Date: Fri, 29 Dec 2006 00:18:11 -0600
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 22 Dec 2006 to 28 Dec 2006 (#2006-54)

There are 6 messages totalling 2609 lines in this issue.

Topics of the day:
1. Electrosurgery
2. Behcet's disease & orthodontics
3. OC Submission
4. Re: scott
5. Finger Habit
6. Re: TADS


Date: Fri, 29 Dec 2006 11:55:17 +1000
From: "Dr P. Miles" <pmiles@BEAUTIFULSMILES.COM.AU>
Subject: Re: Electrosurgery

Hi Scott,

Charlie and all Like Charlie, I am using an electrosurg unit for partial and full exposures as well as frenectomies, operculectomies, and gingival cosmetic contouring. It is very neat and effective with the stiff tip making it very precise. I have done 3mm deep exposures as Scott asked below (photo attached of exposure and 10 wks later). However, disadvantages of electrosurgery include the need for local anaesthesia (which I do initially and then place brackets or adjust the archwire while it goes numb) and that it should not be used on patients with pacemakers or within 15 feet of someone with a pacemaker. Although it has been shown to be safe when used near bone (Schieda, J.D.; DeMarco, T.; Johnson, L.E.: Alveolar bone response to electrosurgical scalpel, J Periodontol. 43:225, 1972.), (and surgeons diathermy bone every day), it is prudent to avoid contact due to the potential risk of necrosis. For this reason, if there is any doubt about the level of underlying bone and as I currently do not have a laser, I either refer the patient or use a scalpel to reflect a small flap to visualise the area prior to using electrosurgery. Electrosurgery is less expensive, provides many of the same benefits as laser treatments, no special eye-protection is required, and has no special registration requirements. There are certainly less expensive units on the market (e.g. I use a Parkell 600SE which is ~$1200 in Australian dollars so probably well less than $1000 USD), however some are presented/packaged more neatly than others which may reflect part of the cost difference. So if you want a cheap intro to exposures and gingival contouring, choose some simple cases to start with (partial exposures) and give it a go but make sure you preserve some attached tissue otherwise it really requries a repositioned flap. I would love to get some of that topical in Australia to try out!

Peter Miles


Date: Sun, 24 Dec 2006 19:02:45 +0200
From: "Adrian Becker" <adrianb@CC.HUJI.AC.IL>
Subject: Behcet's disease & orthodontics

Dear Ronny and ESCO colleagues, Ronny Marks in Australia requested some input regarding a patient with Behcet's disease. I have no experience with it and so I contacted Prof. Rafael Benoliel, Chair of Oral Medicine at our school - the Hebrew University-Hadassah School of Dental Medicine in Jerusalem, Israel and the following was his analysis and advice, with some additional input from Dr. Sharon Elad.

"There is nothing on ortho and Behcet's that I know of. However, we can extrapolate basic knowledge on the disease and its treatment. This means intelligent, informed guesswork ……

I would be concerned about the following:

1. Oral ulcers would probably increase in frequency due to the irritation from appliance/fixed . This usually means that oral health care in general is not optimal; during ortho this may deteriorate further

2. Periodontal indices are poorer and there is a decreased Ab response to early colonizers of plaque.

(Celenligil-Nazliel et al. J Periodontol. 1999;70(12):1449-56).

3. Arthritis is a rare complication and usually affects large joints. However I would definitely refrain from loading the TMJ.

4. Steroids and colchicine therapy; immunosuppressants that will affect infection, wound healing.

5. Additionally, long term steroids may induce osteoporosis and I am not sure how well this type of bone copes with ortho forces.

So a good general approach would be as follows:-

Step 1: Seriously weigh the real benefits of orthodontics versus possible complications. That means in this particular case, what is the real need for ortho? If the answer is that oral health (not only esthetics) will be enhanced we go to step 2.

Step 2: Consult and work closely with the treating rheumatologist, physician. If the rheumatologist agrees we proceed.

Step 3: I would go for a mild compromise in orthodontic result if it can be attained with a simpler, shorter and less aggressive treatment option.

Step 4: Once the treatment plan is formulated, present this to the patient and parents with the premise that there is not much known on the possible problems. In addition to the usual ortho set of images I would recommend:

a. Baseline full mouth periapicals

b. Baseline TMJ radiographs

Step 5: If agreement is reached (careful and precise documentation) proceed. Regular recall (more than usual) to maintain optimal oral hygiene- supplement with chemical antiplaque agents if needed, topical fluoride and soft tissue examination. During treatment I would radiograph (selectively) teeth that are being moved to check that bone is being remodelled.

Having said all this I personally do not think that there should be any problems with basic orthodontic care.

Some relevant references:

[1]        Carl W, Havens J, Kielich M. Behcet's disease: dental and oral soft tissue complications. Quintessence Int. 2000;31:113-6.

[2]        Dervis E. Oral implications of osteoporosis. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2005;100:349-56.

[3]        Kari JA, Shah V, Dillon MJ. Behcet's disease in UK children: clinical features and treatment including thalidomide. Rheumatology ( Oxford , England ). 2001;40:933-8.

[4]        Livneh A, Zaks N, Katz J, Langevitz P, Shemer J, Pras M. Increased prevalence of joint manifestations in patients with recurrent aphthous stomatitis (RAS). Clinical and experimental rheumatology. 1996;14:407-12.

[5]        Mumcu G, Ergun T, Inanc N, Fresko I, Atalay T, Hayran O, Direskeneli H. Oral health is impaired in Behcet's disease and is associated with disease severity. Rheumatology ( Oxford , England ). 2004;43:1028-33.

[6]        Mumcu G, Inanc N, Ergun T, Ikiz K, Gunes M, Islek U, et al. Oral health related quality of life is affected by disease activity in Behcet's disease. Oral diseases. 2006;12:145-51.

[7]        Park JH. Clinical analysis of Behcet disease: arthritic manifestations in Behcet's disease may present as seronegative rheumatoid arthritis or palindromic rheumatism. The Korean journal of internal medicine. 1999;14:66-72.

[8]        Tursen U, Gurler A, Boyvat A. Evaluation of clinical findings according to sex in 2313 Turkish patients with Behcet's disease. International journal of dermatology. 2003;42:346-51."

On behalf of the correspondents to ESCO, I thank Raffi and Sharon for their advice and hope this is helpful to Ronny.


Adrian Becker


Date: Sat, 23 Dec 2006 10:34:24 -0600
From: "SCOTT SMORON" <scottsmoron@COMCAST.NET>
Subject: OC Submission

So who has received ClinChecks on their OC cases. Anyone. I imagine they should be working their way through them now since...a model sent to Align on Nov 6th and received by them Nov. 8th has been today, on Saturday, December 23rd, had the upper model rejected. Now, I have never had a model rejected by Align before. But I won't doubt that the impression was inadequate. But for the past month I have called several times and asked, "Is everything all right." And I have been told that everything was submitted and in good order and the ClinChecks will be up as soon as they can. I would assume no one even looked at the package the last month and a half. I'll bet they weren't even opened. Just love to hear what is happening elsewhere.



Date: Fri, 22 Dec 2006 15:26:00 -0500
From: "Barry Raphael" <drbarry@ALIGNMINE.COM>
Subject: Re: ESCO Digest - 18 Dec 2006 to 21 Dec 2006 (#2006-52)

You go, Scott!  This is our forum for free speech.  Everybody has a delete key if they're bored, or all the other keys if not.

I just got my first OC Clincheck on 12/21. It was submitted on 10/30.  7 weeks. 

The cases are now assigned “real” dates for expected CC deliver.

Another case submitted 11/9 is expected on 2/7.  12 weeks.

These are easy cases (as most of my OC cases were doing really well before the fiasco).

Dear Align, Please Put Patients First.



Date: Sun, 24 Dec 2006 08:43:57 -0600
From: "Jeff Mastroianni" <wirbndr@MAC.COM>
Subject: Finger Habit

I have successfully treated many patients over the years that had thumb habits. I just use a simple thumb crib. However, the other day I had a patient come in with her middle finger and ring finger pushed deeply into her mouth. Her mother states that she keeps them in there all the time and likes to do it. Since angle that the fingers enter the mouth is very different than how a thumb is positioned, do any of you have suggestions on what type of appliance, if any, would help this patient keep her fingers out of her mouth.

Jeff Mastroianni
Glen Carbon, IL


Date: Sat, 23 Dec 2006 09:36:01 -0700
From: "G Carter" <gcarter_123@MSN.COM>
Subject: Re: TADS

"I see them as a solution for a problem that doesn't exist."

Interesting phrase. When I was a resident at the University of Michigan back in the mid 90s, Lysle Johnston , Jr. used this exact term- but not for resorbable TADs - for the whole concept of TADS in general. I guess great minds think alike.

Is a millimeter or two clinically significant-that's the research I'd like to see.

My 02

Gary Carter