Tuesday, January 31, 2023

Skull of Female French Aristocrat from 1600s Shows How the Wealthy Saved Their Teeth

 Today's post is short because the real info is available from the link below.  However, let me tell you a bit about it.

One of the really amazing technologies that has become fairly common in today's dental practices is CBCT (Cone Beam Computed Tomography) that creates 3D x-ray images.  These devices give us the ability to basically pick up a patient's skull and rotate it to see things from any angle as well as being able to look inside as well.

That aspect of things is what makes this particular story so fascinating.  Scientists managed to get a CBCT scan of a body that was around 400 years old.  The things they discovered about this French noblewoman and the amazing things that had been done to her to allow her keep her own teeth in place despite advanced periodontal disease.

The story and the pictures are pretty amazing.

Follow this link for the article and photos.  

Monday, January 30, 2023

Law Enforcement Units Combine their Work to take Hive Ransomware Gang Offline


Score one for the good guys!  The Hive ransomware group has caused a *lot* of damage.  Of course any ransomware group can wreak havoc, but from the standpoint of where I work, Hive seemed to have targeted the healthcare sector more than others.  

This lead to all kinds of terrible outcomes.  In August 2021 Hive ransomware encrypted the network of a hospital that was forced to stop admitting patients during a Covid-19 surge.  Another example was the Lake Charles Memorial Health System in Louisiana.  Their IT folks were able to prevent encryption of their network, but the hackers still got away with data on close to 270K patients.  Of course there are also lots of targets that remain unannounced for a variety of reasons.

Ransomware is a scourge, no matter who it impacts.  However, targeting healthcare carries with it the possibility  of injuring patients or perhaps even causing death.  That is one of the things that makes these type of illegal activities so reckless and dangerous.  Once you start to tinker with systems, you have no idea of the impact you may generate.  The Colonial Pipeline hack created all kinds of strife in different business sectors and also affected millions of individuals.  Ransomware is an example of the old adage of throwing a stone into a lake and you have no idea where all the ripples go or what they do.  Our systems are now so interconnected and oftentimes so dependent on one another that taking one down can very well result in taking others... and sometimes LOTS of others.

So, the good news here is that a task force of law enforcement entities from both the U.S. and internationally, have worked to take down Hive.  According to Lisa Monaco the US Deputy Attorney General "Simply put, using lawful means, we hacked the hackers."  There is a certain amount of poetic justice there, especially since it is coming from the Justice Department.

Of course, we'll probably never get all the details of how they did this.  And, despite the best efforts of law enforcement, there will be another ransomware gang to take their place.  However, I'm glad to see this effort.  Ransomware has a horrible impact on things and it needs to be limited in scope.  I doubt it will ever be eliminated totally.

There is a great write up on this on cnn.com which you can find here.

Thursday, January 26, 2023

DGShape DWX-42W Mill Continues to Impress


I've received some inquiries on my continuing adventure with the DGShape DWX-42W wet mill, so I thought I would post some info on how well our experience has been going.

The DWX-42W is one of the best things we've added to the practice.  The learning curve was short, the restorations are stunning, and the device is an absolute workhorse.  Scratch that, maybe I should say this thing is a *beast*.

By that, I mean that it is durable and reliable. Mechanically we have had zero problems.  I am impressed with the durability the mill has displayed.  In our 10 months with it, all we have had to do is replace some burs and change filters (both of these items are part of routine disposables/maintenance). 

We have paired the machine with exocad design software to design the restorations.

The crowns, inlays, and onlays that the mill produces are incredible!  When we first started with the mill I went so far as to have 2 restorations fabricated for several of our first cases.  The idea was to give me the opportunity to compare lab fabricated versus mill fabricated crowns and I would then permanently place the one that I liked best.  The staff provided them to me in a blinded manner so that I wouldn't know which was which.  In that brief evaluation of ten crowns, I could not distinguish one from the other, even evaluating them at 5.0x magnification.

As someone who had been evaluating the entire CAD/CAM landscape for a while, I have been very pleased with the benefits.  We are making fewer temporaries which means patients get the benefit of not having to wear them, have them come off, or breaking them.  Obviously this is a nice benefit of same day delivery.

We also have cases that, for scheduling of patients who need a shorter appointment, we are doing "next day" care.  This means that the crowns are milled the same day, but bonded next day.  That, of course, means that even though the patient wears a temp, it is a *much* shorter amount of time to put up with one

Acceptance by patients has been tremendous.  Once word got out of our ability to create a lot of cases in-house, we began to get phone calls and in office patient requests.  That of course then translated to more phone calls and even more in office patient requests.

Our experience has been tremendous.  The DWX-42W is *highly recommended*.  

Wednesday, January 25, 2023

OrthoNu® Drives Orthodontic Office Efficiencies, and Redefines Patient Oral Care with Launch of Tweakz® for Braces and Aligners


OrthoNu® today announced the launch of Tweakz® for Braces and Tweakz® for Aligners, ushering in an entirely new category of products specifically designed to meet the needs of orthodontic patients. The Tweakz tools are designed as an oral self-care solution to address the most common orthodontic emergencies in between visits. By addressing manageable discomforts at home until the next scheduled appointment, Tweakz keeps disruptions to a minimum for the practice and patients, which creates office efficiencies and growth opportunities.

An average practice experiences 8-10 emergency visits every day, with each visit costing an office $100 on average. Broken brackets and cutting distal ends account for 99% of braces emergencies. Rough edges and removal of overly retentive trays account for 92% of aligner emergencies. These visits cause great discomfort and interruption for patients and caregivers.

Designed by an Orthodontist, OrthoNu Tweakz 4-in-1 self-care tools are patient-friendly, professional grade, driven by science, and developed from professional tools that are trusted.

“The OrthoNu line of self-care orthodontic products focuses on emergency care, oral hygiene, oral aesthetics, and oral health, reducing the sizeable impact of emergency visits and elevating the patient experience,” said Dr. Sima Yakoby Epstein, OrthoNu Founder and CEO. “Tweakz provides orthodontists with proper tools and solutions to meet these urgent patient needs when they occur, while helping expand patient self-care capabilities, comfort, and confidence.”

Tweakz for Braces feature:

● Flush Distal End Cutter: Eliminates sharp wires by cutting and holding the cut wire piece for


● Dental Pick: Removes broken or dislodged brackets with ease (self-ligating or conventional) and

food interproximally between teeth and appliances

● Rubber Band Applicator: Removes and replaces rubber bands with ease

● Diamond Dental File: Smooths out rough spots on brackets and hooks

Tweakz for Aligners feature:

● Dental Pick: Removes food and debris interproximally

● Rubber Band Applicator: Removes and replaces rubber bands with ease

● Aligner Remover: Removes retentive aligners

● Diamond Dental File: Smooths out rough spots on aligners

Tweakz tools come in a travel case with mirror and are available now to order at www.OrthoNu.com.

“With Tweakz tools, we can provide our patients with safe self-care solutions, at the beginning of their treatment, to address the most common orthodontic emergencies while at home or on-the-go, and in between office visits. Tweakz are truly a welcomed advancement for the industry that will save practices time and expenses resulting from emergency visits,” said Dr. Jamie Reynolds, Reynolds Orthodontics.  For more information about OrthoNu including to see What’s #NU4U, please visit www.OrthoNu.com.

About OrthoNu®

OrthoNu is focused on driving innovation in oral care to support both patient experience and practice efficiencies. OrthoNu is creating a new category of professional-grade, self-care products, including its hero product Tweakz® for Braces and Aligners, for patients, redefining the orthodontic standard of care. With an advisory board of industry leaders and developing partnerships with the University of Pennsylvania’s School of Dental Medicine and the Center for Innovation & Precision Dentistry (CiPD),  OrthoNu is committed to advancing the science of oral health, which has a significant role in improving overall health.

Tuesday, January 24, 2023

California Dental Association Files New Legal Action Against Delta Dental of California


Here is some very interesting news.  The good people at the California Dental Association have decided to pursue legal action against Delta Dental of California.  When it comes to legal issues, I like to let people make up their own minds on things, but here is the "quick summary" on the issue that CDA has on its website.  And please take notice of the terms "nonprofit" and "tax exempt" below.

Quick Summary:

Legal action filed against Delta Dental of California challenges Delta Dental’s adjustments to Premier and PPO provider agreements that took effect Jan. 1. CDA alleges that the board of directors of Delta Dental, a nonprofit, tax-exempt company, violated its fiduciary duties by, among other things, failing to conduct appropriate analysis of the need for and impact of the contract changes to Delta Dental’s provider network and patients. CDA's FAQ and other resources can assist members now and keep them updated on the next steps.

I find it interesting that a "nonprofit" and "tax exempt" entity somehow feels the need to lower its reimbursement to providers.

For all the details from CDA, you can follow this link.  

 If you are interested in reading the actual twenty-nine page legal complaint, you can find it here in pdf format.

Monday, January 23, 2023

ADA Amends the CDT Defintion of Ceramic - Printed Restorations are Now Billable


In the world of healthcare, it is extremely important to bill for what you do.  In dentistry that is especially true when it comes to billing for fixed prosthetics (that is crowns & bridges if you don't speak dentistry).  There are several CDT Codes that apply toward the materials used to create fixed prosthetics and it is important to use the correct one.

That is one of the reasons why the new definition from the ADA is so ground breaking.  Up until this point, there really wasn't a code that would allow for billing (and thus insurance reimbursement) for a crown that was created by a 3D printer.

3D printing in dentistry has been steadily growing for at least the last 5 years.   I began to really notice offices exploring this technology during the 2020 Covid lockdown which allowed me more time online to explore trends, comments, info from manufacturers, and other sources of data.

The Holy Grail of 3D printing has always been permanent restorations.  Now don't get me wrong, 3D printing has multiple applications in dentistry and all of them are terrific.  We have been using 3D printers in my office for years and we absolutely *love* what we can accomplish with them.  However, that being said, the really big deal is to print permanent restorations. 

About a year ago, resins started to appear on the market that could be used to do just that.  At long last, resins were available to allowed doctors to print indirect fixed prosthetics.  The only problem in that equation was the one that dealt with the doctor getting paid for it.  A doctor can use whatever material they feel is the best or appropriate for a given situation, but third party payers (meaning insurance companies) will only reimburse for certain codes.  Without going into great detail about the entire billing procedure, suffice it to say that CDT (Common Dental Terminology) codes are intrinsic to the payment process when dealing with dental insurance.  So, while the doctor could create a printed restoration, they couldn't get paid for it.  The patient, of course, could choose to pay out of pocket for that restoration, but that sort of defeats the entire idea of having dental insurance in the first place.

That's why this amendment to the definition of "Ceramic" is so exciting.  

According to SprintRay:

In the past, “Ceramic” was defined as: “…pressed, fired, polished or milled materials containing predominantly inorganic refractory compounds including porcelains, glasses, ceramics and glass-ceramics.” The new definition eliminates “pressed, fired, polished or milled materials”. The deletion of the manufacturing criteria from the definition of porcelain/ceramic opens the door to permanent restorations printed with predominantly inorganic refractory compounds.

This means that now 3D printing is finally accepted for billing purposes.

SprintRay is a great 3D printing company that deals exclusively with the dental industry.  I've been working with them since I started 3D printing in my office and have had a great experience with them.  If you'd like to learn more about this whole change of CDT definition and what it means, SprintRay has a page dedicated to this info.  Check it out by following this link.   Exciting things are about to happen!

Thursday, January 19, 2023

Orascoptic Announces Ergo Loupe - and a Discount!


The idea of using magnification to better support your posture is not a new one.  In fact, one of the great things about magnification as an operator is the benefit it brings to your neck and back.

Now Orascoptic has made available what I call "declination" telescopes.  The concept is that the operator sits up perfectly straight and the telescope bends.  The Ergo allows you to sit straight with your eyes straight ahead while the scope shows what your hands are doing.  I've got to think it is a similar way that surgeons work off of a monitor in the OR.

I've been using the Ergo for about a month now (I got a pair to test in advance of the launch) and I really like them.  If you are already using magnification on a daily basis, they do take some adjusting to.  You have to train yourself to look straight ahead and NOT at your hands... which is what you do with traditional setups.  The learning curve exists, but I found it was a short one.

A quick note as far as adaptation... I started out in the late 90s with a 2.5x flip up, but I would not recommend a flip up in today's environment.  I had a bad habit of flipping the mag up and then twisting myself around for direct vision.  That was something that I got away from as my clinical skill got better, but in addition to that, TTL (through the lens) setups are much more clear and provide better field of view.

The Ergo is currently available in 3.5x which is the most popular magnification in dentistry and works really well in this configuration.  Orascoptic has amazing clarity in their optics, which is why I've been a fan of theirs for years.

The setup that I've been using is the Ergo telescopes mounted in the Dragonfly frame.  

The Ergo is available now and Orascoptic is currently offering a $200 discount for a limited time.  Head over to Orascoptic.com for more information.