Date: Sat, 23 Dec 2006 00:44:47 -0600
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 21 Dec 2006 to 22 Dec 2006 (#2006-53)

There are 3 messages totalling 270 lines in this issue.

Topics of the day:
1. Re: Miscommunication? Resorbable solution?
2. Newbie, Lasers, Tip-Edge and I gotta be me
3. Ortho Program Tuition


Date: Fri, 22 Dec 2006 16:32:40 -0000
From: "Paul M Thomas" <p.thomas@EARTHLINK.NET>
Subject: Re: Miscommunication? Resorbable solution?


Dr. Kharsa et al, I agree that it would be nice to have some uniform nomenclature/classification of these gadgets. On the European continent, some use the term OBA. The term TAD may conjure up certain amusing mental images, but it has the benefit of being descriptive. From my perspective, the biggest void is not the need for nomenclature, but some decent research on failure rates and the factors leading to failure. Maurice Mommaerts and his group are among the few to produce anything resembling science. As far as the concept of resorbable anchorage devices....I see them as a solution for a problem that doesn't exist. In fact, they could cause more problems than they would solve. If resorbable anchors are being considered at all, I suspect it is an industry driven concept. I had explored this area in the late 90's when working with Walter Lorenz Surgical on development of a temporary implant system using their LactoSorb formulation. The problem is that the existing formulations of PGA PLA (the resorbable polymeres) are designed to resorb *sooner* than desired if they were to be used for orthodontic anchorage. So just as you mention, they would fail "before you were done with them". There is the additional problem of lacking the strength of titanium or titanium alloy. This would not be a problem for the actual tooth movement, but it would for placement. They would have enough bulk to avoid fracture or failure during placement. To lessen placement forces, the existing systems generally require drilling and tapping. The bulk required for strength limits the areas where they can be placed and has implications for the amount tissue reflection required for placement. Any company planning development in this area will have to go through the entire cascade of research leading to FDA approval. This would not be a simple 510K process as has been used for the modified titanium bone screws. It would involve bench, animal, clinical trial testing. Even then there is no guarantee of approval. you probably know, the FDA is VERY twitchy about artifical devices which have the capacity to create tissue reaction. The polyglycolic/polylactic and other similar polymeres resorb by a hydrolytic process which is not without tissue reaction. The typical adverse response is local inflammatory response with sterile abscesses. The effects of this reaction in an orthodontic application would need to be carefully examined. When you consider the R and D investment with the potential return, The headache of placement and the potential for adverse tissue reaction, I don't think we'll be seeing a viable resorbable orthodontic anchorage product any time in the near future. My two cents Kind Regards, Paul M Thomas Senior Research Fellow Departments of Orthodontics and Oral and Maxillofacial Surgery Eastman Dental Institute 256 Gray's Inn Road London WC1X 8LD


Date: Fri, 22 Dec 2006 09:04:17 -0600
From: "SCOTT SMORON" <scottsmoron@COMCAST.NET>
Subject: Newbie, Lasers, Tip-Edge and I gotta be me


Been a member of ESCO for going on about 8 years, maybe longer. I occasionally kick up dust on here about the state of computer software. Right now I am functioning pretty happily on Oasys and have bigger fish to fry. Also, love your postings. I like electrosurg. The laser I got cost about $7k. I saw Sellke talk re the waterlase and the choices he made about why he wanted the waterlase were questions that I could answer differently and thus my Zap Laser. Also, waterlase just too expensive to justify. Have you ever exposed a canine with the electrosurg? I mean, go down through like 4 mm of tissue. Or fully uncover a tooth that has no enamel showing? This is probably irrational, but I feel afraid I will fry some bone going deep with eletrosurg than with a laser. Really, I could do it with the laser too. TIP EDGE: You may not know this about St. Louis University, but it is huge. Typically 42 residents are there at a time, minimally, and there were 45 when I was there. While there I treated patients with actual Tweed Mechanices and J-pull headgear...set up anchorage, start START on 17x25 stainless steel, etc., I also treated patients with mods on standard edgewise, straightwire, extreme non-ex and, in my feeling, the unwarranted extraction, and many other variations. Even segmented mechanics, functionals, Kloehn, J-pull, sagittals, distal-jets, etc. We also do a typodont course in which we become somewhat adept at soldering hooks...and then do it chairside, which is not pretty, may i say. We also travel to Indiana and do the Tip-Edge course and treated patients with 3 tip-edge instructors in our clinic (Thanks to Chris and Peter Kesling and Dr. Richard Herz). SLU has something on the order of 20 to 25 part timer instructors that you treat at least one case with and learn their appliances, their choices, their philosphy and technique, etc. It is a diverse experience that leaves your head swirling for a while. You graduate with a breadth of clinical knowledge that there really isn't anything out there you have not seen or done. No really great need to experiment when you graduate because you already have. Tip-edge was not for me. I really admire the technique. I think it is elegant and has some real huge advantages over what I do daily (Ormco's Orthos straightwire). However, I want more CONTROL. I like small, twin brackets. So I just can't do it. It's the same reason I jettisoned the Damon 3s...finishing the cases was taking more effort and time than my traditional appliances and I normally treat out in about 18-24 months. The number of over 24 months cases in my practice can be counted on both hands. I have actually taken off the D3s and put on orthos for the final month or two on several cases. And please, don't take this as an invitation to Damonize me. I've been Damonic and I respect him, but it did not solve a problem for me and created new ones. I can finish someone tip-edge who transfers in, but I figure someone else can do it better. Kind of like with lingual orthodontics...Dr. Neil Warshawsky (of lingual care fame) is near by, does it better than me, so I occasionally refer the truly lingual-interested patient to him because he can do that better. Neil, don't get a swollen head.

scott smoron

ps thanks to all for feedback on topicals. Can't wait to try some new things in the new year!


Date: Fri, 22 Dec 2006 07:20:43 -0600
From: "Joe" <jsmileb@NETWURX.NET>
Subject: Ortho Program Tuition

Ladies and Gentlemen,

Especially any old timers, I was perusing the AAO website while trying to purchase the November AJO test (not yet available as of this writing, 12/22/06).  Anyway, came across the listing of programs.  I scrolled through and looked at the tuition costs for the various programs.  Decided that if I wanted to go back to ortho school now, I could not afford to. Another issue, I take the AJO test each month as a way of disciplining myself to read the journal, keep current.  Since they have gone to the online only format, I find they do not post the tests in a timely manner.  Also, it would be helpful to have a printer friendly format available to be able to print the test for taking while reading the articles.  Then, again, maybe I am the only one who takes the test so they may not want to cater to me.

Joe Brenner