Class B Autoclaves

One cannot overemphasise the importance of sterilisation and infection control not just for implant surgery but for all aspects of dentistry.
Effective sterilisation can be the difference between success and failure in implant dentistry.
A Class-B autoclave is the standard of care when it comes to steam sterilisation . This is specially true when sterilising tools and instruments with hollow insides such as handpieces, drills, cannulas etc.
For the last many years my trusted Class B was a unit from Prestige Medical in the UK. In February this year it finally gave in. This, namely the lack of service and spares from foreign manufacturers or their agents has been a constant problem with many imported hi tech equipments. With a complicated , sophisticated expensive and critical device such as a vacuum autoclave it is imperative that service and spares be readily available for many years after the purchase of the autoclave. I was reasonably lucky with my Prestige. Other colleagues have not been so fortunate.
Although many imported brands are available in place of the Prestige we bought the Indian made/assembled Equitron autoclave from Medica Instruments. This is a true Class B autoclave and except for a few initial glitches has performed very well. The service from the CEO Mr.Hemant Shah has been courteous and prompt.
As usual I have NO FINANCIAL INTEREST in this product. Just a product and a company I believe deserves support and encouragement.

Sumita Mitra named among Heroes of Chemistry for 2009

Sumita Mitra named among Heroes of Chemistry for 2009: "3M ESPE inventor of composites and RMGI technology honored."
Not strictly an implant related post but I just couldn't resist posting. Dr.Sumita Mitra of 3M has played a pivotal role in the development of glass ionomers , specially resin reinforced glass ionomers. Her accomplishments are stupendous and have revolutionised restorative and preventive dentistry. We are all proud of her !

HEINE HRP Binocular Loupes

HEINE HRP Binocular Loupes

These are the new loupes that I've got myself. For nearly ten years I used a set of 2.5x Galilean loupes. Not the greatest. They were cheap, heavy and not very good but they served the purpose. But then advancing age (I just crossed 45) and deteriorating eyesight necessitated a more powerful set of extra "eyes". The Heines I have are 3.5x prismatics that are a joy to use. I use it for practically all implant surgery but specially when doing sinus lifts where the magnification and the additional illumination is a great help. There are quite a few additional accessories that come with the loupes in it's handsome case that make this set of loupes a joy to use. Having said this 3.5x is not the ideal first loupe to own. For that the 2.0 or 2.5x is a better choice. Not sure which loupe is best for you? Checkout this article to help you decide.

I also have a led light that goes with the loupes. I have to admit I am not as happy with the light as I am with the loupes. The light just doesn't seem to have enough intensity and the battery handle is bulky and uncomfortable to use . It's a beautifully designed little light but it's needs more power and a smaller longer lasting battery pack that easy on to carry and easy on the pocket.


I would like to add that I have NO financial interest whatsoever in this product!

Dynamic CBCT Imaging

Dynamic CBCT Imaging: "

Dr. Doug Chenin the Director of Clinical Affiars for Anatomage has announced Dynamic CBCT. According to Dr Chenin “Dynamic CBCT features allow you to create dynamic treatment simulations to be used for patient education, increasing case acceptance, and for making the most cutting edge professional presentations or CE material.” Here is an example of a surgery simulation:

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EnBIO launches OsteoZip surface for dental implants

EnBIO launches OsteoZip surface for dental implants: "OsteoZip is designed to enhance the osteointegration and early bone fixation of dental implants into host bone tissue."

Lingual Foramen

Vascular channels are often found in the midline and lateral to the midline of the mandible. Although the lingual foramen was found in 99% of dissections it was seen in less than 49% of peripaical films . Here is patient I saw recently.One can see the lingual foramen clearly on the CT slice, as well as the periapical film and also if you look carefully at the OPG.

The lingual foramen harbors an artery that is an anastomosis of right and left sublingual arteries. This tiny vessel (0.4 to 1.5mm) has been implicated in serious hemorrhage and rarely fatalities. one should be aware of the presence of this vessel and avoid it when possible.

For the periapical and the opg image click on the title of this post

JIACD

JIACD Is a new online journal that is free. you can download the latest copy onto your desktop and read at leisure. lots of pictures and simple practical stuff !

A Novel Connective Tissue Graft

These are the images of a simple connective tissue graft I did recently. The advantage I think was that a second surgical site was not needed. The site did not need large volume of tissue. The pictures are self explanatory.

The Paresthesia Case

The patient with parasthesia came in this morning for follow up. The parasthesia is just a bit better (he says 5%) but otherwise adjusting quite well . I've included the postop pano so you can see the relation of the nerve to the implant.

Follow-Up to the Parathesia Case

I had the parasthesia patient in for a check up yesterday. The parasthesia or rather dysesthesia involves the teeth from 44 to 46. The implant was placed in the 47 region.The teeth feel "dead" to use the patient's own words. All else is fine. There is no problem with the lips, tongue or gingiva. The wound is healing well. The postop OPG shows the implant well clear of the nerve. I am puzzled. What could it be?Here are some options

• A twist drill that damaged the nerve while preparing the osteotomy- This is most likely. Although I was as careful as could be (of course!). Hopefully given that all other sensations are normal ,sensation should return sooner or later. Once more the need for careful measurement, preop OPG's and CT Scans and the use of stops. Even better would be the use of a surgical guide with depth control.
• Pressure on the nerve as a result of bleeding ,edema etc in the osteotomy. This too should resolve. Is it worth backing out the implant? Not in the case of a tapered implant such as this. Turning it back even a turn will more often than not result in a loss of stability.
• An accessory canal. Not unknown but the CT Scan of the patient does not seem to show any accessory canals.
• The loss of sensation is easier for the patient to get used to than altered sensation or pain .

YouTube - umichdent's Channel

YouTube - umichdent's Channel

Just this morning as I was surfing the web I came across these videos on You Tube. Hundred's of videos on dentistry including lectures and tutorials from dental schools such as The University of Michigan and The University of Southern California are available for free viewing. Entire conferences are available by eminent lecturers and all for FREE !

Enjoy !