Topics of the day:

1. ESCO - The Electronic Study Club for Orthodontics
2. Re: bonding to porcelain
3. Fw: ESCO Digest - 3 Dec 2002 to 10 Dec 2002 (#2002-41)
4. ESCO Digest - 10 Dec 2002 to 20 Dec 2002 (#2002-42)
5. SCANNERS
6. Imaging Program
7. Bonding to porcelain
8. Cuspid protection or group function?
9. Tip-Edge versus Edgewise


Dear Colleague:

The Electronic Study Club for Orthodontics (ESCO) is a free forum for exchange of information and opinions among orthodontists, and for distribution of professional information, sponsored by the Department of Orthodontics, University of Illinois at Chicago.  Information distributed on this list-server is NOT edited or refereed, and it represents only the opinions of the writers of the individual messages. Such writers bear the sole responsibility for the content of messages they author.  Authors are required to verify information regarding other parties included in their messages.  

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Sincerely,

Joseph H. Zernik, D.M.D. Ph.D.
Professor of Orthodontics
http://home.earthlink.net/~jz12345/index.html



From: Ted Schipper [DrTedsBraces@AOL.COM]
Sent: Fri 1/3/2003 3:25 PM
Subject: Re: bonding to porcelain

What do you do with/to the roughened porcelain after treatment?
Ted Schipper


From: Roy King [rkking@BELLSOUTH.NET]
Sent: Sun 1/5/2003 8:54 PM
Subject: Fw: ESCO Digest - 3 Dec 2002 to 10 Dec 2002 (#2002-41)

John. I have had excellent success useing porcelain etch for 5 minutes instead of the 2 minutes that the manufacturer recommends.  Of course you should remove the glaze on the porcelain with a diamond burr. Roy King

----- Original Message -----
From:
BENKOVICHJ@AOL.COM
Sent:
Wednesday, December 11, 2002 9:52 AM
Subject:
Re: ESCO Digest - 3 Dec 2002 to 10 Dec 2002 (#2002-41)

Hello all,

I am very much interested in finding a reliable way to bond brackets to porcelain.  Who has a tried and true method for me?

Thanks,

John Benkovich
(Annapolis, MD)


From: Dr. Ormond Grimes [heyorm@RAINBOW-ORTHO.ORG]
Sent: Thu 1/9/2003 9:48 AM
Subject: Re: ESCO Digest - 10 Dec 2002 to 20 Dec 2002 (#2002-42)

In reference to bonding to porcelain: I use a microetcher from Henry Schein called a Clinical Sand Blaster to roughen the surface of the porcelain and the posterior teeth. I do not use bands anywhere except with a face bow or after repeated breakage. The sand come out of it pretty good so I place a mask on the patient and used rapid air evacuation to try to catch some of it before it exits the mouth. I ask the patient to try not to breathe any of it.

After the mouth is cleaned up I use a product sold by Reliance Orthodontic Products (800-323-4348, P.O.Box 678, Itasca, Il 60143) which comes with instructions and all you need to do this including gingival protectant and porcelain conditioner. It works very well. It does use a severely corrosive acid, hydrofluoric, so precautions must be used. The kit has all you need. Just follow the directions.

On a different subject: canted occlusal plane. I believe that the best way to correct a canted plane is the use of micro implants. Pull up on one side in one jaw, down on the other side in the other jaw. This will give an intrusive effect on opposite sides. Intrusive or extrusive forces depending on whether the bite should be opened or closed. I haven't tried it yet because I haven't used ortho implants yet. Looking for a course or something so that I can. I do have an oral surgeon here who says he can do it, but I had rather do it myself. I will certainly let him do the first implant placement.

Orm
--
Orm's web site is <http//www.Rainbow-Ortho.org>
Mailto: <HeyOrm@Rainbow-Ortho.org>


From: Dr. Bill Odom [bill@ODOMORTHO.COM]
Sent: Mon 1/6/2003 5:31 PM
Subject: Re: bonding to porcelain

Group,
Attached is the simplified and latest iteration of surface treatments that we have used for bonding, both directly and indirectly with great success. The porcelain technique rarely failed clinically and more importantly did not result in damage to the porcelain surface upon debonding. The same can be said of the other surface treatments on the list. Generally my concern is for a bond that is too strong which could results in damage to the enamel or porcelain upon debonding.
Bonding is still technique sensitive, but not nearly so much as a few years ago. The most significant advance is Ormco's product Ortho-Solo which simplified and improved reliability of all second molar to second molar bonding. The other device that is mandatory for bonding to other than enamel surfaces is Danville Engineering's Micro etcher. I can recommend the following products for other than enamel surfaces:Ormco's Porcelain Primer and Reliance Metal Primer and for all surfaces we use Ortho Solo with Unitek Transbond, even for atypical enamel. The step by step is shown on the attachment.
Best regards,
Bill Odom

(Please click here to see the attachment.)


From: Lively Orthodontics, P.A. [mdlively@BELLSOUTH.NET]
Sent: Sun 1/5/2003 4:05 PM
Subject: SCANNERS

Happy New Year to All: I was wondering what has been found to be the most affordable and most consistent scanner on the market from letters to x-rays.  Any input would be greatly appreciated.  I just bought an HP scanner with transparency adapter (in a hurry) and found out that the TA was for negatives and slides and not as I was advised for x-rays. With warmest personal regards,

Mark

Mark David Lively, DMD
Lively Orthodontics, P.A.

mdlively@bellsouth.net


From: David Young [davyoun@ITSA.UCSF.EDU]
Sent: Sun 1/5/2003 7:39 PM
Subject: Re: Imaging Program

Gosh,

I hope I didn't create too much confusion with my previous message.  Looking over my previous post and after reading your post, I'm not sure where the confusion you make reference to lies.  However, for the sake of clarity, let me again repeat that contrary to the claims on the Quick Ceph website:  " Quick Ceph 2000 uses images with a resolution of 1200 by 1200 pixels. Other programs use only up to 640 by 480 pixels. Why buy a high resolution digital camera when 5 of 6 pixels, or 83%, of the image content is discarded"  it is a mistake to make that type of generalization. Eighty-three percent of the image content is discarded? That statement is just bizarre. Maybe you were referring to a particular program and not all imaging programs? What imaging programs do this? You also ask:  "Can the orthodontic imaging software process, digitize, perform treatment simulations, and morph images at a higher resolution than 640 x 480 pixels?" The answer is yes. At least Dolphin can. I'm not as familiar with other imaging programs so I cannot speak to them. However, I would be surprised if any of the popular imaging programs currently on the market were working with images at such a low resolution. Ton, which particular programs were you thinking of? I do applaud your effort to dispel any confusion that might exist about your product. I think more companies would benefit from this type of proactive customer care. However, given how this topic came up (Bob Gange's question), I would not be surprised if the confusion originated from your website. The page which lists on a point-by-point basis the advantages of Quick Ceph over its competition ( http://www.quickceph.com/qc_advantages.html ) has quite a few mistakes and inaccuracies. It looks like most of the text dealing with these comparisons hasn't been changed in about 2.5 years. Given how quickly the field of digital imaging changes, an update to that page may go a long way towards avoiding future confusion.

David Young


From: Dr. Lars Fuck [fuck@UNI-DUESSELDORF.DE]
Sent: Fri 1/3/2003 2:29 AM
Subject: Re: bonding to porcelain

Hello John,

Here is another at least most successful way of bonding to porcelain. it doesn´t really differ from Kevin´s suggestion but maybe you have the equipment and will try it out. First we use this so called microetcher - a relatively aggressive sandblaster roughening the surface of porcelaine very satisfying (it also works on metal surfaces with same results). Second we apply porcelain etcher from Reliance and use a tissue blocker to avoid gingival damage. Further the patient is equipped with protection specs to avoid eye damages. Wipe and rinse after 90 sec the same way Kevin does. Then we use Maximum Cure (Reliance) as a bonding layer which will cure chemically and use Reliabond as normal adhesive! For best results the use of Concise (Unitek) is suggested. Results are most successful. The same way will work on metal surfaces with one exception: Use a metal primer (Reliance) insead of Porce-etch!

Greetings and all the best for 2003.

Lars Fuck
Duesseldorf, Germany
Orthodontist


From: Dr. Tim Dumore [Tim@DRDUMORE.COM]
Sent: Fri 1/3/2003 6:04 PM
Subject: Bonding to porcelain

Hello,

The only thing that I might add to Kevin Utley's suggestion on how to bond to porcelain is to consider micro etching the porcelain surface with aluminum oxide (if you don't have air hookups at your chairs, you would need to do this) instead of using a bur.

As well, I believe that the porcelain etch must stay on the tooth for 3 minutes, while the porcelain conditioner only needs to stay on the surface for 1 minute.

Either way, it works swell!

Tim Dumore

Winnipeg

…happy new year!

Please visit our website @

www.drdumore.com


From: PAUL JOHNSON [p8johnson@YAHOO.COM]
Sent: Fri 1/3/2003 8:00 PM
Subject: Cuspid protection or group function?

Dear group,

From what I have read in the ESCO Digests about half of our members subscribe to each scheme. Considering that most of our referring dentists believe in mutual protection, it seems that we (brightest and…) should strive for what is taught in our under graduate curricula. This concept is where you get the lift as far forward as possible so the +/- 400 # of closing force (molar area) will not be directed laterally against the posteriors, rather, this strong vector will go solely along the vertical axes of the teeth.

With canine guidance, during mastication, the mandible is directed to centric relation where with immediate disclusion it is impossible for lateral forces to traumatize the posteriors. The incisors will not receive excessive stress because the masseter, internal pterygoid, and temporal muscles are moderately deactivated in protrusive; consequently, we incise using approximately 30 #.

If our referrals come from occlusion oriented dentists (Aren't they all?) and if they realize that our goal is group function, then I doubt that we would receive any new patients. How many of us would inform our communities that we think group function is the better of the two choices when we know that it would be just as easy to formulate a treatment plan ending with mutual protection? Of course, the potential would have to be there at the start.

Let's go back and see what the “Father of Modern Orthodontics” had to say about functional occlusion: His textbook (1) has a photo of the Broomell skull -“Old Glory”- which shows that the maxillary canine is 1 ½ mm longer than the adjacent teeth. Do we need any more “hard science” or “truth” than this?

The term “Old Glory” was found in T. M. Graber's book (2) referring to Broomell.


Fast-forward to 2003 to see a patient similar to Angle's and Graber's insinuation of what is ideal: < http://www.bocaratoncosmeticdentist.com/biteocclusion.html > (Dec 2002).

The Canine Guidance illustration is 1/3 down his (Dr. Pohl's) (3) web page. Anterior Guidance is about half way down. Please note that the mandibular canine is about ¾ mm longer than its neighbors: it has the strong root.

Here we have two color photos of the “Old Glory” dentition (+/-) in right lateral and protrusive, which I'll try and put into attachments.

Kindly “zoom in” to maximum size to appreciate “truth.” It makes no sense to me to set up the occlusion to foster lateral forces against the first bicuspid when the “cornerstone” cuspid is so readily available.

For Esco readers who still believe group function is superior to a cuspid protected occlusion (I am going to get a little ridiculous right now so hopefully you are sitting down) the obvious approach would be to take the occlusion in the Canine Guidance photo and grind down the cuspids until the posteriors reached group function. All of us would agree that would be a terrible tragedy. If you would not “diamond stone” these canines, how can you say group function is better?

Did someone state that the cuspids would wear down, in time, to produce what I call second best? While that may happen in some cases, it never happened in my mouth: Yes, my canines have worn considerably, but somehow cuspid lift is still operative. My family dentist practices using good occlusal principles which helps.

Dr. Pohl's caption states, “Starting at centric occlusion and keeping the teeth in contact as much as possible, we slide the lower jaw to one side: In an ideal occlusion when the lower jaw is shifted, the posterior teeth should not touch…

“Canine protected occlusion is an important concept especially for people who have excessive wear on their teeth, erosion of their roots, gingival recession, and suffer from TMJ dysfunction.”

A good article (4) points out the merits of cuspid function.

How about putting together a “balance sheet” listing the pros and cons of the two arrangements? Some day when “truth” is established, my prediction is that the ledger will have many pro factors in favor of cuspid protection. The only thing favoring group function will be that when orthodontists first started placing brackets on teeth they decided that the occlusal margin of the slot should be a certain distance from the occlusal (incisal) edge of the tooth. When the brackets end up so as to produce the group function protocol, that is a wrong. If the patient becomes a bruxer the chances of harm are compounded. It is time to enter the 21 st century with what is best for our patients by teaching graduate students the same principles that are taught to undergrads.

An afterthought: A third snapshot (the one just above Dr. Pohl's Canine Guidance) shows Centric Occlusion with +/- 3 mm of overbite (central incisors) and a nice Curve of Spee. None of my American Board cases (I was only able to complete three of them) looked like this, the ideal. Take one of your referral sources into the A.B.O. case presentation room at the next national meeting and pick up one of the “finished” models, one having about 1 mm overbite and group function. Hold the reproductions and slide the mandibular cast into the three excursions. At that moment you may wish to place cotton in your ears because you may never have heard some of the expletives before, in polite society, that is.

(1) Angle, Edward H., M.D., D.D.S. MALOCCLUSION OF THE TEETH. 7 th Ed. Philadelphia, SS White Dental Mfg. Co., p. 9, 1907.

(2) Graber, Thomas M., D.D.S., M.S.D. Ph.D. ORTHODONTICS. Philadelphia, W. B. Saunders Co., p. 130, 1961.

(3) Mitchell Pohl, D.D.S., N.Y.U., c. 1978 put the “cosmeticdentist” web page together.

(4) D'Amico, A.: The Canine Teeth-Normal functional relation of the natural teeth of man. Southern California Dental Association Journal, 26:6; 49; 127; 1958. Available, I believe, from the A.D.A. library on an inter library loan arrangement.

Regards,

Paul Johnson

Tustin, CA

CANINE GUIDANCE ANTERIOR GUIDANCE CENTRIC OCCLUSION

From: Jérôme Wanono [jeromewanono@YAHOO.FR]
Sent: Sun 1/5/2003 3:15 PM
Subject: Tip-Edge versus Edgewise

Hello everyone !

My name is Jerome WANONO, I am 30 years old and a 3 rd year student at Montreal's University Orthodontic Department. Montreal University is basically a " Burstone " school : we use segmented mechanics when we need them and regular SWA.

During my second year, I had to present a lecture on the Tip-Edge appliance (TE). So I read the TE Guide, the articles in the press and in " Tip-Edge today " and I saw all the TE videos. Then, students of 3 rd year went to the TE course in La Porte, kindly paid by TP orthodontics.

I would like to mention that I never treated a single case with TE. Still, I would like to add some points to the interesting TE debate of ESCO.

Best regards to Edgewise and TE ladies and gentlemen ! !

Jérôme WANONO