Date: Thursday, January 11, 2007 12:26 AM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 5 Jan 2007 to 16 Jan 2007 (#2007-5)

There are 6 messages totalling 483 lines in this issue.

Topics of the day:

  1. Employee Handbook
  2. MEAD
  3. Electrocautery
  4. TADs insertion
  5. TAD Placement
  6. FDA notice to Pharmacies compounding Topical Anesthetics


Date: Wednesday, January 10, 2007 10:31 AM
From: Leon <drleon@OPTONLINE.NET>
Subject: Employee Handbook

Once again the topic of developing an official office manual is under discussion in my office.? My partner and I are thinking about either hiring an professional company or adapting an existing manual. I recognize that from an employee labor relations standpoint, this is a legal document with risk management ramifications.? Do you have one for your office?? If so, who would you? recommend to help develop it.? If not, why not?? Is there a legal downside?

Date: Wednesday, January 10, 2007 6:59 AM
Subject: MEAW

Is anyone out there using MEAW?  I just took a four day course in San Francisco at the IDEA Facility with Dr. Sadao Sato from Japan.  He is able to treat surgical anterior open bites non-surgically with amazingly stable results by changing the occlusal plane with multiloop archwires.  He has been doing it for 20 years and shows very long term follow up results.  All other types of malocclusions are treated too and he does it all non-extraction.   The method was developed by Dr. Kim, but Dr. Sato has taken it to another level.   He is coming back to IDEA again this year and I would highly recommend his course as one of the best I have ever taken.  He is also giving a short presentation at the Midwest Angle Society this year.  He gave a two day lecture to the Florida Association last year, but you need to take the four day course to get the true effect.  IDEA limits the course to only about 16.  It was eye opening and will definitely change your way of looking at orthodontics. Greg Scott

Date: Wednesday, January 10, 2007 1:53 AM
From: "SCOTT SMORON" <scottsmoron@COMCAST.NET>
Subject: Electrocautery

Is electrocautery with those little battery driven devices?  I never
considered those?  Did those work well or are you glad to have a better
instrument now?  Do you still use them?


Date: Wednesday, January 10, 2007 1:24 AM
From: Dr P. Miles <pmiles@BEAUTIFULSMILES.COM.AU>
Subject: MEAWRe: TADs insertion

Hi Charlie and all;

Some miniscrew companies will advocate that exact technique for
miniscrew insertion - start perpendicular to make a small hole then back
off and reangulate. You just don't want to insert it too far and risk
bending the miniscrew as the metal is quite soft so you need to keep the
same path of insertion as you screw it in (do not wobble and don't treat
it like a wood screw as they will bend or deform).

The brand I currently use and the thickness it is (1.5mm) will allow
some leeway - for example; if you insert the screw under minimal
anaesthesia and the patient flinches, you are near the PDL so you must
back off and reangulate or even try a new insertion point. In such cases
I have not had any problems (touch wood) with screw fracture or
distortion but I am very careful to not wobble the driver while
inserting. I would always suggest examining the screw before trying
reinsertion and if at all distorted, grab a new one. Screws with less
thread depth may not be as forgiving with reangulating and fail more
readily and the thinner it is it the potentially more prone to deforming
but there is minimal data available on failure rates and problems so
far. The initial brand I used with a shallower thread depth and higher
taper had a 1:3 failure rate (much higher than currently) which was also
anecdotally reported in a TAD lecture I attended so there can be big
differences between designs so we still have a lot to learn with these.


Peter Miles

From: SCOTT SMORON <scottsmoron@COMCAST.NET>
Date: Wednesday, January 10, 2007 1:17 AM
Subject: TAD Placement

I think your resident was correct in that unscrewing a TAD once FULLY placed
is not recommended.  However, the technique you described, where essentially
you create a small entry point into the bone and re-direct just as it
"bites" would not likely cause significant failures.  Research has not
really compared all these finer points, but I would liken your technique to
just barely entering the bone with a small round bur as a start point.

Might not be a bad research topic to compare placement techniques.

Hopefully, Dr. Cope will ring in here too.

But I think that if you are planning on placing the implant with enough of
an angle that you might slip while placing, thus causing soft tissue damage,
then the technique you described with a re-direct would work well.


Date: Tuesday, January 09, 2007 12:00 PM
From: Ronald Heiber <rheiber@COO.COO.COM>
Subject: FDA notice to Pharmacies compounding Topical Anesthetics

Many of us are using compounded topical anesthetics purchased from
various pharmacies for use during minor gingival procedures. While the
individual drugs used in the compound have all passed FDA muster, their
combination and concentration in a gel form for topical use has not.
Below is an excerpt from a recent FDA notice. You can view the source
material at .

FDA MedWatch - Compounded Topical Anesthetic Creams Can Cause Serious
MedWatch - The FDA Safety Information and Adverse Event Reporting

FDA notified healthcare professionals and consumers about the serious
public health risks related to compounded topical anesthetic creams. FDA
issued warning letters to five firms to stop compounding and
distributing standardized versions of topical anesthetic creams,
marketed for general distribution. Exposure to high concentrations of
local anesthetics, like those in compounded topical anesthetic creams,
can cause grave reactions including seizures, irregular heartbeats and
death. Compounded topical anesthetic creams are often used to lessen
pain in procedures such as laser hair removal, tattoos, and skin
treatments. They may be dispensed by clinics and spas that provide these
procedures, or by pharmacies and doctors' offices.

Excerpt from the FDA Press Release
These creams contain high doses of local anesthetics including
lidocaine, tetracaine, benzocaine, and prilocaine. When different
anesthetics are combined into one product, each anesthetic's potential
for harm is increased. This potential harm may also increase if the
product is left on the body for long periods of time or applied to broad
areas of the body, particularly if an area is then covered by a bandage,
plastic, or other dressing.

Read the complete 2006 MedWatch safety summary, including a link to the
FDA press release .

Consumers and health care professionals should notify FDA of any
complaints or problems associated with compounded drugs, including
compounded topical anesthetic products. These reports may be made to
MedWatch, FDA's voluntary reporting program, by phone at 1-800-FDA-1088,
or online at this link.

To send a comment or question to the MedWatch program:

The above message comes from "FDA MedWatch", who is solely responsible
for its content.