Thursday, December 14, 2017

Garrison Composi-Tight® 3D Fusion® Evaluation Complete

Garrison Compositite 3D.jpg
 
For over a month now, I’ve been working with the newest sectional matrix system from Garrison.
 
The system, which Garrison calls the Composi-Tight® 3D Fusion® is a complete and well thought out restorative system.  It has performed extremely well in a variety of clinical situations.
 
Rings
It consists of different rings (Short, Tall, and Wide Prep).  The rings, as pictured above, have strong gripping silicone covers over the tines.  These silicone grippers (Garrison calls them Ultra-Grip™ retention extensions) are pointed, which allows the ring to better conform the band to the prep as well as providing good pressure to open the contact area.  There is also a notch on the gingival surface that allows the ring to “straddle” the wedge so that the wedge stays in place and does the job it is designed to do.  They also are curved in an occlusal-cervical direction to better engage the anatomical curvature of the tooth.  This allows them to truly lock into place and grip the tooth and band with firm and stable pressure.  You can see this curvature in the photo below.
 
FXR01.jpg
Wedges
Companies have tried several different versions of silicone wedges over the years and all the designs have worked better than the original wooden wedge, but Garrison has come up with a unique and well thought out idea, the “feather wedge”.  I have to admit that when I first saw them, I thought they would perform poorly… but I was wrong.  The small projections on these wedges allow them to effectively seal the band against the cervical of the prep.  They are also remarkably easy to place and, once placed, stay firmly between the teeth.  They come in four sizes as shown below:
 
 
 
 
 
3D Fusion Wedges.jpg
 
Forceps
The system also comes with Ring Placement Forceps which are extremely sturdy and feature a Garrison logo open stop.  These forceps are made of stainless steel, which makes them incredibly strong and able to provide a significant amount of strength when opening rings.  Many of the forceps I’ve used over the years are not made of stainless steel and flex when opening the ring.  The flexure means less pressure is applied to the ring which translates into a ring that will not open as far.  These forceps might just be the best ones I’ve ever used in restorative dentistry.  They are designed to work with other types of rings so if you happen to use more than one system in your office the assistant is not forced to find the exact forceps that works with whatever ring system is being laid out.  This “one size fits all” design helps streamline organization and operative setups.
 
My hands require a large glove and both of my assistants wear small gloves.  However, we all felt that the forceps fit our hands well.  I can say with confidence that no matter your hand size, you will find these forceps comfortable and easy to use.
FXP01 full with ring.jpg
Conclusion
After a month of usage, I’ve found the Composi-Tight® 3D Fusion® to be reliable for any Class II restoration.  I have had NO open contacts, minimal flash, and very nice contours.  I’ve had no rings slip off teeth and the rings are easy to place.  I’m especially impressed with the wedges, especially since at first glance I was not sure how well they would work.
 
My overall impressions are that this is a first rate product for anyone looking to improve their Class II restorations.  This product is highly recommended!!!
 
For more information or to order the kit, here is a link to the product page on the Garrison website.  

Wednesday, December 13, 2017

Periodontitis Appears to be Linked to Breast Cancer

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We’re continuing to see more and more links between diseases of the oral cavity and different types of cancers is several parts of the body.  Pathogens found in the mouth have easy access to the rest of the body.  Lately there have been studies showing links to esophageal cancer.
 
A recent study done at the State University of New York at Buffalo examined data pertaining to periodontal disease and the incidence of cancer in postmenopausal women.  The results are intriguing, to say the least:
 

Abstract
Background: Periodontal pathogens have been isolated from precancerous and cancerous lesions and also shown to promote a procarcinogenic microenvironment. Few studies have examined periodontal disease as a risk factor for total cancer, and none have focused on older women. We examined whether periodontal disease is associated with incident cancer among postmenopausal women in the Women's Health Initiative Observational Study.

Methods: Our prospective cohort study comprised 65,869 women, ages 54 to 86 years. Periodontal disease information was obtained via self-report questionnaires administered between 1999 and 2003, whereas ascertainment of cancer outcomes occurred through September 2013, with a maximum follow-up period of 15 years. Physician-adjudicated incident total cancers were the main outcomes and site-specific cancers were secondary outcomes. HRs and 95% confidence intervals (CI) were calculated using Cox proportional hazards regression. All analyses were conducted two-sided.

Results: During a mean follow-up of 8.32 years, 7,149 cancers were identified. Periodontal disease history was associated with increased total cancer risk (multivariable-adjusted HR, 1.14; 95% CI, 1.08–1.20); findings were similar in analyses limited to 34,097 never-smokers (HR, 1.12; 95% CI, 1.04–1.22). Associations were observed for breast (HR, 1.13; 95% CI, 1.03–1.23), lung (HR, 1.31; 95% CI, 1.14–1.51), esophagus (HR, 3.28; 95% CI, 1.64–6.53), gallbladder (HR, 1.73; 95% CI, 1.01–2.95), and melanoma skin (HR, 1.23; 95% CI, 1.02–1.48) cancers. Stomach cancer was borderline (HR, 1.58; 95% CI, 0.94–2.67).

Conclusions: Periodontal disease increases risk of total cancer among older women, irrespective of smoking, and certain anatomic sites appear to be vulnerable.

Impact: Our findings support the need for further understanding of the effect of periodontal disease on cancer outcomes. Cancer Epidemiol Biomarkers Prev; 26(8); 1255–65. ©2017 AACR.

Tuesday, December 12, 2017

Make Your Restorative Dentistry Easier & Better with Addent's Calset

 
 
Calset 1.jpg
When it comes to restorative dentistry, most of us are always on the hunt for ways to improve our techniques and to also improve our clinical results.
 
Every once in a while, we get lucky and something comes along that helps with both of those things.  However, when that “something” is also super affordable, that’s the dental win-win-win trifecta.  The Calset composite warmer from Addent is one of those products.
 
The Calset is a device that warms the composite.  It plugs into an AC outlet and gently warms the composite to one of three temperatures.  The user selects whether the temperature is 98°F, 130°F, or (my preferred setting) 155°F.  The device can hold a composite dispenser with a compule loaded in it as well as 4 other compules, composite syringes & instruments.
 
There have been plenty of studies done over the years that show warm composite provides a better cure with better polymerization for stronger restorations & even better depth of cure.  Warm composite also has a more workable consistency which means easier placement and easier adaptation to the preparation.
 
Here is what the company has to say:
 
The Calset Composite Warmer increases the flow of composites up to 68%. The reason this is so important is that it makes the composite so much easier to work with. Now a heavily filled material can be used on posterior teeth with no compromise to the strength of the restoration.
 
By warming composite, the properties change in a positive way. Once the composite has been warmed to 130°F or 140°F, and the composite is cured immediately after placement, a greater depth of cure is experienced in the same amount of curing time, hence a much stronger restoration.
 
When the composite is warmed, it becomes more flowable. By becoming more flowable, the composite has much better adaptation to the tooth structure, which decreases microleakage significantly. When a flowable is used prior to composite placement, the shrinkage is much greater since the resin is very thin and there is very little filler. When composite is warmed, you are still using a heavily filled material, therefore the shrinkage is much less.
The price?  The unit pictured above is $520.  There are also several different variations and models to choose from.  I’ve been using the Calset in my office for about 10 years and absolutely love it.  It’s one of those devices that just makes you life easier and your clinical results better.
 
 
Addent also makes other great products which I’ll review from time to time.
 
 
 

Monday, December 11, 2017

ADA Working to Help Dentists Meet End of Year CE Requirements

ADA Logo.png
 
Sometimes life just gets too busy.  You know how it is.  Suddenly the end of the year approaches and you realize that for whatever reason, you’re lacking on the number of hours of continuing education you need to fulfill licensure requirements.  
 
If that is something that is causing you angst as we head into the holiday season, fear not!  The ADA is coming to your rescue.
 
That rescue consists of an awesome discount on online CE that you can watch at your leisure and earn those needed CE credits.  You can take any course between now and December 31, 2017 and get a 30 percent discount!  That’s a heck of a deal for CE from people like Dr. Stanley Malamed, Dr. Ray Padilla, Dr. Steve Carsten and others.  Heck you might just find a couple of courses by me in there.
 
  

Thursday, December 7, 2017

Oral Microbiome Composition Reflects Prospective Risk for Esophageal Cancers

cancer-cell.jpg
 
 
As more and more links are beginning to be found between the bugs found causing disease in the oral cavity and the bugs that cause disease in the rest of the body, more and more we’re beginning to understand the interconnection of the body.
 
Now comes word of a potential link between periodontal pathogen Tannerella forsythia and a higher risk of esophageal adenocarcinoma.  The abstract from the American Association for Cancer Research is as follows:
 

   Abstract

Bacteria may play a role in esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), although evidence is limited to cross-sectional studies. In this study, we examined the relationship of oral microbiota with EAC and ESCC risk in a prospective study nested in two cohorts. Oral bacteria were assessed using 16S rRNA gene sequencing in prediagnostic mouthwash samples from n = 81/160 EAC and n = 25/50 ESCC cases/matched controls. Findings were largely consistent across both cohorts. Metagenome content was predicted using PiCRUST. We examined associations between centered log-ratio transformed taxon or functional pathway abundances and risk using conditional logistic regression adjusting for BMI, smoking, and alcohol. We found the periodontal pathogen Tannerella forsythia to be associated with higher risk of EAC. Furthermore, we found that depletion of the commensal genus Neisseria and the species Streptococcus pneumoniae was associated with lower EAC risk. Bacterial biosynthesis of carotenoids was also associated with protection against EAC. Finally, the abundance of the periodontal pathogen Porphyromonas gingivalis trended with higher risk of ESCC. Overall, our findings have potential implications for the early detection and prevention of EAC and ESCC. Cancer Res; 77(23); 6777–87. ©2017 AACR.

 
 

Wednesday, December 6, 2017

TIO Networks Announces Data Breach Exposing Records of 1.6 Million Customers

Pay Pal Tio Networks logos.jpeg
 
PayPal recently acquired the company TIO Networks to use as their payment processor.  The purchase price was $238 million and now it looks like that purchase may have come with an expected surprise… a data breach. 
 
The good news is that PayPal has not done any type of integration between their data and that of TIO which means that if you have a PayPal account, that info was not involved.
 
As I continue to stress, if this can happen to companies that are working constantly to prevent these types of breaches, everyone needs to be as vigilant as possible to keep their data and the data of their business secure.
 
Here is what the company has to say:
 

TIO Networks Provides Update on Suspension of Operations

SAN JOSE, Calif. – December 1, 2017 – PayPal Holdings, Inc. (Nasdaq: PYPL) today announced an update on the suspension of operations of TIO Networks (TIO), a publicly traded payment processor PayPal acquired in July 2017. A review of TIO’s network has identified a potential compromise of personally identifiable information for approximately 1.6 million customers. The PayPal platform is not impacted in any way, as the TIO systems are completely separate from the PayPal network, and PayPal’s customers’ data remains secure.

As announced on November 10, PayPal suspended the operations of TIO to protect customer data as part of an ongoing investigation of security vulnerabilities of the TIO platform. This ongoing investigation has identified evidence of unauthorized access to TIO’s network, including locations that stored personal information of some of TIO’s customers and customers of TIO billers. As a result, PayPal is taking steps to protect affected customers.

TIO has also begun working with the companies it services to notify potentially affected individuals, and PayPal is working with a consumer credit reporting agency to provide free credit monitoring memberships. Individuals who are affected will be contacted directly and receive instructions to sign up for monitoring.

More information has been posted at www.tio.com.

About PayPal

Fueled by a fundamental belief that having access to financial services creates opportunity, PayPal (Nasdaq: PYPL) is committed to democratizing financial services and empowering people and businesses to join and thrive in the global economy. Our open digital payments platform gives PayPal’s 218 million active account holders the confidence to connect and transact in new and powerful ways, whether they are online, on a mobile device, in an app, or in person. Through a combination of technological innovation and strategic partnerships, PayPal creates better ways to manage and move money, and offers choice and flexibility when sending payments, paying or getting paid. Available in more than 200 markets around the world, the PayPal platform, including Braintree, Venmo and Xoom, enables consumers and merchants to receive money in more than 100 currencies, withdraw funds in 56 currencies and hold balances in their PayPal accounts in 25 currencies. For more information on PayPal, visit https://www.paypal.com/about. For PayPal financial information, visit https://investor.paypalcorp.com.

Tuesday, December 5, 2017

AliveCor Merges the EKG with the Apple Watch Through KardiaBand

Apple Watch.jpg
 
 
Here’s an interesting bit of info from the healthcare sector.  As FitBit & other platforms begin to see sales level off, the idea of portable healthcare updates are still popular with consumers.
 
To that end, AliveCor has announced the KardiaBand.  The company had previously released the Kardia which is an EKG monitor that connects wirelessly to your smartphone.  The KardaBand moves that same technology to the band of your Apple Watch for even easier access.
 
497923-kardia-band.jpeg           KardiaBand.jpg
 
 
Both devices are pictured above.  They are FDA approved and have show some serious benefits for patients suffering with AFib.  To learn about the devices, check out the company website.  
 
The press release on the Kardia platform gives a pretty good indication of the benefits it provides:
 

New Research Confirms Significance of AliveCor’s 30 Second EKG

App Based, FDA-cleared, EKG technology substantiated by top researchers to detect possible Atrial Fibrillation (AFib), including those in previously undiagnosed cases; Breakthrough for population suffering from AFib without knowing it.

September 6, 2017 – Mountain View, CA – AliveCor, the leader in FDA-cleared personal electrocardiogram (EKG) technology, today announced the results of four clinical research presentations that demonstrate AliveCor’s hyper-fast, 30 second, digital EKG can positively impact and potentially even save the lives of millions of people around the world who suffer from Atrial Fibrillation (AFib). As a medtech leader, AliveCor uses advanced artificial intelligence, mobile, cloud, and micro-electrode technology to change the dynamic in cardiac care. AliveCor empowers patients worldwide to proactively manage heart health and provide the potential to vastly improve the quality of care in the fight against heart disease. AliveCor’s Kardia Mobile enables patients and their care teams to easily, quickly, and inexpensively detect and manage possible AFib, the single leading cause of stroke and heart failure. “Over 35 million people around the world unknowingly suffer from Atrial Fibrillation,” said AliveCor CEO Vic Gundotra. “AFib is widely understood to be the leading predictor of stroke and heart failure. AliveCor’s app based digital EKG enables patients to conveniently and precisely detect AFib and to deliver clinical grade EKGs to their health care providers.”
Key Kardia Mobile-focused findings from the 2017 European Society of Cardiology Congress In Barcelona include:

  • Patients using Kardia Mobile had a 4X increase in AFib Detection: Professor Julian Halcox of Swansea University Hospital in Wales presented The REHEARSE-AF Study at ESC with simultaneous publication in Circulation, The Journal of the American Heart Association. This randomized study provided AliveCor Kardia units to 500 seniors, who used them to record two EKGs per week for a year and compared the results to 500 seniors who received conventional care from their General Practitioner. At the end of the year, the Kardia group had a 4-fold increase in AFib diagnosis compared to the control group, thereby enabling the initiation of potentially life-saving anticoagulant therapy.
  • Cleveland clinic study shows Kardia Mobile AFib detection accuracy similar to that of physicians. Dr. Khaldoun Tarakji from the Cleveland Clinic presented the iREAD Study which evaluated the accuracy of the AliveCor automatic AFib algorithm versus expert cardiology over-read of both the Kardia recordings and 12-lead EKGs. Dr. Tarakji found that the Kardia algorithm in 52 patients had a 96.6% sensitivity and a 94% specificity compared to a cardiology over-read of the simultaneous 12-lead EKGs for the diagnosis of AFib. Additionally, over 93% of the patients found the Kardia to be easy to use and that it “lessened AFib-diagnosis anxiety.”
  • Kardia Mobile is able to detect more patients with AFib that were previously undiagnosed: Dr. Bryan Yan of The Chinese University of Hong Kong presented research of over 12,000 patients 65 and older. He found that at each 30-second EKG using Kardia Mobile, his team was able to identify more and more patients with previously undiagnosed AFib. This result demonstrates the empirical value of convenient, inexpensive self-screening using Kardia Mobile.
  • Patients find Kardia Mobile easy to use: Dr. Ngai Yin Chan of Princess Margaret Hospital in Hong Kong presented the AFinder Study which used community volunteers to perform opportunistic screening for AFib using AliveCor’s Kardia Mobile in over 10,000 Hong Kong citizens age 50 and older. 244 participants were found to have AFib, with 74 of those previously undiagnosed. This study validates, that using Kardia Mobile, that volunteer senior citizens who were not medical professionals could perform medical screening of their peers with successful identification of a serious medical condition.

AliveCor’s FDA-cleared Kardia Mobile continues to be the most clinically-validated EKG solution on the market and is currently recommended by physicians at top cardiovascular health systems in the U.S. For more information: https://www.alivecor.com/.

About AliveCor
AliveCor, Inc. is pioneering the creation of FDA-cleared machine learning techniques to enable proactive heart care and is recognized around the world for transforming cardiac care. The FDA-cleared Kardia Mobile is the most clinically validated mobile EKG solution on the market and is recommended by leading cardiologists and used by people worldwide for accurate EKG recordings. This simple-to-use mobile device and app-based service provides instant analysis for detecting atrial fibrillation (AF) and normal sinus rhythm in an EKG. Kardia Pro is the first AI-enabled platform for doctors to monitor patients for the early detection of atrial fibrillation, the most common cardiac arrhythmia that leads to a five times greater risk of stroke. AliveCor was recognized by Fast Company as one of 2017’s most innovative companies in health (#3). AliveCor is a privately-held company headquartered in Mountain View, Calif. For more information, please visit alivecor.com.

Monday, December 4, 2017

An Interesting Case of Wasted Healthcare Dollars

Front with FP Left Angle.jpg
 
 
Recently I was reading an article on Propublica.com.  The article stated a mother was offered the chance to have her 5 year old daughter’s ears pierced while she was under general anesthesia for another procedure.  The mom thought that was a nice offer by the surgeon and agreed, only to receive a bill for $1877 from the hospital for the procedure which was not covered by insurance.
 
From the article:
 

Only months later did O’Neill discover her cost for this extracurricular work: $1,877.86 for “operating room services” related to the ear piercing — a fee her insurer was unwilling to pay.

At first, O’Neill assumed the bill was a mistake. Her daughter hadn’t needed her ears pierced, and O’Neill would never have agreed to it if she’d known the cost. She complained in phone calls and in writing.

The hospital wouldn’t budge. In fact, O’Neill said it dug in, telling her to pay up or it would send the bill to collections. The situation was “absurd,” she said.

“There are a lot of things we’d pay extra for a doctor to do,” she said. “This is not one of them.”

Kelley and the hospital declined to comment to ProPublica about the ear piercing.

Surgical ear piercings are rare, according to the Health Care Cost Institute, a nonprofit that maintains a database of commercial health insurance claims. The institute could only find a few dozen possible cases a year in its vast cache of billing data. But O’Neill’s case is a vivid example of health care waste known as overuse.

Now I will be the first to admit that overcharges occur in hospitals routinely.  The part of the whole article that I found mildly amusing is… the procedure the 5 year old was in for?  A simple lingual frenectomy.  Now perhaps there is more to the story as far as management goes.  Perhaps the child is very frightened & difficult to control without general.  Perhaps there is more to this than meets the eye.  However, if this was a routine lingual frenectomy, that could have been done in my office with a few drops of local, no bleeding, no scalpel, no sutures, no post-op pain.  I would have done this with a laser.  I do it all the time.  So, in my opinion, the entire reason the child was in the hospital could have potentially been not necessary… potentially.  I don’t know all the facts.

However, if you are considering a similar procedure for your child, consult a dentist before going to a hospital.