement. Hum Cell 2007;20:63-70. Back to cited text no.  1 [PUBMED] [FULLTEXT]
2.Taba M Jr, Jin Q, Sugai JV, Giannobile WV. Current concepts in periodontal bioengineering. Orthod Craniofac Res 2005;8:292-302. Back to cited text no.  2 [PUBMED] [FULLTEXT]
3.Sonoyama W, Liu Y, Fang D, Yamaza T, Seo BM, Zhang C, et al. Mesenchymal stem cell-mediated functional tooth regeneration in swine. PLoS ONE 2006;1:e79. Back to cited text no.  3 [PUBMED] [FULLTEXT]
4.Young CS, Terada S, Vacanti JP, Honda M, Bartlett JD, Yelick PC. Tissue engineering of complex tooth structures on biodegradable polymer scaffolds. J Dent Res 2002;81:695-700. Back to cited text no.  4 [PUBMED] [FULLTEXT]
5.Hu B, Unda F, Bopp-Kuchler S, Jimenez L, Wang XJ, Haïkel Y, et al. Bone marrow cells can give rise to ameloblast-like cells. J Dent Res 2006; 85: 416-21. Back to cited text no.  5
6.Ohazama A, Modino SA, Miletich I, Sharpe PT. Stem-cell based tissue engineering of murine teeth. J Dent Res 2004;83:518-22. Back to cited text no.  6 [PUBMED] [FULLTEXT]

Tuesday, February 02, 2010

Congratulation Paul Feuerstein

Congratulations to my friend and lecture partner Paul Feuerstein on being named

Clinician of The Year 2010 at Yankee Dental Congress.

Way To Go Paul!!!!

Monday, February 01, 2010

The Chemical Forms of Mercury in Aged and Fresh Dental Amalgam Surfaces

Mercury-containing dental amalgam is known to be a source of human exposure to mercury. We have explored the use of electron yield Hg LIII X-ray absorption spectroscopy to characterize the chemical nature of dental amalgam surfaces. We find that the method is practical and that it shows extensive mercury depletion in the surface of the aged amalgam with significant differences between old and fresh amalgam surfaces. Whereas the fresh amalgam gives spectra that are typical of metallic mercury, the aged amalgam is predominantly β-mercuric sulfide. The toxicological implications of these results are discussed.

Read the article in Chemical Research In Toxicology