Date: Wednesday, February 14, 2007 11:44 AM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 12 Feb 2007 to 14 Feb 2007 - Special issue (#2007-19)

There are 13 messages totalling 22962 lines in this issue.

Topics in this special issue:

  1. Lab stone
  2. Retraction re "Headless Lateral"
  3. Various-on openness-Vulnerability to marketing
  4. Open standards for 3D already exist.
  5. The tale of the headless lateral...
  6. Re: Tale of Headless Lateral
  7. SureSmile opinions
  8. Technology Standards

Date: Wednesday, February 14, 2007 10:19 AM
From: charles ruff <orthodmd@MAC.COM>
Subject: lab stone

recently I was reading about a particular form of lab stone (not sure 
what it was) that the clinician chose to use because it had a little 
more setting expansion than most stones.  he used this when he was 
constructing a splint.  his rationale was that the stone model would 
be slightly larger than the patient's dentition and that would make 
the initial tightness of the splint less.

any ideas on what stone he was talking about?


charlie ruff

Date: Wednesday, February 14, 2007 6:12 AM
From: Ron Parsons <ronparsons@MINDSPRING.COM>
Subject: Retraction re "Headless Lateral"

I would like amend my earlier comments, “Just say ‘no'.... the treatment prescribed by the dentist should not be implemented. ... The real challenge is educating your referring dentist”. It would probably be better to meet with attending general dentist and exchange concerns, and then present the risks and treatment options to the patient. The dentist could be thinking that removal of a root after ortho treatment would be preferable to a bone graft if the root were removed before orthodontic treatment.

The general dentist's treatment plan – to leave the lateral root – might provide acceptable results. But if you don't believe your treatment will work, don't do it.

Just one persons opinion.

Ron Parsons

Atlanta, GA


Date: Tuesday, February 13, 2007 10:06 AM
From: Dr. M.Jayaram <jmailankody@GMAIL.COM>
Subject: Re: Various-on openness-Vulnerability to marketing

Dear Barry,                    

Good to know your views on the subject. I appreciate your frankness as well as the objective of  betterment of profession, patient and public at large. More than forty years back Graber Sr.spoke of three 'M's-Muscles, Malformations and Malocclusions.(AJO:49.p418-450:1963). Today, if a section of orthodontists prefer to indulge mostly with commercial three 'M's.viz:Money, Marketing and Manipulations, one cannot object. Since it is an open forum, wherein there is unrestricted entry to market men, financial interests should not be allowed to outdo scientific/objective appraisals. It appears from the recent AJODOs that doctors advertising for various products and techniques very common. The financial interests of the doctors is not mentioned in the advertisements, but can be understood! So long as we believe in the proclamation of 'Lokah Samastha Sukhino Bhavanthu': Let the whole world be in happiness, as the lofty objective of the forum and members over commercial fringes, it is really worthwhile.

Jayaram Mailankody


Date: Tuesday, February 13, 2007 9:38 AM
From: Stanley M Sokolow <overbyte@EARTHLINK.NET>
Subject: Open standards for 3D already exist.


    Owen Crotty (Ireland) wrote:

    "On the other hand, I would love to see some group define a workable
    open standard, as there is JPEG for static images, and MP3 for
    music, and have this standard defined so that 3-D scanners can
    capture images in that form."

There have been many 3d data standards developed over the years, of
various levels of detail for various purposes.  The latest major effort
is called X3D.  Here's a link to the consortium:
Search with Google on X3D and on VRML (predecessor of X3D) and you'll
find a world of information, such as:
The medical imaging industry also has its standards and a group is
working on applying X3D to medical imaging for such things as
virtual-reality aided surgery.

The capture of scanned images is only the low level of the 3d problem. 
The cloud of 3d points must be partitioned into subsets that are of
interest, such as individual teeth, bone, etc..   X3D also addresses the
higher levels of dealing with 3d objects and their properties, even way
beyond what medical/dental imaging may need.   When applied to a
specific purpose, such as an orthodontic application, a file format
would necessarily have to contain much more information that is specific
to the dental tasks it is designed to aid.   There is no data format
that I know of that has been standardized for that higher level dental
use, but the vehicle for creating such a standard data language is out
there.  XML is widely used to define application specific data languages
for standardized file format.  I would hope that the dental
organizations could get together to define an XML language that our
software application programmers can use to store and interchange dental
patient data, between practitioners when patients transfer and with case
repositories that can be mined for research word-wide.   So far much of
the work that approaches that kind of standard is focused on data that
describes diagnoses and treatment for insurance billing transactions. 
But their scope just doesn't come close to what we need in orthodontics.
I know that the ADA committee working on these informatics standards put
out a call for orthodontists to participate, but I don't have much hope
that it will result in something other than a format to facilitate
insurance transactions.  Moreover, the ADA standards are developed
behind closed door, so to speak, without putting their working papers
and draft standards out in the light of day on the Internet for others
worldwide to see and critique, and then after they're final, the
standards aren't published in the open, they must be purchased from the
ADA.  Too bad that the orthodontic organizations of the world, such as
the American Assoc. of Orthodontists and World Federation of
Orthodontists, are ignoring this problem.  A standard language for
interchanging orthodontic data (images, 3d models, treatment records,
appliance definitions, etc.) would not only help with interchange of
data among orthodontists and among researchers, but also would solve the
problem of being locked into one proprietary office management software
system and then the company goes out of business or becomes unreasonably
expensive or whatever, and you just can't switch your data easily into
the next computer system without loss of information or lots of hand
work on the computer.

The trouble with standards is that there are so many of them, someone
once said.   We need not only 3d data standards, but a much wider
standard to solve some of our perpetual problems and to boost our
ability to pool our data worldwide.  I'm sure that each of our practices
generates a wealth of information that would, if pooled together, give
researchers a much better data warehouse to explore for answers to our
clinical unknowns.   But we need to face the reality that orthodontics
is a niche within a niche in the world of medical informatics.  Unless
the profession instigates this work, it's not going to be standardized
by industry, where they want to solve the problem in the way most
expedient for them business-wise.

Stan Sokolow

Date: Tuesday, February 13, 2007 9:38 AM
From: Morris Rapaport <mrapapor@MAIL.USYD.EDU.AU>
Subject: Re: The tale of the headless lateral...

Dear Barry,

A lateral answer to your question about the lateral. Why not revise your treatment plan to extract 3 bi's and UR2 and substitute UR3 for UR2, then UR4 for UR3, etc? It might compromise the aesthetics a little but save her an implant.  

Best wishes

  ^   ^

Morris Rapaport
Orthodontist / Lecturer P/T

Date: Tuesday, February 13, 2007 6:55 AM
From: Barry Raphael <drbarry@ALIGNMINE.COM>
Subject: Re: technology

With regard to universal standard for 3D imaging:  We may “ have a huge orthodontic community worldwide”, but we are but a small part of the technology world.  Who else is using 3D modeling on a large scale that we could borrow from?  Manufacturing? Engineering?  Are there ANSI standards already in place.   If they already exist, then perhaps we could push those standards through our organizations' technology committees.



Date: Tuesday, February 13, 2007 6:55 AM
From: Ron Parsons <ronparsons@MINDSPRING.COM>
Subject: Re: Tale of Headless Lateral

Great story, “Tale of Headless Lateral”.

Barry, simply solution. To quote Nancy Reagan, “Just Say No”.

You, and you alone, are responsible for your treatment, even if the patient signs a waiver and if the general dentist indemnifies you. Therefore, you must control the treatment – or not treat. Rendering the “general dentist's prescribed treatment” will not absolve you from your duty.

Based on my 30 years experience as a certified orthodontist & periodontist, the treatment prescribed by the dentist should not be implemented.

Of course, you probably recognize all the aforementioned. The real challenge is educating your referring dentist. Good luck.

Ron Parsons


Orthodontic Management Consulting

Atlanta , GA


Date: Tuesday, February 13, 2007 6:55 AM
From: Dr.Kharsa <dr.kharsa@GMAIL.COM>
Subject: Re: Tale of Headless Lateral


No the lone root will not travel along. The adjacent incisors will not encourage remodeling on the lingual and labial of the lone root, as well. At the end of the day this lone root may stay with a protruded axis relatively to the rest of adjacent incisors. Have a nice day.



Date: Monday, February 12, 2007 10:33 PM
From: Mbellard@AOL.COM <Mbellard@AOL.COM>
Subject: SureSmile opinions

Sorry to be so late responding, but I have been out of town for several days.

John Mamutil asked about the intra-oral scanner. To me, it was one of the most onerous parts of the whole SureSmile process. A typical scan involves painting titanium oxide on all teeth and marginal gingiva, and then spending 45 minutes (on average) scanning the patients dentition.  We made the best of it, and our patients put up with it, but there is no denying that it is an unpleasant experience for all involved.  OraMetrix is trying to move away from the OraScanner and plans to use cone beam CT in the future.  Make your own assumptions regarding how successful they will be gaining wide spread mainstream acceptance with cone beam CT, given the costs involved.  You can of course scan models with the OraScanner, which allows the user to diagnose and treatment plan in the virtual world.  As I mentioned, their software is very sophisticated, and allows you to do treatment simulations and set-ups better than any other software I have seen.

Barry Raphael asked if specific brackets were necessary.  SureSmile supports most commonly used fixed appliances, both banded and bonded.  If you use a bracket they don't support, they will try to add your appliances to their library. They are very accommodating.  Their lab does a CT scan of each bracket to get specific dimensions.  We learned the hard way that you can't count on the manufacturer to provide accurate data.

Jean Marc Retrouvey and Charlie Ruff discussed the relative benefits of technology applied to ortho, and both make good points.  It does seem that some technology begs for a real world application and conventional techniques often are more elegant by virtue of their sheer simplicity. I am still fascinated, though, by the possibilities of applying technology to our specialty, and that is why I got involved in SureSmile.  And I am disappointed it didn't work out better for me.  Like Charlie, I applaud the thinkers and innovators that have advanced orthodontics so far, and I wouldn't want to go back to the "good old days".

Mark Bellard


Date: Monday, February 12, 2007 11:34 PM
From: Lively Orthodontics, P.A. <mdlively@BELLSOUTH.NET>
Subject: Re: The tale of the headless lateral...

Hi Barry: If the treatment plan calls for the extraction of four bicuspids and maximum retraction of the  incisors, why would you need to preserve ridge for the implant.  If the lateral incisor was not fractured and you retracted all four incisors, the lateral incisor would be tracing back into bone that would be in the vicinity of the canines (saggitally) and between the canine and lateral incisor (transversely).  So, you will be placing the implant in an area that was never occupied by the original lateral incisor.  The root will only get in the way.  This would make great sense if you were performing ortho without the extractions and just aligning the incisors. If a canine substitution has been withdrawn as an option, why not do the root canal, run a post down the root and secure a temp crown to allow for an esthetic 2 years for the patient.  Though I float pontics routinely for missing teeth, it has been a soft tissue nightmare upon retraction of the pontic with the other incisors in a purely saggital direction.  Bottom line, you should not need to hold onto the root of the UR2 just to preserve bone, if you are retracting the incisors with maximum anchorage.

With warmest personal regards,


Mark David Lively, DMD

Lively Orthodontics, P.A.

Date: Tuesday, February 13, 2007 1:18 AM
From: Moshe DAVIDOVITCH <davidom@POST.TAU.AC.IL>
Subject: Re: The tale of the headless lateral...

Hello Dr. Raphael,

I had several similar cases I instructed on at the University of Tel Aviv .  I can tell you (in this case it was a central incisor root remnant), that the root will move but not much.  This usually makes the prostodontist happy because it leaves a wide labio-palatal width of alveolar bone.  However, in the other cases the lost incisor was included as part of the extraction protocol instead of a premolar, and the lateral incisor restored to look like a central, and the canine etc. These cases were all successful, so good luck.

Moshe Davidovitch

PS: a case similar to the latter situation I mentioned was published in the AJO-DO about 3 years ago.


Date: Tuesday, February 13, 2007 6:00 AM
From: Lou Chmura <louiechmur@AOL.COM>
Subject: Re: The tale of the headless lateral...

I can't imagine that it wouldn't and approximately 6 mm, which would be
noticible.  Then it will need to be extracted then.  Why not either use
the crown until it doesn't hold up to ortho, then extract it and place
a pontic on the wire or extract now and use a pontic. Preserving bone
on the maxilla is far less troublesome than on the lower.  LGC

Date: Wednesday, February 14, 2007 11:44 AM
From: ESCO <>
Subject: Technology Standards

Technology Standards ¨C answer to Owen Crotty The American Dental Association¡¯s Standards Committee on Dental Informatics (SCDI) is preparing for the introduction of the National Health Information Infrastructure (NHII) in 2015. NHII communications will require exchange of electronic patient information in a reliable and secure manner without having to open files or perform any additional functions. Information about NHII is available on the ADA website at this address: . SCDI Working Group 11.6 deals with the integration of orthodontic standards and is tackling the very issues mentioned by Owen Crotty (see attachment).