Date: Fri, 20 Jul 2007 00:16:16 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 17 Jul 2007 to 19 Jul 2007 (#2007-60)

There are 2 messages totalling 106 lines in this issue.

Topics of the day:
1. Adult Impacted Canines
2. Ink jet


Date: Wed, 18 Jul 2007 18:59:05 -0500
From: "SCOTT SMORON" <scottsmoron@COMCAST.NET>
Subject: Adult Impacted Canines

I think this was beat to death already, but I have my 2 cents on impacted canines on adults. First, there are good published articles on this. Overall, the consensus is under 18 is well over 95% success...over age 18 about 50% success. That is not my experience, however. This will ramble, but I have a point that I think is important about impacted canines on adults. I know there are canines that cannot be brought in. I just have never had that. The canines are always movable...but not always easily. And here is my point. YOU NEED A SURGEON INVOLVED on the treatment planning who you trust and is good. They need to know what you want done and you have to talk to them. Simply referring them to someone is not enough. And the patient has to understand this is a difficult process. It should not take 3-4's either done quick or not at all. And there are canines that are just not worth the effor. But you need to diagnose the movement and the condition of the canine at each visit. It is not tug tug tug...have your assistant tie it again. You have to do it yourself. As soon as movement is slow, a surgeon needs to go in and loosen it immediately before you beat on the other teeth. I have a specific surgeon that I work with where we have teamed up for "hopeless canines" that other orthos said was hopeless. In the extreme, if you have a badly impacted canine that is ankylosed (and the surgeon should check for ankyolosis when exposing the canine on any adult) it needs to be loosened, sometimes to the point of extraction. The patient then has to come to your office immediately and a severe load has to placed on that ankylosed tooth. You need to see them weekly, if not more often. Your office staff has to know the level of importance of getting this patient in. If it was ankylosed, assume it will fuse again if given the chance and aggressively move it. The entire dentition has to prepped for this. It is not like treating a teenager. As he said the first time we did this, "be careful how hard you pull, it may come out". You cannot delegate this stuff. And a laser can be invaluable for chasing tissue out of the way of engaging the chain. And further exposing it. I have seen impacted palatal canines approached from the buccal by a surgeon (did you want to keep this alveolar bone?). I have seen bonded chains on root surfaces...try pulling on that and see how far you get. I have had chains come loose the 1st time traction is applied. With adults, these screw-ups are devastating. Talk flap design and why. Open v. closed. Check for ankylosis. Get them to use a chain with loops large enough to engage. The cone-beam can be valuable, but not necessary. I had a girl whose canines both destroyed the laterals prior to treatment...and then her brother looked about the same and we were debating starting early or waiting. The cone beam let us see whether the laterals were truly in the path of the canines or not, which a pano can't really show. In an adult, the cone beam would mostly be valuable to better understand orientation and surgical feasibility.

Scott Smoron


Date: Wed, 18 Jul 2007 18:31:33 -0500
From: "SCOTT SMORON" <scottsmoron@COMCAST.NET>
Subject: Ink jet

I currently use a Dell Color Laser printer that is over two years old for patient photos. I previously used a color laser that was awful (Okidata)...I used to sell Okis in the 80s so don't think I am knocking the company, just that particular product 3 years ago. You can use an ink jet, but the ink costs are high. Color lasers tend to be cheaper in the long run. I print out on heavy, 32lb paper that is hyper white...but not photo paper, which saves a ton of money. Also, patients regularly comment on the paper thickness since it used for appointment slips, accounting statements, etc. Also, the laser prints two-sided, so I can use half the paper printing things out. The pano is on the opposite side from the collage. The heavy quality paper does not show through. AND, it is instantly dry. Parents sometimes ask how we printed it all out so quickly on both sides. So no recommendation for an inkjet, but you willl spend more on the ink than the printer typically....beware of that. And I change laser cartidges every 9000 pages, not every couple hundred... As far as multifunction, the new HP inkjet units are good. I think one model is the 7780. It has multiple paper trays, two sided printing, two sided xeroxing...I have used it and its great. As soon as I use the ink left in my current multifunction, I will get one of those. THey start at around $300 with 1 paper tray and fewer options and they are relatively good with ink, according to my friend. Anyone using any other lasers? I love to hear their thoughts.

Scott Smoron