Healthy smiles magazine

http://www.healthysmilemagazine.com/

ABOUT HEALTHYSMILE MAGAZINE HealthySmile is a consumer oriented, pro-dentist magazine designed to help you communicate more effectively with your patients prior to their visit to your office. A celebrity cover feature draws the patient into the magazine, where universally identifiable wellness topics such as fitness and nutrition engage and hold the readers’ interest. Sprinkled generously between these basic wellness articles are features and focus pieces on the issues, conditions, and services dentists care about and want to promote – things like preventive care, cosmetic dentistry, orthodontics, and more. ABOUT THE HEALTHYSMILE PROGRAM Below are some of the benefits of sending HealthySmile Magazine that will make it an integral part of your practice. Greater Visibility to Your Patients – A 40-page magazine is much more noticeable than a postcard. Your patients are more likely to notice and acknowledge that they’ve received the communication from you, and will appreciate the free gift.

Piezosurgery

Piezosurgery® technology opens up a new age for osteotomy and osteoplasty in Implantology, Periodontology, Endodontics and surgical Orthodontics.
 

Ø       Micrometric cutting action

Ø       Selective cutting action: minimum soft tissue damage

Ø       Maximum intra-operative visibility (cavitation effect)

Ø       Minimum surgical stress

Ø       Excellent tissue healing

    Maximum safety

Piezo Surgery Video

13/08/2007

http://www.piezosurgery.com/homeDent.asp  İlk kez 1998 yilinda bir periodontolog olan İtalyan Dr.Thomas Vercelotti tarafindan bu cihazin kesfedilmesi ile calismalar baslamis. Bugun o kadar cok kullanim alani var ki : 1-Osteotomi ve osteoplasti tekniginde kullanimi (J oral maxillofac surg 62, 759-761, 2004) 2-Dar kretlerde  alveoler kret genisletmesi isleminde (Int J Periodontics Restorative Dent.,20,358-365,2004) 3-Otojen kemik grefti alim islemlerinde ( J clin periodontol., 32, 994-999, 2006) 4-Nervus alveolaris inferiorun transpozisyonunda (J oral maxillofac surg., 34, 590-593, 2005) 5-Sinus tabani yukseltilmesi isleminde (Int J periodontics Restorative Dent., 21, 345-367, 2001) 6-Ortagnatik cerrahide kullanimi (Journal of Cranio-Maxillofacial surgery., 32, 381, 2001) Piezosurgery® technology opens up a new age for osteotomy and osteoplasty in Implantology, Periodontology, Endodontics and surgical Orthodontics.   Ø       Micrometric cutting action Ø       Selective cutting action: minimum soft tissue damage Ø       Maximum intra-operative visibility (cavitation effect) Ø       Minimum surgical stress Ø       Excellent tissue healing     Maximum safety   1-Mectron (piezosurgery) (www.piezosurgery.com) 2-Esacrome (Surgysonic) (www.cellinelaser.com/TR/surgysonic.asp) 3-BioSaf (Easysurgery) (www.bio-saf.com/prodotti/easysurgery04.html ) 4-Satelec (Piezotome) (www.acteongroup.com/SitePiezotome/LANG_u/Acc.asp)   Thank you for informations about piezosurgery to: Muammer GÖZLÜ,DDS,PhD Periodontist Dentestetik Dental Center 0090 533 472 12 12 Konya/TURKIYE www.dentestetik.com  DENTSECTORTV BLOG

What causes gum disease?

In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

• What’s your risk for having or developing periodontal disease?
  Use AAP’s risk assessment tool to find out!

Causes of Periodontal Disease

The main cause of periodontal disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. However, factors like the following also affect the health of your gums.

Smoking/Tobacco Use
As you probably already know, tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. What you may not know is that tobacco users also are at increased risk for periodontal disease. In fact, recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

• Smokers May Want to Kick Butt Before Dental Procedures (Press Release)
• Smoking and Periodontal Disease (Consumer Article)
• Cigar and Pipe Smoking Are as Dangerous as Cigarettes to Periodontal Health (Press Release)
• Study Points to Smoking as Major Cause of Gum Disease (Press Release)
• Smokers Have Lower Success Rates with Periodontal Treatment (Press Release)
• Study Shows Yet Another Reason Why Quitters Are Winners (Video News Release)
• Periodontists Encourage Patients To Quit Smoking Habit (AAP Member Survey)

Genetics
Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime.

• Study Finds Substantial Genetic Basis for Risk of Periodontal Disease (Press Release)
• Genetic Marker Common in People of European Heritage Doesn’t Explain High Rates of Periodontal Disease in Chinese (Press Release)
• Families and Periodontal Disease (Press Release)

Pregnancy and Puberty
As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet, and regular exercise are all important to help you stay in shape. You also know that at specific times in your life, you need to take extra care of yourself. Times when you mature and change, for example, puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy. During these particular times, your body experiences hormonal changes. These changes can affect many of the tissues in your body, including your gums. Your gums can become sensitive, and at times react strongly to the hormonal fluctuations. This may make you more susceptible to gum disease. Additionally, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver preterm, low birth weight babies.

• Dental Procedure May Reduce Risk of Premature Births (Press Release)
• More Severe Periodontal Disease Poses Additional Threat to Pregnant Diabetics (Press Release)
• Women and Periodontal Disease (Consumer Article)
• A Mouthful of Reasons to Consider Hormone Replacement Therapy (Press Release)
• Oral Health Advice for Mothers-to-Be (Press Release)
• Research Provides Further Evidence on the Importance of Good Oral Health in Pregnant Women (Press Release)

Stress
As you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

• Identifying Patients’ Stress Coping Behavior Key to Treatment Outcomes (Press Release)
• Financial Stress Doubles Periodontal Disease Risk (Press Release)
• Researchers Find Clinical Depression May Have Negative Effect on Periodontal Treatment Outcome (Press Release)

Medications
Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

• Common Treatment for Acne May Cause the Appearance of Discolored Gums (Press Release)
• Patients Taking Medication for High Blood Pressure Benefit from Frequent Dental Care (Press Release)

Clenching or Grinding Your Teeth
Has anyone ever told you that you grind your teeth at night? Is your jaw sore from clenching your teeth when you’re taking a test or solving a problem at work? Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

Diabetes
Diabetes is a disease that causes altered levels of sugar in the blood. Diabetes develops from either a deficiency in insulin production (a hormone that is the key component in the body’s ability to use blood sugars) or the body’s inability to use insulin correctly. According to the American Diabetes Association, approximately 16 million Americans have diabetes; however, more than half have not been diagnosed with this disease. If you are diabetic, you are at higher risk for developing infections, including periodontal diseases. These infections can impair the ability to process and/or utilize insulin, which may cause your diabetes to be more difficult to control and your infection to be more severe than a non-diabetic.

• More Severe Periodontal Disease Poses Additional Threat to Pregnant Diabetics (Press Release)
• Controlled Diabetics Have New Reason to Smile (Press Release)
• Diabetes: The Mouth-Body Connection (Consumer Article)

Poor Nutrition
As you may already know, a diet low in important nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of your gums.

• Researchers Find Link Between Obesity and Periodontal Disease (Press Release)
• Low Dietary Vitamin C Can Increase Risk for Periodontal Disease (Press Release)
• Healthy Gums Are Likely to Lie Behind Milk Mustaches (Press Release)
• Calcium Consumption and Oral Health (Video News Release)

Other Systemic Diseases
Diseases that interfere with the body’s immune system may worsen the condition of the gums.

• The Mouth Body Connection (Consumer Article)
• Healthy Gums, Healthier Bodies (Press Release)
• Why Periodontal Disease May Pose a Risk to Your Health (Video News Release)
• People With Rheumatoid Arthritis Have More Periodontal Disease (Press Release)

Types of Periodontal Disease

There are many forms of periodontal disease. The most common ones include the following.

Gingivitis
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with professional treatment and good at home oral care.

Aggressive Periodontitis
A form of periodontitis that occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.

Chronic Periodontitis
A form of periodontal disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gingiva. It is recognized as the most frequently occurring form of periodontitis. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Periodontitis as a Manifestation of Systemic Diseases
Periodontititis, often with onset at a young age, associated with one of several systemic diseases, such as diabetes.

Necrotizing Periodontal Diseases
An infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immunosuppression.

Treatment of Periodontal Disease

If you’re diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

• Pocket Reduction Procedures
• Regenerative Procedures
• Crown Lengthening
• Soft Tissue Grafts

If you’ve already lost a tooth to periodontal disease, you may be interested in dental implants – the permanent tooth replacement option.

http://www.perio.org/consumer/2a.html

Sinus Floor augmentation

Sinus floor augmentation Elevation and augmentation of the sinus floor is a widely accepted method of treatment. The application of Bio-Oss® alone or in combination with autogenous bone is very well documented scientifically. Various factors influence the decision whether autogenous bone should be mixed with Bio-Oss®. The use of Bio-Oss® alone is recommended when there is adequate residual bone height (< 5 mm) and good quality of the surronding bone. With less than 5 mm of residual alveolar bone, adding autogenous bone to Bio-Oss® is recommended.      Clinical Case: Sinus Floor Elevation

Case by Dr. Stephen Wallace  

                Histologic documentation is important to assess the biological response to any regenerative therapy. The photomicrographs below document the lack of any immunologic response to Bio-Oss®; rather new bone formation is present on the surface of the Bio-Oss® and forms bridges between the particles. In approximately six months, Bio-Oss® becomes integrated with newly formed lamellar bone; it is subsequently included in the physiologic remodeling process.

 Histology – Maxillary Sinus Floor GraftCase by Dr. Pascal Valentini, Histology by Dr. Robert Schenk; Berne, Switzerland  At 6 months postgrafting, the grafted area (coronal half of the section) consists of a dense scaffold of Bio-Oss® (*) interconnected by new bone. The orignial host bone (apical half of the section) represents a spongiosa of lower density. (Original magnification x 3.2)

 

At 6 months postgrafting, remodeling activity in the newly formed bone is high. Bio-Oss® (*) particles exposed to bone marrow are often lined by clear seams (arrows) partially covered by osteoclasts (arrowheads). (Original magnification x25.)         At 12 months postgrafting, the interconnecting bone in the grafted area has matured. The ongoing remodeling activity spreads out upon Bio-Oss® (*) surfaces that are exposed to bone marrow. (Original magnification x25.)

 

Bio-Oss® particle (*) enclosed by bone 12 months postgrafting. Particle surfaces exposed to marrow are lined by clear seams (arrows). Intensely stained lines indicate recalcification (arrowheads). (Original magnification x 50.)

 

     At 12 months postgrafting, new bone formation is seen in a preformed canal in a Bio-Oss® particle (*). The clear seam (arrows) within the canal indicates additional osteoclastic activity and is continuous with a dark seam (arrowheads) formed underneath newly deposited, packed lamellar bone. (Original magnification x50).   Bio-Oss® and Bio-Gide®: Long-term implant survival The slow resorption of Bio-Oss® results in a greater bone density and may have apositive influence on implant stability in the augmented maxillary sinus.2       Overall survival rates at 6.5 years following maxillary sinus augmentation:1Bio-Oss® alone = 96.8%Bio-Oss® + DFDBA = 90% Patients treated with Bio-Oss® alone show comparable survival rates using1-stage or 2-stage procedures.1         Comparable results with particulate autogenous bone or Bio-Oss®/Bio-Gide®.2 The resistance of Bio-Oss® to resorption is advantageous in maintaining the initial dimensions of the augmented graft.    In a meta-analysis, implant survival rates in the maxillary sinus increased by covering the lateral window with a membrane.3*93.6% survival rate with membrane*88.7% survival without a membrane. *p < 0.05   The use of a membrane has a positive influence on vital bone formation and implant survival The efficacy of membrane placement over the lateral window has been reported as both an increase in vital bone formation and as a resultant increase in implant survival. Three controlled trials (Tarnow, Tawil, Froum) show higher implant survival when a membrane is utilized. Two of these trials also show increased bone formation of 60-100% with a membrane. A comparison study (Wallace) of non-absorbable (ePTFE) and absorbable (Bio-Gide®) membranes showed similar histomorphometric and implant survival rates.    Histology – Graft with a Collagen Membrane

Histology by Dr. Stephen Wallace

 

                                                               

Eight month lateral window core biopsy of 100% Bio-Oss® graft covered with Bio-Gide® membrane. Membrane resorbed with lateral wall (left) reformed in bone the graft (right) consists of equal parts newly formed bone (30%) and residual Bio-Oss® (30%). Original magnification x 10. Higher magnification of internal portion of biopsy reveals intimate contact and “bridging” between Bio-Oss® particles (yellow) and newly formed bone (red). Original magnifcation x 20    Histology – Graft with an ePTFE MembraneHistology

by Dr. Stephe Wallace                                                                                                                        

Eight month lateral window core biopsy of 100% Bio-Oss® graft covered with ePTFE membrane. The graft consists of equal parts newly formed bone (30%) and residual Bio-Oss® (30%). Original magnification x 10. Higher magnification reveals intimate contact and “bridging” between Bio-Oss® particles (yellow) and newly formed bone (red). Original magnifcation x 20    References: 1-Valentini P, Abensur DJ. Maxillary Sinus Grafting with Anorganic Bovine Bone: A Clinical Report of Long-Term Results. J Oral Maxillofac Surg 2003; 18 (4) 556-560. 2-Hallman M, Sennerby L, Lundgren S. A clinical and histologic evaluation of implant integration in the posterior maxilla after maxillary sinus floor augmentation with bovine hydroxyapatite and autogenous bone. J Oral Maxillofac Surg 2002; 60:277-284. 3-meta-analysis: Wallace S, Froum S; 2003 

http://www.osteohealth.com

Introduction of normal and para functions of TMS

 INTRODUCTION OF NORMAL AND PARA FUNCTIONS OF

 TEMPORO MANDIBULAR SYSTEM

 

(3 “chews” per side, then a functional shift)

The image to the left is demonstrating normal reciprocal functioning of the Lateral Pterygoids and Masseters/Med.Pteygoids/Temporalis’.
The Lateral Pterygoids advance the condyles, thereby opening the mouth (depressing the mandible), with the assistance of the Digastric (next webpage).

The oblique orientation of the Masseters and Medial Pterygoids create a sling. The non-working side Medial Pterygoid contacts simultaneously with the opposide side working Masseter.

It is this oblique orientation of the Med.Pterygoids and Masseters that create the functional “shift” of the mandible, not an unilateral contraction of a Lateral Pterygoid.

In normal chewing function, the mandible opens, and then, while initiating closing, there is a shift slightly to the side of the bolus, due to the orientation of the masseter and medial pterygoid. There is no “canine rise” during normal chewing fuction. Canine rise is mechanism to combat parafunction.

The moving yellow dot in the jaw tracing to the left shows the tracking of the gingival margin of a lower incisor during the left “working” movement of chewing. The red lines are jaw movements with the teeth in contact (excursive grinding to each side). The outter most line is the envelop of maximum movements.

Notice how the during normal masticatory function, the teeth do not contact, but may occasionall glance off each other.
(From Lindeen and Gibbs: Advances in occlusion, Boston, 1982, John Wright PSG, p.19)

The animations above show the effect of the contractions of the lateral pterygoids: the advancement (translation) of the condyles. A voluntary opening of the mandible requires the LPs to contract, thus the immediate translation upon attempted opening.
However, a voluntary attempt at closing requires the immediate retrusion of the condyles by the posterior temporalis, thereby “un-translating” the condyles. At the final arc of closure, the condyle is braced against the eminance, while the anterior temporalis rotates the mandible closed.

The animation above and to upper demonstrate how the condyle immediately translates upon opening during masticatory function, due to the contraction of the lateral pterygoid. As closing ensues, the LPs relax, and the elevators contract. The tension of the posterior segment of the temporalis “un-translates” the condyle. During last portion of closing, the anterior temporalis and masseters brace the condyles against the eminance (seating to “CR”), referred to as “rotation”.

The blue dot is the position of the gingival margin of the central incisor. The condyle translates immediately upon opening, and is rotating during the final phase of closure. The superior head of the lateral pterygoid is bracing the disc against the eminance as the elevators rotate the mandible closed against the resistance of the bolus.

Just as the anterior temporalis can sustain considerable contaction intensities over extended periods, so it may be with the posterior temporalis. The result would not be the clenching of the teeth, but of the blockage of the airway. It is this possiblity that makes for the varying reports of tooth soreness from the use of anit-snoring/anti-apnea devices, that attempt to hold the jaw forward. The reason why there is difficulty in holding the jaw forward for some patients is their intensity of retrusion by the posterior temporalis.

Bruxism can not be casually described as “hyperactivity of the lateral pterygoid”. Each of the graphics below displays identical degreess of LP “hyperactivity”:

Only the graphic to the far left can be considered to NOT be bruxism, although there IS hyperactivity of the LPs. The definitive component of bruxism is the degree of parafunctional elevation, that is, the clenching component. An accurated definition of bruxism is: Jaw clenching, with or without forcible excursive movements, where the intensity of the clenching dictates the severity (or lack of) grinding (neither the graphic at the far left or the far right would display tooth wear, yet the graphic at the far right is the most extreme form of bruxism).

Above: “Protusive Clenching”
In the event the Temporalis’ do not cease their active contractions, scenarios of varying degrees of parafunction result, as the Lateral Pterygoids encounter resistance to their attempts at condylar advancement, thereby increasing their intensity of contraction and strain on their origins and insertions: the pterygoid plates of the sphenoid bone, and the condylar neck and disc.
The degree of frequency, duration and intensity of the contractions of a Lateral Pterygoid is a function of the resistance provided by the parafunction ipsilateral and/or contralateral Temporalis. For example, in the animation to the left, as a Lateral Pterygoid attempts to translate its condyle, it is met with resistance provided by the contralateral Temporalis, thereby causing the Lateral Pterygoid to pull its condyle in a medial direction toward the contralateral contact.

Dentistry has stipulated that an elevated mandible
is a presentation of a “functional” position.However,
the duration and frequency of elevation is rarely taken into consideration. Just as elevating one’s arm from its rest position to an elevated position with enough frequency and duration will present symptoms of parafucntion, the same applies to a mandible.
Once the mandible (or an arm) has been elevated, the resistance to the elevation will dictate the intensity of contaction and degree of symptoms. Whereas skeletal muscle needs a foreign resistance to contract with maximal intensity, the temporalis has built in resistance, the maxilla. Sleeps studies have recorded clenching intensities above voluntary maximum

James P. Boyd, DDS