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As human beings have evolved during the past 6 million years, our resident microbes also have evolved into different species to adapt to different conditions throughout the body, according to research from Duke University. For example, the researchers found that a group of streptococci bacteria in the oral cavity diverged fairly recently, as the palate, tongue, throat, tonsils, gums, and plaque all house their own species of bacteria. According to the university, these findings could help researchers determine how different genes allow microbes to adapt to one place or another and could lead to new therapies that shape the microbiome.

"Over the last decade, there has been significant interest in developing probiotics and transplants of beneficial bacteria to treat a wide variety of health issues," said Lawrence A. David, PhD, senior author of the study and assistant professor of molecular genetics and microbiology at the Duke University School of Medicine. "Our analysis gives us a window into how different bacteria adapt and evolve so that we can more effectively predict which implanted species will survive to make an impact on disease."

Scientists typically learn about the microbiome by sampling a few million bacteria from an area of the body and sequencing them to count which bacteria belong to each species. Then, they compare these counts and generate values that tell them the relative abundance of each type of bacteria. However, relative abundance data requires statistical methods that account for how shifts in one species might affect another. Justin Silverman, an MD-PhD student in David's laboratory, found a mathematical tool used by geologists, called the PhILR transform, that could be adapted to study the relative amounts of bacteria in the microbiome.

Using data from the Human Microbiome Project, the new technique combines the sequencing counts for each species with information on their position on the bacterial family tree. The resulting statistical framework starts with a common ancestor at the top and subsequent generations suspended underneath, like a mobile over a baby's crib, connected by a series of crossbars. By looking at how these crossbars tilt and sway with the weight of the various species dangling from their tips, the researchers could assess how microbial communities grew and evolved in different body sites.

"This technique unlocks a tremendous toolbox of statistical methods that wouldn't have worked before, but that can now be used to analyze microbiome data," Silverman said.

The study, "A Phylogenetic Transform Enhances Analysis of Compositional Microbiota Data," (https://elifesciences.org/content/6/e21887) was published by eLife.

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The American Association for Dental Research (AADR) and the Friends of the National Institute for Dental and Craniofacial Research (NIDCR) have released a statement announcing their opposition to President Trump's fiscal year 2018 budget request. In particular, the groups oppose the White House's proposal to cut $5.8 billion of funding from the National Institutes of Health (NIH), which is a 20% reduction from the fiscal year 2016 budget, and urge Congress to do the same. NIDCR is part of the NIH.

In 2016, Congress passed the 21st Century Cures Act with bipartisan support. The act approved $4.8 billion in funding for the NIH for precision medicine and biomedical research as part of $6.3 billion overall. According to the AADR, this act is an example of the broad support the NIH has always appreciated from Congress. Furthermore, the AADR notes that the White House is requesting a major reorganization of the NIH's institutes and centers, such as the NIDCR, and calls such moves a needless exercise that will divert attention from the NIH's core mission of uncovering new knowledge that will lead to better health for everyone.

The federal government founded the NIDCR during World War II to improve the oral health of American soldiers deployed overseas. Noting that the nation's defense is linked to the health of its population, the AADR has expressed its continued support for the NIDCR and the role it plays in funding research into less invasive and more cost-effictive and cost efficient ways to improve oral health and reduce the economic burden that dental, oral, and craniofacial diseases and conditions place on Americans.

The AADR has additionally stated its desire to work with Congress on a bipartisan basis to increase funding for all of NIH's institutes and centers, including NIDCR, and to reject any proposals to cut or reorganize NIH. Furthermore, the organization aims to encourage members of Congress to honor its tradition of allocating resources to the entire biomedical enterprise at NIH, recognizing that a discovery in one area of research may be applied to another.

Dentsply Sirona has announced a definitive agreement to acquire all of the outstanding shares of Recherche Techniques Dentaires (RTD), a privately owned French company that produces endodontic posts, including fiber-reinforced composite posts. 

“RTD’s unique and innovative offering perfectly complements our new R2C, the Root to Crown Solution. R2C provides state-of-the-art products and procedural guidance from diagnosis and treatment planning to the final coronal restoration,” said Jeffrey T. Slovin, Dentsply Sirona CEO.

“R2C and the RTD acquisition will enable us to provide dental professionals with a more complete end-to-end solution for better, safer, and faster root canals and tooth restoration,” said Slovin.

Dentsply Sirona will continue to support and grow the RTD’s brand and private label businesses. The companies have a long history together, as RTD has been supplying Dentsply Sirona with root canal posts for many years.

According to the companies, RTD pioneered fiber-reinforced composite post technology and is the only firm to integrate the manufacturing of composites, cements, and drills to offer complete solutions to its clients.

RTD’s portfolio comprises several styles and shapes of translucent and tooth-colored posts as well as cements and other accessory products for post-core restoration. The company reports that millions of its posts have been successfully used.

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New dentists joining Aspen Dental practices now can take part in the company’s Best Grad Gift Ever. Through this program, all graduating dental students who accept a job at an Aspen Dental practice by April 30, 2017, can participate in the New Grad Edition of the company’s VIBE Sessions exclusive professional development event. They also can enter into a sweepstakes for a 2017 Ford Mustang Shelby GT350R.

“In partnership with Aspen Dental practice owners who serve as mentors to new dentists, we’re committed to making it easier for dentists to achieve their dreams,” said Arwinder Judge, DDS, chief clinical officer at Aspen Dental Management. “We invest millions of dollars annually to support doctor development and mentorship, and this program is just one more way for us to demonstrate our commitment to supporting dentists at every stage of their career journey.”

To be eligible, fourth-year dental students or dental residents must accept a job at an Aspen Dental practice by the end of April 2017. All who qualify will be invited to participate in the Aspen Dental VIBE Session: New Grad Edition on September 16 and September 17 in Chicago, where one winner will be awarded a 2017 Ford Mustang Shelby GT350R.

During the past 3 years, the Aspen Dental VIBE Sessions have brought together hundreds of managing clinical directors, associates, and dental students for professional development, team building, and panel discussions with practice owners and partners. The New Grad Edition will be geared specifically to new dentists with a focus on long-term career building and networking with their peers and established practice owners.

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Dental implants are now standard solutions for replacing teeth that are lost due to caries, gum disease, or injuries. But we’re another step closer to growing new teeth in their absence, as researchers at Okayama University have demonstrated successful functional tooth restoration via regeneration in a postnatal large-animal model.

First, the researchers dissected embryonic tooth germ cells and tissues from a beagle 55 days before birth and reconstructed bioengineered tooth germ by means of the organ germ method, which regenerates ectodermal organs by replicating their developmental process starting from a bioengineered organ germ.

Next, these germs were transplanted into mice. In many cases, the germs resulted in tooth-crown formation, featuring both the hard and soft tissues present in natural teeth after several weeks. The researchers also were able to identify the necessary conditions for achieving this success.

Autologous transplantation experiments, which use an organism’s own stem cells instead of relying on a donor to avoid immunological rejection, were then conducted as researchers extracted deciduous teeth from the jawbone of a beagle that was 30 days old. Tooth germ engineered from the dog’s permanent tooth cell and tissue was transplanted after 2 days of cell culture into the dog’s mandible, resulting in tooth eruption 180 days later.

The developmental process of the bioengineered tooth’s formation was practically identical to a natural tooth’s, according to micro-CT analysis. Also, scanning electron microscopy and energy-disruptive x-ray spectroscopy revealed that the bioengineered tooth had the same structure and chemical composition of a natural tooth. Plus, the regenerated tooth’s response to mechanical force was consistent with the proper physiological functioning of the periodontal ligament.

As for human beings, the researchers noted that immature wisdom tooth germ would be a possible source of stem-cell germs, as it is available in the human postnatal jawbone, though this would only pertain to younger people as wisdom teeth mineralize after the age of 7 years. Elderly patients would need other stem-cell sources. Still, the researchers believe this work highlights the feasibility of fully functional restoration by autologous transplantation of bioengineered tooth germ.

The study, “Practical Whole-Tooth Restoration Utilizing Autologous Bioengineered Tooth Germ Transplantation in a Postnatal Canine Model,” was published by Scientific Reports.

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Poor oral hygiene isn’t always the result of laziness. Sometimes, your patients are mistaken about what they need to do to take care of their teeth—and they think they’re doing a good job anyway. To celebrate March 20 as World Oral Health Day, Federation Dentaire International (FDI) World Dental Federation is busting popular myths about proper oral hygiene with the help of a survey of consumers conducted across 12 countries.

For example, in 8 of these countries, 50% or more of those surveyed think it’s important to brush their teeth immediately after every main meal. Brazil, Mexico, Egypt, and Poland were the worst offenders of this incorrect oral health practice, at 84%, 81%, 62%, and 60%, respectively. FDI World Dental Federation recommends waiting at least 30 minutes to brush after eating to avoid weakening the tooth enamel.

“These survey results highlight an alarming discrepancy between knowledge and actual good oral health practices,” said Dr. Patrick Hescot, FDI president. “We want everyone to take control of their oral health this World Oral Health Day and understand that by adopting good oral hygiene habits, avoiding risk factors, and having a regular dental checkup, they can help protect their mouths.”

Also, most countries surveyed believe that rinsing the mouth out with water after brushing is important, with Brazil, South Africa, Mexico, India, and Canada practicing this myth the most (77%, 75%, 73%, 67%, and 67%, respectively). FDI World Dental Federation believes that not rinsing with water immediately after brushing will allow maximum exposure to fluoride, optimizing its preventive effects.

Nearly half of the population surveyed in India, South Africa, Brazil, and Poland (52%, 49%, 48%, and 42%, respectively) believed that drinking fruit juice instead of fizzy drinks was important for good oral health. However, fruit juice also can be high in sugar and cause tooth decay. FDI World Dental Federation believes that sugary drink consumption should be minimized as part of a healthy and balanced diet.

Plus, 67% of people recognize the need to visit a dentist after seeing signs of bad oral health, but only 42% tend to seek a dentist’s advice. FDI World Dental Federation found that Brazil, the United Kingdom, and Poland were the best at going to the dentist, while Egypt, Japan, and New Zealand were the worst.

The survey also found the following:

  • 77% of those surveyed agreed that visiting a dentist once per year is a good oral health practice, but only 52% actually tend to do it.
  • Only 28% of respondents identified drinking alcohol in moderation as important for good oral health.
  • 66% of respondents knew to avoid tobacco use to maintain good oral health.
  • 69% of respondents recognized that eating excessive sugar is bad for oral health.

“Understanding good oral health practices and adopting them early in life will help to maintain optimal oral health into old age and ensure you live a long life free from physical pain and often emotional suffering caused by oral disease,” said Dr. Edoardo Caville, World Oral Health Day Task Team chair.

The study, comprising 12,849 adults aged 18 years and older, was conducted online by YouGov Plc between January 20 and January 31, 2017. Surveyed countries included Great Britain (2,090 subjects), the United States (1,145), Australia (1,018), New Zealand (1,055), Egypt (1,012), India (1,011), Japan (1,006), Mexico (1,006), Poland (1,004), Canada (1,002), Brazil (1,000), and South Africa (500).

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Melvin Konner, PhD, MD, professor of human biology and medical anthropology at Emory University, was quoted in a 2001 Newsweek article titled “The Downside of Medical Progress.” Speaking as a patient, he said, “technology can come between us and our doctors who may be afraid to talk to patients and their families and even more afraid to touch them. Doctors are rarely sued for applying high technology but are often sued for omitting it.”

Herb Fred, MD, editor of the Texas Heart Institute Journal, states, “I have watched the progressive demise of bedside medicine. Our reliance on technologic marvels has crippled physicians’ use of their minds and their sensory faculties to make diagnoses.” He further states, “This new way of practicing has made the skilled clinical diagnostician a vanishing species. Not only has it taken the ‘fun’ out of medicine, but it has depersonalized the patient-doctor relationship and eliminated the individuality of patient care.”

Fritz Bamgartner, MD, of Vascular & General Surgery Associates in Los Alamitos, Calif, also writing in the Texas Heart Institute Journal, elaborates on the “chasmal disconnection between the barrage of technology with which the ‘techno-doc’ assaults his (or her) patients and the genuine hands-on touch and concern truly humane doctors have for their patients.”

Most family physicians and internists don’t see their patients if they are hospitalized, further de-emphasizing the value of the hands-on healing touch. A hospitalist who has never seen the patient previously communicates with the family doctor via the phone or email. This can be very disconcerting for patients, especially young children and the elderly. 

A discussion of bedside manner and the important role it plays in the ever-changing world of medical technology is relevant for dentists as well. From the time we start dental school, through the next 4 years, and even if we pursue advanced specialty training, we are immersed in a world of learning to become skilled in performing clinical procedures and treatments. 

But sadly missing from this world is a sense of what our future patients expect of us. Of course, they assume we have the technical skills. But what we don’t realize is that the average patient is just as concerned about how much we care as how much we know.

The Technologies

People suffering with serious and even terminal illnesses consistently express their gratitude for the empathy that a truly caring doctor, nurse, or other caregiver provides. For our purposes, let’s address some examples of specific items that tend to enhance or damage the traditional doctor-patient in relationship in the face of pressure to utilize one of an array of high-tech advances.   

First, there’s the Internet. For all the good that easy access to information on Google, Facebook, Twitter, Instagram, email, text, or an office website provides, it does not take the place of one-on-one interaction, the sound of your voice, a shake of your hand, a feel of the touch, and the warmth of the smile contact with the patient.

Next, just to emphasize the fact that the doctor does not want to talk to you, we have the “don’t bother us” answering machine. If this is an emergency, dial 911. If you know the extension of the person you’re calling, dial it now. If you’re calling about your bill, hit 2. If you’re calling about your prescription, hit 3. If you’re calling to make or cancel an appointment, hit 4. If you’d like to speak to to Irma, the office manager, hit 5. If you’re calling to speak to the doctor, good luck.

And of late, various medical authorities have commented on mammograms, PSA tests, MRIs, and CAT scans that are recommended because the doctors are being defensive about their diagnoses, not because they are what the patient truly needs. On the one hand, we can be thankful about the lives these technologies have saved. But sometimes, too much information can cause unnecessary patient anxiety. The wonder and value of looking at a 3-D radiograph cannot be denied, especially if you’re contemplating the extraction of impacted third molars. But often, the less costly panoramic view can provide sufficient information.

Of course, there are some other interesting technologies that are disrupting the way we practice and improving the care we provide—as long as we don’t lose sight of the importance of dentist-patient communiation. For example, Dentsply Sirona’s CEREC technology creates digital impressions via digital scans combined with a milling unit. Along with CAD/CAM equipment, it could be used to construct and deliver a ceramic crown in a couple of hours. This technology has changed the world of restorative dentistry.

Cari-Vu is a new, portable infrared transillumination unit from Dexis that provides a quick, noninvasive look at the interproximal surfaces of the teeth to give dentists a heads-up in regard to early carious lesions. Suspicious areas then could be observed more closely with radiographs. (We just ordered a unit for a trial run in our office.)

In experimental stages now, in Israel, robots are preparing posts for implants. A frame is clamped on the mandible with needles pointed at the desired area of the bone. A drill bit assembly hovers over the area. With the press of a button, the drill enters the bone and prepares the opening for the acceptance of the implant.

Your Turn

These examples just scratch the surface of the lack of awareness some dental practitioners have when it comes to communicating concern and empathy for their patients. We need to spend more time working on our chairside manner as a most valuable adjunct to our clinical expertise. Our patients deserve it.

Dr. Berman is an internationally recognized pediatric dentist with a career as a successful practitioner and as a popular world-class lecturer spanning more than 5 decades. He’s still one of the principal dentists in a thriving practice in Chicago, Ill. He has been an ambassador for dentistry as a health reporter on CBS (News Radio 78) and via media appearances as a consumer advisor for the ADA, the Chicago Dental Society, and the Academy of Pediatric Dentistry and as coauthor of Essentials of Modern Dental Practice. He has published numerous articles and is a member of many professional and service organizations including an honorary membership in the Hinman Dental Society. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

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Dental 3-D Printing Is Here to Stay

21 Mar 2017
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The buzz is back. Excitement about 3-D printing in the dental industry seems to grow every day. With a history of 3-D printing technology generating high expectations but delivering poor reliability and limited applications at a high cost, many dentists are rightfully wondering what the fuss is about this time, and whether to take it seriously.

Well, this time is different. Adoption of 3-D printing in dentistry is growing at a quickening pace, and the signs indicate that 2017 will see that growth intensify. To understand why, let’s take a look at the trends that have led us to this point, how both additive manufacturing technology and the dental industry have evolved, and what these indicators reveal about the future.

Dentistry: The Perfect Environment for 3-D Printing

With unique anatomies and clinical needs for every patient, dentistry has always been a profession in need of not only custom manufacturing, but also highly specialized, high performance devices like crowns, bridges, retainers, splints, surgical guides, and dentures. The list seems almost endless, and it’s all about mass customization.

Enter 3-D printing. The ability to cost-effectively produce high volumes of customized parts at scale makes 3-D printing the perfect solution for dental production needs. It makes sense, then, that dentistry was one of the first spaces where this technology began to take hold as a digital manufacturing solution in the 1990s.

Even clinicians to whom 3-D printing seems radically new have likely interacted with either a 3-D printed part or a part indirectly made using a 3-D printer. Surgical guides and clear aligners were 2 of the earliest applications for direct and indirect 3-D printed parts in dentistry. In fact, Invisalign is probably the largest single manufacturer of 3-D printed models in the world.

In the coming years, we expect to see 3-D printing expand across even more applications as more affordable solutions take hold. But it wasn’t always this way.

Recent Advances in 3-D Printing Driving Adoption

Even with a seemingly perfect market fit, for a long time 3-D printing failed to take off from its initial foothold in dentistry, hamstrung by costly machines, spotty reliability, limited materials, and barriers to usability. Just as hype about consumer 3-D printing failed to deliver 3-D printers in use in every household, dental 3-D printing seemed poised to remain a niche.

But massive technological advancements in recent years are completely changing the game. Professional-grade 3-D printers have been plummeting in cost while simultaneously improving in quality and reliability.

Affordable desktop 3-D printers are pushing barriers to adoption down even further. Some systems have been shown to perform at clinically acceptable levels of accuracy and even to compete with expensive, large-format systems. Desktop machines, designed with simplified user experiences and out-of-the-box precision, are making 3-D printing more intuitive and easier to use than ever before.

These advances have effectively diminished the high barriers to the adoption of 3-D printing technology to the point where it has not only become accessible to dental labs of any size, but chairside 3-D printing also is now a viable reality.

A Digital World in Search of Manufacturing Endpoints

Two other trends in the market are essential to understanding the upcoming possibilities of 3-D printing in dental: the growing adoption of intraoral and desktop optical scanning, and the growth of dental treatment and computer-aided design (CAD) software. For example, 15% to 20% of dental practices have intraoral scanners, with 40% to 50% considering adoption in the next 5 years. Adoption of desktop optical scanners in dental labs has also grown significantly.

In addition, an established set of dental software companies such as 3Shape now offer a wide range of treatment design and CAD software for a huge range of applications. This is creating a large market of dental professionals in need of manufacturing endpoints for their digital workflows.

What’s Next for 3-D Printing and Dentistry?

With a market swinging so heavily into digital workflows, whether dental 3-D printing will take off will depend on its ability to prove itself as the most cost effective, high quality, easiest to adopt manufacturing option for a wide range of dental products.

At the end of the day, what matters to any dental professional isn’t whether something is handmade, milled, or 3-D printed. What matters is the quality of that final part, the ease with which it can be made, and the cost of making it. Ironically, if 3-D printer manufacturers do their job well, 3-D printing itself will never be a selling point, and the process should fall into the background. (Even though, let’s admit it, machines with lasers are pretty cool.)

With prices for desktop dental 3-D printers already less than $5,000, cost doesn’t appear to be the barrier it once was. The key things to look for in the growth of adoption are applications and materials, reliability, and ease of use. Dental offices and labs have already adopted 3-D printing for applications like surgical guides and models, bringing prices for individual surgical guides down from hundreds of dollars to $3 to $5 per printed guide.

But this only represents a small portion of the dental market. We expect to see adoption explode across new 3-D printing applications such as splints, dentures, temporaries, and, one day, permanent restorations, as 3-D printing materials improve in mechanical properties, biocompatibility, and printability.

All signs point to a coming of age for 3-D printing technology in an industry that’s ripe for change. With several industry players sensing the opportunity and positioning themselves to drive the future of digital dentistry toward additive manufacturing, it’s going to be an exciting year!

Mr. Balloch is dental product lead at Formlabs. He holds a bachelor’s degree in engineering from McGill University.

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