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Newsletter dated 04-02-2007     11-02-2007     25-02-2007     04-03-2007     11-03-2007     18-03-2007     25-03-2007

Dental India newsletter dated 11th Feb 2007 - Celeberating 10th year of online in Feb 2007


Newsletter is sponsored by IDS - International Dental Show, Cologne,  Germany

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Graft material was Connexus and Straumann ceramic with BioGide as membrane.  I totally agree about centering the implant but again, it's a learning curve....I have no pretense to being a world class implantologist (yet) any more than being a world class endodontist (never happen).  For those who think that implants are easy – nuh uh!!!  Only problem with Bio-Oss I'm told is globular bone...I'm going to start to use DBX and Pep-Gen 15.....figure by the time I retire at 137 years of age, I may get it right. - Kendo (Implant forum)

I would not use demineralized freeze dried bone as this looses volume as it heals and theres enough in the lit to show if you want to use cadavear bone mineralized is ebtter something like dynagraft putty, or grafton putty.  this will also allow some molding of the area when placed. Pepgen-P15 can be used in socket preservation and a good way is to mix the granules with some of the flow to make a stiffer putty and place that.

 
with regard to implant placement alas you as an endodontist will eb subject to more critisim from the perio and OS as to placement then anyone else because its a turf battle and they dotn want you guys playign in their sand box.  what i would suggest in these cases is at time of socket graft after you close take a quick quad PVS impression and pour it up  then lube the model, stick a denture tooth in the space and flow some triad gel over the occlusal of the tooth in back and infront and over the denture tooth and light cure it  then take a 3/32" twist drill from the hardware store and drill a hole dead center thru the acrylic and denture tooth and into the model.  this will be your surgical stent when you go to place the implant.  pop it in before flappign and take your systems pilot drill and go thru the stent and thru the soft tissue a few mm into bone. then remove the stent flap the ridge replace the stent and continue the pilot hole to depth. remove the stent and continue with your drill sequence.  what this does is show you where the implant will emerge thru the tissue so your crestal incision bisects that starter hole and make site exposure easier -  Dr Gregori Kurtzman (Implant forum)

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Fractured canine  (courtesy ROOTS)
 
18 years old boy  came today as an emergency appointment. He was beated a couple of days ago, he complained of pain but in the LL8. During the check up I found out that the LL3 was completely fractured in 3 pieces. I removed them and the nerve. The tooth now is a rest of root with the margins subginginval and it seems that he will need, besides the RCT + post + crown, a crown lenghtening. I would like to save it and I will try it - Marcela

How about forced eruption? - Fred

Instead of crown lenghtening you could do tooth extrusion - Gerardo

Would this not be best off with a combination of extrusion/forced eruption followed by crown lengthening once a successful RCT had been completed? - Bob

Double post removal       tooth #18 retreatment      12month MSDO Call   Cone fitting is gold standard      Evolution of Endodontics       Extra Canal

Food  left on teeth after every meal or snack often  contains fermentable carbohydrate, which is changed to acid that demineralises tooth, particularly between teeth and inside pits and fissures where the brush, saliva, toothpaste, mouthwash and chewing gum cannot reach.

Strangely only a very smallamount of food is trapped inside pits and fissures, where 80% of cavities occur maunly because saliva and fluoride toothpase cannot gain access to dilute carbohydrate, neutralise acid and remineralise demineralised tooth.

Chewing delivers the carbohydrate like sugar and chewing fibre like celery string for a few minutes after eating, can deliver saliva to help remove trapped food, neutralise acid and repair demineralised tooth as can be seen on
http://ndk.biz/slideshow   - Maurice White 
 

Pulpdent Introduces Embrace Esthetic Opaquer Kit
Pulpdent Corporation has introduced the Embrace Esthetic Opaquer Kit...
.


A conservative multidisciplinary approach for improved aesthetic results with traumatised anterior teeth.

Arhun N, Arman A, Ungor M and Erkut S

Faculty of Dentistry, Department of Conservative Dentistry, Baskent University, Ankara, Turkey.

A subgingival crown-root fracture presents a restorative problem to the clinician because restoration is complicated by the need to maintain the health of the periodontal tissues. If the remaining portion of the root is thought to be enough to support a definitive restoration, the root may be extruded by orthodontic forced eruption after root canal treatment. Extrusion enables the remaining root portion to be elevated above the epithelial attachment. Endodontic posts may be useful in exerting vertical forces to the root for extrusion without buccal tipping. The following case shows multidisciplinary management of a case of dental trauma. Orthodontic forced eruption is incorporated using endodontic posts and restoration with porcelain fused to metal crowns--leading to successful restoration of the traumatised teeth.



Metlife And Previser Launch Oral Health Disease Management Pilot Program
MetLife and PreViser Corporation recently announced the launch of a new pilot program to help identify risks for periodontal disease...

 
 
I would like to have some feedback about immediate loading, extractions with immediate placements and immediate loading, smokers...........Vic Granda  (Perio group)

My personal philosophy / experience on that subject is

1)  I may place implants immediately in single rooted teeth sites free of abscess and/or inflammation.  Most of the time I will place patients on antibiotics afterwards as a prophylactic measure.  Sometimes when indicated, I will also graft some bio-Oss if there are numerous threads exposed and the socket is pretty wide at the coronal aspect.  I am usually able to contain the grafted material without a membrane; if not, membrane it is.  Also, sometimes these procedures can be done flapless but you must be aware when you do that and study the patient good before doing that, the best advantage I have gotten out of that is papilla preservation.  Technique wise, the first step is crucial because it will determine where I want the implant placed, it is usually harder to perform that step (round bur) in the socket than on a ridge that you can see nicely. This step is usually much easier if you have a stent made.  Overall there have been excellent results so far.  Remember the limitation of my experience to the single rooted teeth.
 
2) As far as Immediate loading, I work with prosthodotists and generally there is an agreement between us that immediate loading can be done on edentulous patients needing multiple MANDIBULAR implants  (4-5) that are placed in the inerforaminal area.  Remember that this area usually houses the most dense/strong bone (type 1).  These implants are usually temporized before the placement of a fixed overdenture.  I may sometimes need to use implant lengths similar to the height of residual mandible. 
Another philosophy that I have been a little skeptical with, is the Straumann's SLA and SLActive one when their reps say that if you can torque the implants to 35 Ncm, then you can load it (on single tooth implants)? I am willing to do that but only after many others do and describe favorable results. 
 
3) On the smoking issue, it is believed that smokers have a higher rate of failures with dental implants.  You can read Bain and Moy study from 1993 when they looked at Branemark implants in patients (success rate among nonsmokers was ~ 95% Vs. ~ 89% in smokers).  Now this study was performed on smooth (machined) implants, which are hardly used anymore, I am actually working on a big study that will compare the success rates of implants in smokers between machined and rough implants.  I will be more than happy to share the results with the group when I am done with it.  Practically, I will be honest with you and tell you that I don't see the differences in implant success between the smokers and non-smokers, I am not sure why, that was one of the reasons why I am doing the study since I believe that the rates are now better with rough implants for smokers - I hope all this helps,  -   Ayman Balshe DDS

Patient Newsletters

Patient newsletters serve a specific purpose.  They are a special communication with people who have already accepted your practice as a place to receive dental care.  More than 80% of marketing and sales dollars in industry are spent convincing prospective customers (patients) that you are a viable choice for the product or service they are seeking.  With the patient newsletter you have an audience who already accepts that premise, so you can be more specific about certain types of services. 

You are already their specialist in the field of dentistry.  They told you that by their having already received dental services from us in the past.  The purpose of the newsletter is to remind patients that they are considered a patient of your practice, by you.  In addition, you want to convey specific information to someone who is more likely to read it than a complete stranger.  (Mass mailings are not read usually by people who do not know you in this age of overwhelming junk mail.  More than 95% are destroyed without being read, and a good return is 2%. We do a little different sort of mailing, so we get a much better return. Still, it is not as effective as a patient newsletter at generating quick increased business.) Information you would include in a newsletter would be maximizing insurance benefits, returning for exams and prophys, referring new patients, cosmetic options, personal items about family and staff, tidbits of interest in dental health, etc. 

A well-done newsletter does not have to be long or expensive.  In our experience, the most effective newsletters are professionally produced 8.5 x 11 tri-folds in full color with pictures of staff, families, smile makeovers, etc.  They should be quarterly to insure that the patient is contacted at least six times per year. (Add one or two recall contacts and a birthday card.)  Expensive multi-page newsletters are too expensive to produce frequently so they are not for   the return they get.  Frankly, we find there is almost always filler added that is self congratulatory in most longer newsletters…that they are really for the dentist to brag rather than the patient’s need to know more about what the practice can do for them.

Your patients are like all human beings in the world.  Their favorite station is WII-FM (What's in it for me.)  That may sound cynical, but it is true and ignoring it is silly.  They may have a passing interest in the dentist's awards and association memberships, but it is only relevant for referrals, normally.  They don’t need to know all that to choose you as their dentist. The already made that decision. And, referrals are more likely to come from happy patients who feel part of the practice than from patients who thinks their dentist is bragging on himself/herself.  Contact the patient 6 to 7 times per year.  Remember WII-FM, and provide excellent care.  This will produce a referral rate of 2% to 3% of active patients per month.  If there are 2,000 patients, this will produce about 50, and that is enough to build a million dollar dental practice.

So, when you have enough patients already, you want to make sure you maximize those relationships, first.  That is the best place to spend promotional dollars.  Now, if you discover that you really do not have as many patients of record as you thought or as you need, then you must search for new patients among those who do not yet know your practice.  You will always get some new patients from drive-bys, yellow pages, signage, and insurance connections, but great dental practices are created from internal referrals. That is the key to a stable, profitable dental practice treating patients in a warm, caring environment.  -  L. Hurston Anderson, PhD