Date: Tue, 19 Dec 2006 00:26:29 -0600
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 14 Dec 2006 to 18 Dec 2006 (#2006-51)
To: ESCO@LISTSERV.UIC.EDU

There are 6 messages totalling 961 lines in this issue.

Topics of the day:
1. TAD's
2. Auto immune disease
3. ESCO Digest - 13 Dec 2006 to 14 Dec 2006 (#2006-50)
4. TAD
5. TADs.......
6. Invisalign vs. OrthoClear...Once and for all!

 

Date: Fri, 15 Dec 2006 18:12:22 -0500
From: "Barry Raphael" <drbarry@ALIGNMINE.COM>
Subject: TAD's

I've got four cases of TADs (Scott: Templants, I like it….) going, but seem not to be caught up in the revolution quite yet.  The more thinking I do with treatment planning, the less I find a need for them.  And they always seem to be in the way at one point or another.  Like when distalizing an upper arch.  Where to you put the thing that it won't interfere?  I like the zygomatic bone plate to use for a Class I anchor or for intrusion of the upper posterior region.

TAFN (another stupid acronym for That All For Now. Sorry, Scott…)

Barry Raphael

 

Date: Mon, 18 Dec 2006 23:32:05 +1100
From: "Dr Ronny Marks" <ronnymar@BIGPOND.NET.AU>
Subject: Auto immune disease

Dear Adrian Becker and Colleagues

Regards from Australia I have been requested to do orthodontics on a BEHCET'S DISEASE patient. Behçet's disease is an autoimmune disease that results from damage to blood vessels throughout the body, particularly veins. In an autoimmune disease, the immune system attacks and harms the bodies' own tissues. The exact cause of Behçet's disease is unknown. Most symptoms of the disease are caused by vasculitis (an inflammation of the blood vessels). Inflammation is a characteristic reaction of the body to injury or disease and is marked by four signs: swelling, redness, heat, and pain. Doctors think that an autoimmune reaction may cause the blood vessels to become inflamed, but they do not know what triggers this reaction. Under normal conditions, the immune system protects the body from diseases and infections by killing harmful "foreign" substances, such as germs, that enter the body. In an autoimmune reaction, the immune system mistakenly attacks and harms the body's own tissues. Behçet's disease is not contagious; it is not spread from one person to another. Behçet's disease affects each person differently. The four most common symptoms (as listed) are mouth sores, genital sores, inflammation inside of the eye, and skin problems. Inflammation inside of the eye (uveitis, retinitis, and iritis) occurs in more that half of those with Behçet's disease and can cause blurred vision, pain, and redness. Other symptoms may include arthritis, blood clots, and inflammation in the central nervous system and digestive organs. 
http://www.behcets.com The patient is a 14 year old female. Two issues concern me? I can't find any information when I search the orthodontic literature. Is it OK to treat a patient with Orthodontics, as tooth movement requires some inflammatory process with may or may not be affected by this syndrome? The medication she is on is a steroid and an anti inflammatory drug. Colchicine 2x500mg per day. Will the medication inhibit tooth movement? Will their be excessive ulcers and increased plaque accumulation?  Recurrent and painful episodes of oral ulcerations interfere with regular oral hygiene leading to rapid bacterial plaque accumulation.

J Periodontal. 1999 Dec;70(12):1449-56. Links

Periodontal findings and systemic antibody responses to oral microorganisms in Behcet's disease.

· Celenligil-Nazliel H , · Kansu E ,  · Ebersole JL .

Recurrent and painful episodes of oral ulcerations interfere with regular oral hygiene leading to rapid bacterial plaque accumulation. Your input would be greatly appreciated. Dr Ronny Marks
Specialist Orthodontist [BDS MSc MDent [Ortho] Wits]
Suite 5 Level 1, 55 Grandview Str, Pymble, NSW, 2073, Sydney, Australia
PO Box 6002, Pymble, NSW, 2073, Australia
E-mail: OrthoPym@bigpond.net.au
(W)     +61 2 9440 2522
(Fax)   +61 2 9144 3537

 

Date: Fri, 15 Dec 2006 08:47:06 EST
From: DRGSCOTT@AOL.COM
Subject: Re: ESCO Digest - 13 Dec 2006 to 14 Dec 2006 (#2006-50)
In a message dated 12/15/2006 1:17:04 AM Eastern Standard Time, LISTSERV@LISTSERV.UIC.EDU writes: Here's what I am using...Imtec screws...2% lidocaine...patient paints
tissues around implant with Chlorhexidine on a q-tip twice a day.  I tried
topical anesthetic...no way.  Soft tissue punch...tooo much blood.
Drill...yeah, and go through the root?  I just anesthetize, line it up, and
place it.  The tissues adapt every time...they do "tug" as I screw, but a
little touch releases the friction.

What are you doing?

Scott Smoron
Try using that TAC topical you mentioned in the other post... I have used it to place
TADS without local (in only one patient so far) and they did great.  It has to be on for 3 minutes, rinsed, and then wait another 3 minutes.  I even used it to cut a window over a cuspid close to the surface to bond on a bracket. Greg Scott

 

Date: Fri, 15 Dec 2006 14:08:35 +0300
From: "Dr.Kharsa" <dr.kharsa@GMAIL.COM>
Subject: Re: TAD

Dear Colleagues:

It's very easy for anyone to disdain, ignore or neglect others' accomplishments, however, TAD has been a real breakthrough in orthodontic anchorage, despite of any possible side-effects!. . .

Any issue has its potential side-effects or negative assets, nevertheless, TAD, mini-screws or micro-implants are a leverage, foothold and basis for new approaches as "still under researches" the resorpable mini-screws, which I think is the perspective of future orthodontics.

Thank you.
Dr.M.A.Kharsa

 

Date: Sat, 16 Dec 2006 00:36:40 +0530
From: "Mani K. Prakash" <mkprak@GMAIL.COM>
Subject: TADs.......

Dear Scot,

I do second your thoughts about TADs...sure can't call it by that name with patients (sounds more like like dealing with tadpoles!). I do not even mention the word 'Implants' with the patients as somebody in the family has gone through Prosthetic implants that recalls experiences related with a whole lot surgery with heavy drilling and not to mention the unaffordable cost thereinvolved! The immediate reaction is no to 'Templants' (I like that name). I always use the word Micro screws (which substantially brings down the image of invasive action) and explain the the extent - or lack thereof- surgical intrusion. I do stress on the fact that I do not even infiltrate  local anesthesia,  to gain quick acceptance of the procedure. 95 % of my cases (have inserted better part of 300 screws) have been with surface sprays-sure it works- the only difference is I use 15% Lidocane ( yes,2 or 4% does not work), which works like a dream, even when you need to use a stab incision on areas of unattached gingivae. The only flip side is it takes time to act- you need to wait for 5-7 minutes to start work after the spray.

I use the Korean Dentos screws, which are all self drilling and tapered. No need to pre-drill, it good enough to make a purchase point with a 1mm round bur (of about 1mm deep), so that insertion  of the screw, in an angulated path does not slip around during the act. The gingival enlargement has never been an issue, as they heal very nicely around the neck of the screws, probably due to designing of the neck. Never indulged in tissue punching as in my opinion it is far too invasive then needed. Not even one screw has been removed by us due to gingival enlargement!

Hope that will help...
Mani K Prakash M.D.S.


--
--
Dr. Mani K. Prakash M.D.S.
103, Charisma Centre,
19th Road, Chembur
Mumbai  400 071. India
Alternate e-mail:mkprak@vsnl.com
Visit us at: www.drmkprakash.com

Date: Thu, 14 Dec 2006 10:00:50 -0600
From: SCOTT SMORON < scottsmoron@COMCAST.NET >
Subject: TADs...?
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To those annoyed with Align comments, why not discuss TADs.  I will start
the ball rolling.

TADs suck.  This is the worst term ever.  Ford Probe?  Who comes up with
these?  And my apologies to Dr. Cope if it's you...I have great respect for
you.

I love these things so far...the complications related to them is far
outweighed by the WOW factor.

Templants?  I usually just call them screws and talk plainly.  But I cannot
use the term TAD with a patient.  "I want to use TADs..."  No way.  "We can
make use of these amazing little screws that are used temporarily and then
removed."

Any chance to change this term before it gets embedded in our literature too
deeply?

And I know it's fluff, maybe it's me, but TADs sounds ridiculous.

Here's what I am using...Imtec screws...2% lidocaine...patient paints
tissues around implant with Chlorhexidine on a q-tip twice a day.  I tried
topical anesthetic...no way.  Soft tissue punch...tooo much blood.
Drill...yeah, and go through the root?  I just anesthetize, line it up, and
place it.  The tissues adapt every time...they do "tug" as I screw, but a
little touch releases the friction.

What are you doing?

Scott Smoron

Date: Fri, 15 Dec 2006 08:41:50 -0600
From: "Lester Kuperman" <lester@KUPERMANORTHO.COM>
Subject: Invisalign vs. OrthoClear...Once and for all!

Please accept my apologies in advance if I offend anyone, but this online debate is ridiculous. I'm not always verbatim in quoting famous Americans but I believe there is one that seems appropriate: "I have met the enemy, and the enemy is us." For every choice we make in life...there are consequences...good or bad...and we have to live with them. So always make good choices that you know you can live with and be happy.

CUSTOMER SERVICE AND TREATMENT CAPABILITES I have been a customer of Invisalign and have had excellent customer service throughout the entire 7-1/2 years...since June, 1999. I have submitted approximately 500 cases...many of which have been extremely difficult...and have achieved some spectacular results. The major difference in my cases is patient compliance...and we address that at the practice level. Good patients get good results...with little modification issues. Poor compliance equals major problems. The other major element of success with Invisalign is being a devoted student of the technique and learning what does and doesn't work. I have never attended an OrthoClear seminar...nor have I submitted a case to OrthoClear. Surely, they have some nice innovations...and these might be of interest to me, if and when Invisalign chooses to incorporate these.

CHOICE: It seemed very obvious from the beginning that there would be patent issues and lawsuits. Savings on lab fees seemed tempting...but I was originally concerned with what would happen...NOT IF...BUT WHEN legal action took its bite into the picture. I suspected that OrthoClear would likely not survive and that I would be left holding the bag. It was my CHOICE to stay with Align and to pay the higher fee...even if it weren't reduced...so that I could avoid the issues some of you are now experiencing...and I've only seen a few posters bold enough to complain...I also knew what to expect from Invisalign and did not want to re-invent the wheel.

PATENTS: I accept the fact that Invisalign raised millions of dollar from private investors and then public investors...I have no idea how much but would guess that it is well into the hundreds of millions of dollars. The AAO didn't offer a grant for $100,000,000 to get them off the ground. I didn't see 10,000 orthodontists line up to send in their investment of $10,000-$20,000 to help the product in its initial years. I haven't even seen that many who were committed enough to work with the appliance in its early years...let alone even to try it. There are so many patents involving Orthodontic products and techniques...and so many royalties...that we don't even know about. No one is beating the drum against these.

PATENTS ARE ESSENTIAL to a business development of this size...Align is fully entitled to their products to protect their investors...just like all our other major manufacturers. Obviously competition is good...but there are rules. As orthodontists and patients, we benefit from the competition. Hopefully, Align will continue its business as if it has lots of competitors.

ORTHODONTISTS AND PATIENTS BENEFIT: But it's not all about a business investment....All orthodontists are beneficiaries of this massive technological development. Granted the idea of resetting teeth on a model and making appliances to produce that movement is not a new idea...but who else ever did that to the level of sophistication that we now enjoy today? And our patients are the beneficiaries of this. They can be comfortably treated as adults...with almost NO adverse periodontal effects or root resorption...and still have a TMJ-friendly appliance. It is an absolutely indispensable part of my treatment armamentarium and will only get better. In addition, their advertising whether you liked it or not created an increased public awareness of orthodontics in general. There was no increase in your AAO bill...it's been going on for years...and it probably drove new patients into orthodontic offices. I know my practice grew as a result of this.

LAWSUITS, CONFIDENTIALITY AGREEMENTS AND NON-DISCLOSURES: Lawsuits are ugly and brutal....and lawyers make millions of dollars. The lawyers truly are the consistent winners. When it is all said and done...all of the negotiations and details of the settlement are usually cloaked in "non-disclosure" and "confidentiality" agreements. The bottom line is that none of us will really know what the real discussions were and who did what and why. So why would we even begin to speculate...and then broadcast what is nothing more than gossip?

ALIGN'S OFFER FOR ORTHOCLEAR CASES: I would like to assume that Align is doing its best to accommodate the OrthoClear cases...with consideration given to their own business operations and cash flow. Surely they want this to be a positive experience for all. We have been told that they voluntarily made this offer...but it doesn't matter how this was decided...it is still a generous offer and a costly offer. As an orthodontist getting something for nothing...I would try my best to work with instead of against the system. You catch more flies with sugar than salt.

RESPONSIBILITY: The new American way is to not accept any responsibility for our own actions but rather to blame it on someone else. If that works better, then do it. We all made a conscious decision of who to do business with...and we are responsible for our own choices.

ADVICE: It's probably too late now, but my suggestion is that OrthoClear orthodontists POSITIVELY explain to the patient that OrthoClear is out of business. Their treatment will be continued with Invisalign as soon as possible. In the meantime, make them some clear retainers to be worn at night time so that none of their progress is lost during the transition. While the patient might not like the delay, they will probably accept the explanation in the same way it is presented...and you should be able to continue to a great result. I would also suggest that you try to attend some IPW's or study clubs so that you can understand some of the developments that have occurred in the past two years that have tremendously enhanced the performance of Invisalign treatment.

DISCLAIMER: The above thoughts are purely my own opinion. I am not an Align employee. I do not own stock in the company. I receive no royalties from Align. Please don't sue my buns.

Dr. Lester Kuperman