Monday, December 31, 2012

Reduction in bacterial counts in infected root canals after rotary or hand nickel‐titanium instrumentation: a clinical study

International Endodontic Journal



To compare the antibacterial efficacy of two instrumentation techniques, one using hand nickel-titanium (NiTi) instruments and the other using rotary NiTi instruments, in root canals of teeth with apical periodontitis.


Root canals from single-rooted teeth were instrumented using either hand NiTi instruments in the alternated rotation motion technique or rotary BioRaCe instruments. The irrigant used in both groups was 2.5% NaOCl. DNA extracts from samples taken before and after instrumentation were subjected to quantitative analysis by real-time polymerase chain reaction (qPCR). Qualitative analysis was also performed using presence/absence data from culture and qPCR assays.


Bacteria were detected in all S1 samples by both methods. In culture analysis, 45% and 35% of the canals were still positive for bacterial presence after hand and rotary NiTi instrumentation, respectively (p>0.05). Rotary NiTi instrumentation resulted in significantly fewer qPCR positive cases (60%) than hand NiTi instrumentation (95%) (p=0.01). Intergroup comparison of quantitative data showed no significant difference between the two techniques.


There was no significant difference in bacterial reduction in infected canals after instrumentation using hand or rotary NiTi instruments. In terms of incidence of positive results for bacteria, culture also showed no significant differences between the groups, but the rotary NiTi instrumentation resulted in more negative results in the more sensitive qPCR analysis.

Saturday, December 29, 2012

Oral contraceptives and the periodontium

Periodontology 2000
Volume 61, Issue 1, pages 125–159, January 2013



Oral contraceptives are a safe and effective means of contraception for millions of women worldwide. The first formulations of these drugs contained much higher doses of estrogens and progestins than those available today, and these were associated with an unacceptably high rate of unwanted effects including serious cardiovascular events. In addition, a number of case reports and clinical studies suggested that use of the first generation oral contraceptives was also associated with an increased risk for gingival and/or periodontal disease. Unfortunately, many of these early studies suffered from significant methodological flaws which throw their findings into question. Nonetheless, these studies provided the basis for a perception among the dental profession that oral contraceptives increase the risk for gingivitis and/or periodontitis. Realisation that the adverse events profile of oral contraceptives was dose dependant led to the development of the modern low dose formulations that are in use today. There have been far fewer studies to investigate whether modern oral contraceptives have any impact on the periodontium compared to studies of the early contraceptive formulations, but the quality of the more recent research is undoubtedly better. Following extensive review of the relevant literature and consideration of the historical perspective, the best available evidence strongly supports that oral contraceptives no longer place users at any increased risk for gingivitis or periodontitis. Oral contraceptives should not be viewed as a risk factor for gingival or periodontal disease.

Friday, December 28, 2012

CAESY Cloud 1.3 Adds Smile Channel Content, Search Features

Version 1.3 offers redesigned interface, tag filtering, playlist options and more

ST. PAUL, Minn. – (December 12, 2012) – Patterson Dental Supply, Inc. announces new updates to CAESY Cloud, its online patient education portal. Practices around the country have already experienced the convenience of accessing CAESY Patient Education multimedia presentations via the Cloud, and now CAESY Cloud version 1.3 offers improved functionality and presentation updates. New features include Smile Channel content, multiple new and updated videos, and improved search functionality – all available via fast, convenient Cloud delivery.

For the first time, Smile Channel content has been added to CAESY Cloud, and most Smile Channel presentations are available in high definition for optimal patient viewing. Smile Channel presentations provide engaging programming for the reception area that entertains and educates patients while subtly promoting discretionary services unique to each practice.

In addition to the new Smile Channel offering, a number of other features have been added to make CAESY Cloud even easier to navigate and run on PC and Mac desktop computers, Smartphones, as well as the iPad, iPhone and iPod. The interface has been completely redesigned to support mobile, tablet and desktop browsers. Additionally, videos now include more descriptive titles and explanations, making it simple to confirm the proper content is being shown during an appointment. A tag filtering feature and new search functionality make it easier to quickly find appropriate content, and dental professionals will now be able to create playlists that play a number of videos sequentially.
CAESY Cloud continues to add new content to stay on the cutting edge of dentistry. The latest additions include a new TMD section in high definition, which features the presentations “Orofacial Myofunctional Therapy,” and “What is a T-Scan?” Updated presentations include information on diagnosing neuromuscular problems and treatment, the equilibration procedure, diagnosing bruxism, and more. 
Launched in July 2011, CAESY Cloud currently offers more than 350 multimedia presentations that dental offices can access on multiple devices. CAESY Cloud requires no installation and no network connections between participating devices. All that is needed to access CAESY Cloud is a standard Internet connection. Dental professionals can simply sign up for the service by visiting and gain access to the presentations for immediate use from anywhere. After subscribing, users can visit the website to access the full library of CAESY’s robust patient education presentations. A low monthly subscription fee makes CAESY Cloud available to dental practices with little initial investment.

CAESY Education Systems has been dentistry’s premier developer of leading-edge patient education technology and content since 1993. Patterson Dental Supply, Inc. acquired CAESY in May 2004. The award winning multimedia information on preventive, restorative and esthetic treatment options helps dental practices worldwide educate their patients and grow their practices. The CAESY content is distributed via video and computer networks, DVD players and the Cloud throughout the clinical and reception areas of the dental practice. The family of products includes CAESY Cloud, CAESY DVD, Smile Channel DVD, and CAESY Enterprise, which includes CAESY, Smile Channel and ShowCase. For more information, visit

Thursday, December 27, 2012

ClearCorrect Announces New $395 and Unlimited Treatment Options for 2013

HOUSTON, Texas—ClearCorrect, a leading manufacturer of clear aligners, recently announced new treatment options, available starting January 1, 2013. Refined based on doctor feedback, these new options will provide the greatest combination of affordability, flexibility, and predictability ever offered for clear aligners.

The new treatment options include:

Limited 6 — $395

The new Limited 6 will be the most affordable clear aligner treatment option in the industry. It’s ideal for simple anterior adjustments. The $395 lab fee covers up to 6 sets of clear aligners (single or dual arch). Like all ClearCorrect cases, it also includes a treatment setup, Phase Zero (initial passive aligners), and retainers. That's more aligners than the competition, offered at a lower price. $395 is not a limited-time promotion—it's the everyday lab fee. 

Limited 12 — $695

This includes up to 12 steps of clear aligners, plus a treatment setup, Phase Zero, and retainers. There’s no fee for revisions, as long as the case stays under 12 total aligners. Up to 2 replacement aligners are now included at no extra cost.

Unlimited — $1095

This one is a biggie. If Limited 6 is the most affordable clear aligner option in the industry, the Unlimited is the most flexible and predictable. It’s pretty simple to explain: the doctor gets as many aligners as needed, until the case is closed. That includes unlimited revisions for up to 3 years and replacements for any aligner at no extra cost. Some restrictions apply; see terms & conditions for details.

ClearCorrect will also be offering case evaluations and standalone treatment setups to lower the barrier to entry even further for doctors and their patients. And doctors can upgrade any case to a more comprehensive treatment option just by paying the difference in initial lab fees.

It's the same great ClearCorrect product, now even more flexible and doctor-friendly.

About ClearCorrect, LLC

ClearCorrect works with more than 12,000 doctors, making it a leading manufacturer of clear aligners. The company offers a more affordable and doctor-friendly approach, including a phase-based delivery system to enhance flexibility and control for doctors. For more information, call (888) 331-3323 or visit

Monday, December 24, 2012

Clinical relevance of tests on bond strength, microleakage and marginal adaptation

Dental Materials
Volume 29, Issue 1 , Pages 59-84, January 2013


Dental adhesive systems should provide a variety of capabilities, such as bonding of artificial materials to dentin and enamel, sealing of dentinal tubules, reduction of post-operative sensitivity and marginal sealing to reduce marginal staining and caries. In the laboratory, numerous surrogate parameters that should predict the performance of different materials, material combinations and operative techniques are assessed. These surrogate parameters include bond strength tests of various kinds, evaluation of microleakage with tracer penetration between restorative and tooth, two-dimensional analysis of marginal quality with microscopes and mapping of the micromorphology of the bonding interface. Many of these tests are not systematically validated and show therefore different results between different research institutes. The correlation with clinical phenomena has only partly been established to date. There is some evidence, that macrotensile and microtensile bond strength tests correlate better with clinical retention of cervical restorations than macroshear and microshear bond tests but only if data from different test institutes are pooled. Also there is some evidence that marginal adaptation has a moderate correlation in cervical restorations with clinical retention and in Class II restorations (proximal enamel) with clinical marginal staining. There is moderate evidence that microleakage tests with dye penetration does not correlate with any of the clinical parameters (post-operative hypersensitivity, retention, marginal staining). A rationale which helps the researcher to select and apply clinically relevant test methods in the laboratory is presented in the paper.

Saturday, December 22, 2012

Learning how to be a Chief Information Officer (CIO) in dentistry: A new online course

From my friend Titus Schleyer's blog.

The course is formally titled Introduction to Health Information Technology in Dentistry and the product of two years of work by the Center for Dental Informatics. Here are the short stats:
  • designed as a full-semester, 15-credit graduate course
  • 15 sessions, each of which takes about 3 hours to complete
  • expected to award about 50-60 continuing dental education credits
  • priced at prevailing rates
So, why are we offering this course? Successfully implementing and using health information technology (HIT) requires more than just knowledge about technology. It is, essentially, a complex, socio-technical challenge. Therefore, the course delivers solid technical knowledge about informatics, as well as leadership and management skills. The course is not designed to make participants into experts in everything “technology.” Rather, it delivers a strong technology- and management-focused package to help them succeed at implementing electronic dental records (EDR) and other technologies.
The course has two main objectives. It will participants:
  1. use information systems for managing dental data and supporting clinical decision making in the context of the dental care and office workflow; and
  2. plan, evaluate technology for, administer and manage information technology implementations in dentistry.
Our premise for the course is that participants are not simply interested in becoming consumers of a fully implemented information system, but intend to acquire a deeper background for the “why” and “how” of HIT implementation in dentistry. By doing so, they will become “educated consumers” of HIT and will be able to optimize how HIT contributes to achieving their goals. Successful completion of the course will make participants competent to lead and/or substantially contribute to applying HIT to dentistry successfully in a variety of clinical care settings.
The course modules include (subject to finalization): Course introduction and overview; Dental care workflow and analysis; Overview of electronic dental records; Dental data and their representation; Controlled vocabularies, terminologies and ontologies; User-centered design methods for EDRs; Practical information design; Supporting clinical decision making with computers; Failures in Health Information Technology (HIT); Planning and implementing IT in dental practice; Requirements analysis and technology evaluation; Managing HR for IT; Introduction to hardware and software; Privacy, confidentiality and security; and a Course review session.
So, who is the course targeted at? Three main audiences:
  1. Dentists: Dental personnel will benefit from the course through a comprehensive overview of health information technology use and implementation in dental practice. A key focus of the course is how information technology can help improve patient care and support the clinical activities of the dental team. As leaders of the dental team, dentists will gain a particular understanding of how the office workflow relates to requirements for IT systems, and how to best plan and select products for, as well as manage, implementation.
  2. Dental auxiliary personnel: Auxiliary personnel often play a key role in the success of HIT systems because they are the most frequent users. Dental hygienists and assistants will mostly benefit from an understanding of system functions and usability in light of the daily use of IT applications.
  3. Non-dentists, such as information technology support personnel and consultants: Non-dental personnel will gain a basic understanding of how dental offices work and how IT can be used to support its operations.
Did this description get you mildly interested? If so, check out our marketing video:

Last but not least, you probably want to know who is teaching the course:
  • Titus Schleyer, DMD, PhD, Assoc. Professor and Director, Center for Dental Informatics
  • Thankam P. Thyvalikakath, DMD, PhD, Assistant Professor, Center for Dental Informatics
  • Heiko Spallek, DMD, PhD, MSBA, Associate Professor, Dental Public Health, Center for Dental Informatics
  • Richard A. Oldham, DDS, Graduate Student, Department of Biomedical Informatics
  • Corey Stein, BSc, Graduate Student, Department of Biomedical Informatics
There are a limited number of slots available in the course. If you’re interested, please e-mail me at
With my best wishes for Happy Holidays!
P.S. This course is not an in-depth tutorial on the functions of particular practice management or EDR systems. Rather, it uses practical examples from these systems to highlight important theoretical concepts relevant to health information technology in dentistry.
– Titus Schleyer, DMD, PhD
Assoc. Professor and Director, Center for Dental Informatics

Friday, December 21, 2012

AADOM Announces Launch of Business College Along with Season Four of the Virtual Study Club for Dental Office Managers and Dentists

Red Bank, NJ:  December 17, 2012 The American Association of Dental Office Managers (AADOM) is pleased to announce the launch of the AADOM Business College (ABC) to begin January 2013. The college will feature a Foundational Track and an Advanced Track. Both tracks will be provided via online webinars and phone conferences. The popular Virtual Study Club (VSC) will return under the umbrella of the ABC Advanced Track.

The online Foundational series will feature sessions geared toward the new administrative team member. The modules will focus on important foundational skills such as Dental Terminology, Beginning Insurance, Phone Skills, Marketing Basics, Record-Keeping and Report Generation. In addition to the recorded modules learners will be able to attend monthly calls with a rotating focus on each of the topics.

ABC host Teresa Duncan, MS, FADIA, FAADOM is thrilled that AADOM is offering these courses. “We hear from managers that this is needed for their entry level hires. An office manager’s most precious commodity is time and training new employees demands a lot of time. The ABC provides a baseline of knowledge for managers to build upon.”

Now entering its fourth season is the Virtual Study Club – a popular series of six well-known industry speakers who share advanced level knowledge with attendees. The VSC is perfect for the experienced manager who needs more in-depth classes than are typically found via traditional webinars. Topics include Conflict Resolution, Practice Trends, Team Training Techniques, and Revenue Management. VSC member Wendy Lombardo shared with us that “a wealth of information is necessary to maintain a healthy, knowledgeable and prosperous office. I attend many courses throughout the year and found that the most important, valuable and accurate information I learned was from the AADOM’s VSC.”

The ABC and Virtual Study Club will each earn six AADOM credits toward Fellowship. All sessions are recorded and available for download so that learners can still participate even after the classes have begun. For more information please visit
# # #
About AADOM:
The American Association of Dental Office Managers (AADOM) is an organization of professional office managers, practice administrators, patient coordinators, insurance and financial coordinators, and treatment coordinators of general and specialized dental practices.  AADOM is the nation's largest education and networking association dedicated to serving dental practice management professionals. For more information please call 732-842-9977 or email us:

Thursday, December 20, 2012

New Guideline for the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures

The American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) have released a new evidence-based guideline on the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. The new guideline has three recommendations and replaces the previous 2009 AAOS Information Statement on Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacement.

Based on a collaborative systematic review of the scientific literature, the AAOS and the ADA have found that the evidence does not support routine prescription of antibiotic prophylaxis for patients with joint replacement undergoing dental procedures. As described in the new guideline, the AAOS-ADA recommendations are:

1. The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.

2. We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.

3. In the absence of reliable evidence linking poor oral health to prosthetic joint infection, it is the opinion of the work group that patients with prosthetic joint implants or other orthopaedic implants maintain appropriate oral hygiene.

The AAOS and ADA have advised that these recommendations are not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician, dentist and other healthcare practitioners in accordance with evidence based medicine applicability.

The full guideline, executive summary, shared decision making tool and other supporting documents are available from both websites of the AAOS ( and the ADA (

The College's Quality Assurance Committee will be reviewing the new AAOS-ADA guideline and members can expect to receive additional information about this important subject in the new year

Wednesday, December 19, 2012

Safety of oral midazolam sedation use in paediatric dentistry: a review

Papineni, A., Lourenço-Matharu, L. and Ashley, P. F. (2012), Safety of oral midazolam sedation use in paediatric dentistry: a review. International Journal of Paediatric Dentistry. doi: 10.1111/ipd.12017
Little information is available as to the safety of midazolam when used as an oral sedative.


To evaluate the side effects and other adverse outcomes following use of oral midazolam for behaviour management in paediatric dentistry.


A review of published literature relating to the safety and side effects of oral midazolam for use in paediatric dental procedures was conducted. Both randomised controlled trials and non-randomised studies were assessed. Reported side effects were recorded and classified as either significant or minor. The percentage prevalence of significant or minor side effects per episode of treatment was calculated.


Sixteen papers of randomised controlled trials met the inclusion criteria. None of the side effects recorded were considered as significant. Minor side effects were reported (n = 68, 14%), with nausea and vomiting being the most frequently recorded (n = 30, 6%). Eleven papers of non-randomised studies were included. No significant side effects were recorded. Minor side effects were recorded (n = 157, 8%), with paradoxical reaction being the most common at 3.8%.


Significant side effects associated with oral midazolam usage for behaviour management in children and adolescents requiring dental treatment appear to be rare. Minor side effects are more common but determining precise figures is complicated by poor reporting.

Tuesday, December 18, 2012

Impact of traumatic dental injury on the quality-of-life of children and adolescents: A case-control study

Antunes LS, Debossan PF, Bohrer LS, Abreu FV, Quintanilha LE, Antunes LA. Acta Odontol. Scand. 2012; ePub(ePub): ePub.

Objective. To evaluate the quality-of-life of students in Nova Friburgo, Rio de Janeiro, who suffered traumatic dental injury. Materials and methods. A case-control study was carried out by means of structured questionnaire for traumatic dental injury evaluation, clinical oral examination and application of a quality-of-life questionnaire (CPQ11-14), validated in the Portuguese version. This study consisted of 50 children/adolescents (17 cases of traumatic dental injury and 33 controls). Psychometric properties, like internal consistency (Cronbach's Alpha) and test-re-test reliability (ICC), were evaluated. The independent variables were collected for being of interest to the study (dental trauma) or for acting as potential confounding factors (malocclusion, caries). Descriptive and univariate analyses were performed.

Results. The Cronbach's Alpha was 0.90 for case and 0.77 for controls. ICC was 0.99. When the groups were compared, confounding factors showed no statistical difference (p > 0.05). Among the cases CPQ11-14 mean score was 17.59 (SD = 14.01), median = 17.00, whereas among the controls it was 3.09 (SD = 4.42), median = 1.00 (p < 0.01, Mann-Whitney test). When the groups were compared, there was statistical difference frequencies between CPQ11-14 total scale and sub-scales (p < 0.05). The functional limitation and emotional well-being were the sub-scales most affected. The TDI impact was related to 'delay and difficulty in chewing', 'embarrassed or ashamed' and 'caring about what others were thinking of appearance'.

Conclusions. One can observe a relationship between traumatic dental injury and its impact on quality-of-life. Children and adolescents who suffered traumatic dental injury showed negative experiences and greater functional and emotional impact.

Monday, December 17, 2012

A New Strategy To Prevent Or Halt Periodontal Disease Suggested By Research

Periodontitis, a form of chronic gum disease that affects nearly half of the U.S. adult population, results when the bacterial community in the mouth becomes unbalanced, leading to inflammation and eventually bone loss. In its most severe form, which affects 8.5 percent of U.S. adults, periodontitis can impact systemic health.

By blocking a molecular receptor that bacteria normally target to cause the disease, scientists from the University of Pennsylvania have now demonstrated an ability in a mouse model to both prevent periodontitis from developing and halt the progression of the disease once it has already developed.

The study, published in the Journal of Immunology, was led by Toshiharu Abe, a postdoctoral researcher in the Department of Microbiology in Penn's School of Dental Medicine. Abe works in the lab of George Hajishengallis, a professor in the department who was a senior author on the paper. The co-senior author was John D. Lambris, the Dr. Ralph and Sallie Weaver Professor of Research Medicine in the Department of Pathology and Laboratory Medicine in Penn's Perelman School of Medicine. Kavita B. Hosur and Evlambia Hajishengallis from Penn Dental Medicine also contributed to the research, as did Penn Medicine's Edimara S. Reis and Daniel Ricklin.

In previous research, Hajishengallis, Lambris and colleagues showed that Porphyromonas gingivalis, the bacterium responsible for many cases of periodontitis, acts to "hijack" a receptor on white blood cells called C5aR. The receptor is part of the complement system, a component of the immune system that helps clear infection but can trigger damaging inflammation if improperly controlled.

By hijacking C5aR, P. gingivalis subverts the complement system and handicaps immune cells, rendering them less able to clear infection from the gum tissue. As a result, numbers of P. gingivalis and other microbes rise and create severe inflammation. According to a study published last year by the Penn researchers, mice bred to lack C5aR did not develop periodontitis.

Meanwhile, other studies by the Penn group and others have shown that Toll-like receptors, or TLRs - a set of proteins that also activate immune cell responses - may act in concert with the complement system. In addition, mice lacking one form of TLR called TLR2 do not develop bone loss associated with periodontitis, just like the C5aR-deficient mice.

In the new study, the Penn team wanted to determine if the synergism seen by other scientists between the complement system and TLRs was also at play in this inflammatory gum disease.

To find out, they injected two types of molecules, one that activated C5aR and another that activated TLR2, into the gums of mice. When only one type of molecule was administered, a moderate inflammatory response was apparent a day later, but when both were injected together, inflammatory molecules increased dramatically - soaring to levels higher than would have been expected if the effect of activating both receptors was merely additive.

This finding suggested to the scientists that the Toll-like receptor signaling was somehow involved in "crosstalk" with the complement system, serving to augment the inflammatory response. Turning that implication on its head, they wondered whether blocking just one of these receptors could effectively halt the inflammation that allows P. gingivalis and other bacteria to thrive and cause disease.

Testing this hypothesis, the researchers synthesized and administered a molecule that blocks the activity of C5aR, to see if it could prevent periodontitis from developing. They gave this receptor "antagonist," known as C5aRA, to mice that were then infected with P. gingivalis. The C5aRA injections were able to stave off inflammation to a large extent, reducing inflammatory molecules by 80 percent compared to a control, and completely stopping bone loss.

And when the mice were given the antagonist two weeks after being infected with P. gingivalis, the treatment was still effective, reducing signs of inflammation by 70 percent and inhibiting nearly 70 percent of periodontal bone loss.

"Regardless of whether we administered the C5a receptor antagonist before the development of the disease or after it was already in progress, our results showed that we could inhibit the disease either in a preventive or a therapeutic mode," Hajishengallis said.

This is significant for extending these findings to a potential human treatment, as treatments would most likely be offered to those patients already suffering from gum disease.

Because not all cases of periodontitis are caused by P. gingivalis, the research team also wanted to see whether C5aRA could effectively prevent or treat the disease when it arose due to other factors. To do so, they placed a silk ligature around a single molar tooth in a group of mice. The obstruction not only blocked the natural cleaning action of saliva, but also enabled bacteria to stick to the ligature itself, resulting in a massive accumulation of bacteria. This microbial build-up rapidly leads to periodontitis and bone loss, within just five days in the mice.

The researchers then injected the gum tissue adjacent to the ligated molar tooth with C5aRA in some of the mice, and gave the other mice a control.

"These mice that got the C5a receptor antagonist developed at least 50 percent less inflammation and bone loss compared to an analog of C5a receptor antagonist which is not active," Hajishengallis said.

This result gives the researchers greater confidence that the C5aRA treatment could be effective against periodontitis in general, not just those cases caused by P. gingivalis bacteria.

The team is now working to replicate their success in mice in other animal models, an important step toward extending this kind of treatment to humans with gum disease.

"Our ultimate goal is to bring complement therapeutics to the clinic to treat periodontal diseases," Lambris said. "The complement inhibitors, some of which are in clinical trials, developed by my group are now tested in various periodontal disease animal models and we hope soon to initiate clinical trials in human patients."

University of Pennsylvania. (2012, December 11). "A New Strategy To Prevent Or Halt Periodontal Disease Suggested By Research." Medical News Today. Retrieved from

The study was supported by the National Institutes of Health.
University of Pennsylvania

Saturday, December 15, 2012

Incidence of Apical Root Cracks and Apical Dentinal Detachments after Canal Preparation with Hand and Rotary Files at Different Instrumentation Lengths

Journal of Endodontics
Volume 39, Issue 1 , Pages 129-132, January 2013



The aim of this study was to compare the incidence of apical root cracks and dentinal detachments after canal preparation with hand and rotary files at different instrumentation lengths.


Two hundred forty mandibular incisors were mounted in resin blocks with simulated periodontal ligaments, and the apex was exposed. The root canals were instrumented with rotary and hand files, namely K3, ProTaper, and nickel-titanium Flex K files to the major apical foramen (AF), short AF, or beyond AF. Digital images of the apical surface of every tooth were taken during the apical enlargement at each file change. Development of dentinal defects was determined by comparing these images with the baseline image. Multinomial logistic regression test was performed to identify influencing factors.


Apical crack developed in 1 of 80 teeth (1.3%) with hand files and 31 of 160 teeth (19.4%) with rotary files. Apical dentinal detachment developed in 2 of 80 teeth (2.5%) with hand files and 35 of 160 teeth (21.9%) with rotary files. Instrumentation with rotary files terminated 2 mm short of AF and did not cause any cracks. Significantly less cracks and detachments occurred when instrumentation with rotary files was terminated short of AF, as compared with that terminated at or beyond AF (P < .05). The AF deviated from the anatomic apex in 128 of 240 teeth (53%). Significantly more apical dentinal detachments appeared in teeth with a deviated AF (P = .033).


Rotary instruments caused more dentinal defects than hand instruments; instrumentation short of AF reduced the risk of dentinal defects.

Friday, December 14, 2012

Impact of cross-sectional root canal shape on filled canal volume and remaining root filling material after retreatment


Rechenberg D-K, Paqué F. Impact of cross-sectional root canal shape on filled canal volume and remaining root filling material after retreatment. International Endodontic Journal.


To assess the impact of cross-sectional root canal shape (CSRCS) on the canal volume that can be filled and the root filling material that remains following a subsequent retreatment procedure.


A total of 15 extracted two-rooted human maxillary premolars and 15 mandibular first molars were used. Both root canals in the premolars (N = 30) and the distal root canal in the molars (N = 15) were prepared using ProFile instruments and filled by lateral compaction using gutta-percha and AH Plus sealer. Canals were later retreated using the last ProFile used for instrumentation followed by two ProFiles of increasing size. Teeth were viewed in a μCT scanner before and after each treatment step. Defined and validated threshold levels were used to differentiate empty root canal volumes, root dentine and root filling materials from each other. CSRCS was defined as the averaged ratio between bucco-lingual and mesio-distal canal diameter (round ≤ 1, oval 1–2, long oval 2–4 and flattened ≥ 4), determined for each 1 mm over the total root length. Data were averaged between the two canals in premolars, only the distal canals were assessed in molars. Parametric and non-parametric tests were used to statistically compare the data, alpha = 0.01.


Canals in premolars had a round CSRCS after preparation (1.0 ± 0.0), whereas distal counterparts in molars were oval (1.6 ± 0.5). Significantly (< 0.01) more canal volume could be filled, and significantly less filling material remained after retreatment in premolars compared with mandibular molar distal canals. There was a high correlation between CSRCS, filled canal volume and remaining filling material.


The endodontic procedures under investigation were significantly influenced by the cross-sectional root canal shape.

Thursday, December 13, 2012

Effect of enamel surface treatment on the bond strength of metallic brackets in rebonding process

Eur J Orthod 34 (6): 773-777. doi: 10.1093/ejo/cjr093 


Bond failure after rebonding for newly placed brackets can be reduced by appropriate enamel surface treatment. This in vitro study investigated the effect of two enamel surface treatments on the bond strength of metallic brackets in the rebonding process. After debonding the brackets and removing the residual adhesive on the enamel surface of 50 upper premolar teeth, the teeth were divided into two equal groups. In the first group, the enamel surface was etched with phosphoric acid 37 per cent, and in the second group, the teeth were sandblasted prior to acid etching. After bonding of the new brackets, the shear bond strength (SBS), probability of bond failures, and adhesive remnant index (ARI) were determined and compared with the t-test, Weibull analysis, and chi-square test.
Mean SBS in both groups did not differ significantly (P = 0.081). Most bond failures occurred with ARI scores of 2 and 3, and the difference between the two groups was statistically significant (P < 0.001). Weibull analysis showed that for a given stress, the probability of failure differed between groups. Enamel surface preparation with sandblasting prior to acid etching did not significantly improve SBS in bracket rebonding and left more residual adhesive remnants on the enamel surface.

Wednesday, December 12, 2012

Effect of whitening toothpaste on titanium and titanium alloy surfaces

Brazilian Oral Research
Print version ISSN 1806-8324
Braz. oral res. vol.26 no.6 São Paulo Nov./Dec. 2012 Epub July 19, 2012

Dental implants have increased the use of titanium and titanium alloys in prosthetic applications. Whitening toothpastes with peroxides are available for patients with high aesthetic requirements, but the effect of whitening toothpastes on titanium surfaces is not yet known, although titanium is prone to fluoride ion attack. Thus, the aim of the present study was to compare Ti-5Ta alloy to cp Ti after toothbrushing with whitening and conventional toothpastes. Ti-5Ta (%wt) alloy was melted in an arc melting furnace and compared with cp Ti. Disks and toothbrush heads were embedded in PVC rings to be mounted onto a toothbrushing test apparatus. A total of 260,000 cycles were carried out at 250 cycles/minute under a load of 5 N on samples immersed in toothpaste slurries. Surface roughness and Vickers microhardness were evaluated before and after toothbrushing. One sample of each material/toothpaste was analyzed by Scanning Electron Microscopy (SEM) and compared with a sample that had not been submitted to toothbrushing. Surface roughness increased significantly after toothbrushing, but no differences were noted after toothbrushing with different toothpastes. Toothbrushing did not significantly affect sample microhardness. The results suggest that toothpastes that contain and those that do not contain peroxides in their composition have different effects on cp Ti and Ti-5Ta surfaces. Although no significant difference was noted in the microhardness and roughness of the surfaces brushed with different toothpastes, both toothpastes increased roughness after toothbrushing.

Monday, December 10, 2012

Lanmark360’s “Shave the Shore™” Campaign Exceeds Goal of $20,000

Collective Support From the Dental Industry Credited for Staggering Donation Amount that Continues to Grow

West Long Branch, NJ (December 7, 2012) – Lanmark360’s “Shave the Shore” campaign recently exceeded its fundraising goal by raising more than $20,000 for Hurricane Sandy relief efforts, and the agency contributes the majority of its success to donations collected from friends and colleagues throughout the dental industry. All proceeds from the campaign will be donated to the American Red Cross Hurricane Sandy Relief Efforts in order to help local families affected by Hurricane Sandy.

Originally, in the first few days following super-storm Sandy, Lanmark360 President, Howard Klein, made a pledge on Facebook NOT to shave until he personally raised at least $10,000 to help Jersey Shore families struck by Sandy’s path. On Day 14 of the campaign, Michael Bocian, Vice President of Sales and Marketing at Darby Dental Supply, challenged Klein to raise his goal to $15,000, pledging that Darby Dental Supply would contribute an additional $5,000, bringing the total donation amount to $20,000. Since then, Klein and his team at Lanmark360 have exceeded that goal, and contributions continue to pour in. 

“I am so humbled by the amount of support we received for this campaign from the dental industry alone,” remarked Klein. “Following the storm, the amount of support we received from our friends and colleagues has been nothing short of amazing. This industry is truly like no other, and Lanmark360 is proud to serve our clients, publication partners and associates each and every day. In the dental industry, we often joke that once you enter dental, you can’t get out – well it’s times like these that I can’t ever imagine leaving. It confirmed to me that we all really do have an extended family that serves as a real united force within dental.”

Klein and his team at Lanmark360 celebrated the victory with a nice, hot shave at a Frank’s Barber Shop, a local business Klein has been frequenting for over 20 years. 

“Most importantly, everyone at Lanmark360 would like to thank all the individuals and companies within the dental industry who so generously showed their support through either not shaving, or funding monetary donations to the cause,” remarked Klein. 

Klein has decided to keep the Shave the Shore donation site active in order to maximize the total contribution to Hurricane Sandy relief efforts. For more information about Shave the Shore and how you can help, please visit or visit for regular updates. 

You can also follow Shave the Shore on Twitter by using the hashtag, #ShaveTheShore or following Howard Klein at @ShaveTheShore.

About Lanmark360

Lanmark360 is a fully integrated advertising, marketing and communications agency serving a diverse roster of clients in the healthcare industry. Located at the Jersey Shore in West Long Branch, the company provides 360° of strategic marketing services.

Sunday, December 09, 2012

Indirect Resin Laminates

I spent last weekend in Columbus Ohio learning about some new indirect resin veneers.  The  Pearlfect Smile is ultra-thin veneers made to fit intimately on the tooth, with razor-thin finish lines that require no adjustment or finishing after bonding. This is truly a no prep or minimal prep veneer. The thickness of these veneers can be 02-.03mm. They are made of a hybrid of resin and zirconia. This gives the veneers strength and the ability to be repaired if necessary. I saw 8 veneers seated and finished in under 1 hour. The case looked great.

Go check out these veneers and see how you can offer your patients a less expensive alternative to porcelain veneers.

Pearlfect Smile Web site

Saturday, December 08, 2012

Comparison of the outcomes of the lower incisor extraction, premolar extraction and non-extraction treatments

  1. Eur J Orthod 34 (6): 681-685. doi: 10.1093/ejo/cjr064


The aim of this retrospective study was to evaluate the treatment outcome of lower incisor extraction and to compare it with premolar extraction and non-extraction treatment. The sample consisted of 60 subjects with Class I malocclusion and moderate crowding. The sample was separated into three groups: extraction of a lower incisor group, extraction of a four first premolar group and a non-extraction group. All groups involved 13 girls and 7 boys with a total of 20 patients. The Peer assessment rating (PAR) index was applied to a patient’s pre-treatment (T1) and post-treatment (T2) dental casts. T1 dental casts were also used for determining Bolton discrepancy. One-way analysis of variance and post hoc Tukey HSD tests were used for statistical analysis. For the mean percentage PAR score reduction for each group, there was one significant difference seen between the lower incisor extraction group and the non-extraction group (P = 0.047). For the mean anterior ratios, there were significant differences among premolar extraction group versus non-extraction group (P = 0.042) and non-extraction group versus lower incisor extraction group (P = 0.000). For the mean overall ratios, there were significant differences among the premolar extraction group versus lower incisor extraction group (P = 0.048) and the non-extraction group versus lower incisor extraction group (P = 0.001). Orthodontic treatment without extraction has a better treatment outcome than the four-first premolar extraction and single lower incisor extraction protocols in Class I cases with moderate to severe mandibular anterior crowding.

Friday, December 07, 2012

Does dentistry really need more than one diagnostic vocabulary?

My friend and colleague Titus Schleyer recently published an article on his blog concerning the future of dental coding.  I think everyone should take a few minutes to read this valuable information.

Here is a link to his blog post.

Dental Informatics Blog

Thursday, December 06, 2012

Vitamin D Linked To A 50 Percent Reduction In The Incidence Of Dental Caries

A new review of existing studies points toward a potential role for vitamin D in helping to prevent dental caries, or tooth decay.

The review, published in the December issue of Nutrition Reviews, encompassed 24 controlled clinical trials, spanning the 1920s to the 1980s, on approximately 3,000 children in several countries. These trials showed that vitamin D was associated with an approximately 50 percent reduction in the incidence of tooth decay.

"My main goal was to summarize the clinical trial database so that we could take a fresh look at this vitamin D question," said Dr. Philippe Hujoel of the University of Washington, who conducted the review.

While vitamin D's role in supporting bone health has not been disputed, significant disagreement has historically existed over its role in preventing caries, Hujoel noted. The American Medical Association and the U.S. National Research Council concluded around 1950 that vitamin D was beneficial in managing dental caries. The American Dental Association said otherwise - based on the same evidence. In 1989, the National Research Council, despite new evidence supporting vitamin D's caries-fighting benefits, called the issue "unresolved."

Current reviews by the Institute of Medicine, the U.S. Department of Human Health and Service and the American Dental Association draw no conclusions on the vitamin D evidence as it relates to dental caries.

"Such inconsistent conclusions by different organizations do not make much sense from an evidence-based perspective," Hujoel said. The trials he reviewed increased vitamin D levels in children through the use of supplemental UV radiation or by supplementing the children's diet with cod-liver oil or other products containing the vitamin.

The clinical trials he reviewed were conducted in the United States, Great Britain, Canada, Austria, New Zealand and Sweden. Trials were conducted in institutional settings, schools, medical and dental practices, or hospitals. The subjects were children or young adults between the ages of 2 and 16 years, with a weighted mean age of 10 years.

Hujoel's findings come as no surprise to researchers familiar with past vitamin D studies. According to Dr. Michael Hollick, professor of medicine at the Boston University Medical Center, "the findings from the University of Washington reaffirm the importance of vitamin D for dental health." He said that "children who are vitamin D deficient have poor and delayed teeth eruption and are prone to dental caries."

The vitamin D question takes on greater importance in the light of current public health trends. Vitamin D levels in many populations are decreasing while dental caries levels in young children are increasing.

"Whether this is more than just a coincidence is open to debate," Hujoel said. "In the meantime, pregnant women or young mothers can do little harm by realizing that vitamin D is essential to their offspring's health. Vitamin D does lead to teeth and bones that are better mineralized."

Hujoel added a note of caution to his findings: "One has to be careful with the interpretation of this systematic review. The trials had weaknesses which could have biased the result, and most of the trial participants lived in an era that differs profoundly from today's environment. "

Hujoel has joint appointments as a professor in the University of Washington School of Dentistry's Department of Oral Health Sciences and as an adjunct professor of epidemiology in the UW School of Public Health. His research has concentrated on nutrition with a focus on low-carbohydrate diets, harmful effects of diagnostic radiation, and evidence-based methodology and applications.

His research has also covered sugar substitutes, the use of antibiotics in the treatment of periodontal disease, and cleft lip and cleft palate. He has also studied the link between dental disease and systemic disease, as well as trends in disease prevalence.

Wednesday, December 05, 2012

Respect at CE courses- It goes both ways!

I recently attended a 2 Day CE course. The documentation stated registration was at 7:30am and the course was to start at 8am SHARP! I drove an hour and a half and made sure I got there on time. Many others did also.

Well, the course did not start until after 8:30am. The administration of the course was in disarray. This was totally unacceptable. There were further administration issues as to timing of course activities, as different pieces of literature stated different start and stop times for breaks, lunch and the workshop portion. This was not the CE providers first workshop. These types of problems are unacceptable. The people putting on CE events need to respect the time of the attendees.

This is not a one way street. For those taking the CE classes. Try to arrive on time.  A few minutes late is one thing but having groups wandering in 20+ minutes late is disruptive to those who were able to arrive on time.  Have your paperwork together. If you need a ticket for admission, please have it available so you don't have people lining up behind you. Don't forget common courtesy.

CE events are a wonderful way to learn more about ways to help our patients and ourselves. Lets maximize the opportunity.

Tuesday, December 04, 2012

European and American Periodontal Thought Leaders Collaborate to Advance the Science behind the Perio-Systemic Link

European Federation of Periodontology and American Academy of Periodontology host Joint Workshop on Periodontitis and Systemic Diseases

Chicago, IL – November 30, 2012 – A large body of research has focused on the role periodontal health plays in systemic health and specifically, how periodontal disease may be related to other conditions. A recent joint workshop organized by the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) aimed to establish a consensus knowledge base of the scientific evidence on the association between periodontitis and systemic diseases, specifically cardiovascular disease, diabetes and adverse pregnancy complications. Periodontal thought leaders from both Europe and the United States participated in the workshop, which was held in Segovia, Spain November 11 through 14.

“International collaboration is necessary to better understand and advance the science behind the relationship between periodontal disease and systemic disease. By working together, periodontists in both Europe and the U.S. will be able to better promote the importance of periodontal health as part of overall health in our regions and worldwide,” said Robert Genco, DDS, PhD, co-chair of the EFP-AAP 2012 Workshop Organizing Committee and Distinguished Professor of Periodontics and the University at Buffalo.

Over 70 experts in the specialty of periodontology were invited to participate in the workshop and were assigned to one of three workgroups: cardiovascular disease and periodontal disease; diabetes and periodontal disease; and adverse pregnancy outcomes and periodontal disease. The workgroups were responsible for reviewing the scientific evidence in their respective areas and developing a consensus statement on each topic.

“The American Academy of Periodontology welcomed the opportunity to collaborate with the European Federation of Periodontology on this landmark workshop,” said Nancy Newhouse, DDS, MS, President of the American Academy of Periodontology and an Assistant Clinical Professor at the University of Missouri – Kansas City School of Dentistry. “As leaders in the research of the relationship of periodontal disease to other diseases, it is crucial that periodontists from all over the world maintain an open dialogue and collaborate to expand our understanding of the science in this area.”

Added Mariano Sanz, DDS, MD, co-chair of the EFP-AAP 2012 Workshop Organizing Committee and Dean of the Faculty of Dentistry at the Complutense University of Madrid, “Both the AAP and the EFP are enthusiastic to share the proceedings of the workshop with our dental and medical colleagues in an effort to improve the periodontal and systemic health of the public. We are optimistic that the collective energy demonstrated at the workshop will help drive advances in periodontics not because it is self-serving for the profession, but to advance human health globally.”  

The workshop was supported by an educational grant from Colgate Palmolive. Workshop proceedings will be co-published in the Journal of Clinical Periodontology and the Journal of Periodontology in 2013. For more information, visit

About the American Academy of Periodontology
The American Academy of Periodontology (AAP) is the professional organization for periodontists – specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,300 members world-wide.

Monday, December 03, 2012

Carestream Dental Showcases Latest Products at the American Association of Oral and Maxillofacial Surgeons Dental Implant Conference

New Product Offerings, Software Features and Partnership Benefit Practices’ Clinical and Front Office Teams

CHICAGO – Carestream Dental will present three of its latest products at the American Association of Oral and Maxillofacial Surgeons (AAOMS) Dental Implant Conference, held through Saturday, Dec. 1, at Sheraton Hotel and Towers in Chicago. The three products include two imaging systems that expand practices’ diagnostic capabilities and a new feature in CS WinOMS practice management software that streamlines workflow for front office teams and offers patients added convenience.

First launched in October at the American Dental Association (ADA) Annual Session, the compact CS 8100 digital panoramic system delivers highly detailed and optimally contrasted images. Supporting the day-to-day panoramic imaging needs of practices, the CS 8100’s capabilities include panoramic imaging (for adult and pediatric patients) as well as segmented panoramic, TMJ and maxillary sinus imaging.

For practices ready for 3D imaging, Carestream Dental’s new CS 9300 Select provides practitioners with four selectable fields of view, ranging from 5 cm x 5 cm to 10 cm x 10 cm. A new addition to the CS 9300 family, the CS 9300 Select is complete with 3D cone beam computed tomography (CBCT) and 2D digital panoramic imaging in addition to an optional cephalometric modality. Tailored to meet any practice’s diagnostic needs and budget, the CS 9300 Select is ideal for general practitioners and specialists placing implants or performing oral surgeries of the teeth and jaws. Unlike systems limited to a smaller field of view, the CS 9300 Select’s 10 cm x 10 cm field of view allows for clear viewing of the second and third molar regions regardless of patient size and gives practitioners the ability to visualize the paranasal sinuses, including the maxillary sinus region prior to sinus lift procedures.

“Carestream Dental continues to deliver high-quality solutions, like the CS 8100 and the CS 9300 Select, that improve diagnoses and treatment planning,” said Edward Shellard, D.M.D., chief marketing officer and director of business development for Carestream Dental. “We also work to incorporate features into our software that enable front office teams to work efficiently and save time.”

Also during the conference, Carestream Dental is introducing ePrescriptions. This new feature of CS WinOMS allows practices to automatically send electronic patient prescriptions directly to a preferred pharmacy. This helps prevent confusion and possible errors in prescription fulfillment, sometimes resulting from handwritten forms, and saves patients’ time since they will no longer have to wait on prescriptions to be filled at their pharmacies.

The AAOMS Dental Implant Conference is also the first meeting for attendees to learn more about three of Carestream Dental’s new partners, including:

Amazing Charts:
·         Amazing Charts Electronic Health Record (EHR) meets all 25 of the necessary requirements to be certified for meaningful use, enabling eligible CS WinOMS customers to receive the significant financial incentives offered by the Centers for Medicare & Medicaid Services under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

·         In 2013, PBHS will release iConsult v3.0, which will soon offer two-way integration with CS WinOMS Practice Management Software. With iConsult v3.0, the entire consultation, including all images, documents, informed consents, forms, notes, diagrams and audio files are automatically synced and integrated back into your patient’s CS WinOMS account.

·         OMS3’s Practice Pilot uses CS WinOMS data to provide numerous customizable dashboards to visualize practices’ key productivity indicators for referrals, collections, provider performance, marketing, procedure code analysis and office performance.

Carestream Dental welcomes all AAOMS Dental Implant Conference attendees to visit booth number 616 to get a hands-on demonstration of its suite of products during the show. For more information on Carestream Dental’s innovative solutions or to request a product demonstration, call (800) 944-6365 or visit

About Carestream Dental
Carestream Dental provides industry-leading imaging, software and practice management solutions for dental and oral health professionals. With more than 100 years of industry experience, Carestream Dental products are used by seven out of 10 practitioners globally and deliver more precise diagnoses, improved workflows and superior patient care. For more information or to contact a Carestream Dental representative, call (800) 944-6365 or visit

About Carestream Health
Carestream Health is a worldwide provider of dental and medical imaging systems and healthcare IT solutions; X-ray film and digital X-ray systems for non-destructive testing; and advanced materials for the precision films and electronics markets.

For more information about the company’s broad portfolio of products, solutions and services, please contact your Carestream Health representative or visit

Saturday, December 01, 2012

Saliva and dental erosion

J. Appl. Oral Sci. vol.20 no.5 Bauru Sept./Oct. 2012

Dental erosion is a multifactorial condition. The consideration of chemical, biological and behavioral factors is fundamental for its prevention and therapy. Among the biological factors, saliva is one of the most important parameters in the protection against erosive wear. Objective: This review discusses the role of salivary factors on the development of dental erosion. Material and Methods: A search was undertaken on MeDLINe website for papers from 1969 to 2010. The keywords used in the research were "saliva", "acquired pellicle", "salivary flow", "salivary buffering capacity" and "dental erosion". Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. Results: Several characteristics and properties of saliva play an important role in dental erosion. Salivary clearance gradually eliminates the acids through swallowing and saliva presents buffering capacity causing neutralization and buffering of dietary acids. Salivary flow allows dilution of the acids. In addition, saliva is supersaturated with respect to tooth mineral, providing calcium, phosphate and fluoride necessary for remineralization after an erosive challenge. Furthermore, many proteins present in saliva and acquired pellicle play an important role in dental erosion. Conclusions: Saliva is the most important biological factor affecting the progression of dental erosion. Knowledge of its components and properties involved in this protective role can drive the development of preventive measures targeting to enhance its known beneficial effects.