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ACCURACY OF DETECTING CARIES BENEATH COMPOSITE RESIN RESTORATIONS USING THE CANARY SYSTEM, BITEWING RADIOGRAPHS AND CONEBEAM CT SCAN


A new paper was just published in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology that evaluated the accuracy of The Canary System, Bitewing Radiographs and Cone Beam CT for detecting natural caries under composite restorations in interproximal regions (https://doi.org/10.1016/j.oooo.2019.09.006).  This study found that The Canary System was more accurate than Bitewing Radiographs and Cone Beam CT in detecting caries on the gingival floor beneath composite restorations.  The sensitivity and specificity data (table on the right) indicates that The Canary System could find 89% of the caries where the other devices found 40% of the lesions.
One of the major reasons for replacing restorations is tooth decay that develops around the edges of the filling.  This study found that “Radiographs though valuable in the detection of advanced caries lesions, are less sensitive for early or recurrent lesions under restorations.”  The Canary System which does not use ionizing radiation can serve as a sensitive tool in early caries detection.
The findings in this study mirror the findings from other studies done by Dr. Amaechi’s group at the University of Texas at San Antonio.  A clinical trial, which was reported at a research conference in 2015, found The Canary System was superior to bitewing radiography for the detection of proximal caries.  The Canary System found 92% of the caries while bitewing radiographs found only 67%.
Radiographs including bitewings are commonly used to detect caries at the interproximal or contact areas but they do not reveal enamel white-spot lesions or all recurrent caries around restorations.  Approximately 30%–40% mineral loss is necessary before an early enamel caries lesion is visible radiographically and demineralization may not appear radiographically until at least 9 months or longer after initiation.
Finding decay early may allow oral health providers to use various preventive / remineralization products to help stabilize the lesion or re-harden it. 
The Canary System, with its unique crystal structure diagnostics, can quantify, image, monitor and record changes in the structure of enamel, dentin and cementum. It can detect caries beneath opaque sealants, around the margins of restorations, around orthodontic brackets and beneath interproximal, occlusal and smooth surfaces.
Visit www.thecanarysystem.com or email sales@thecanarysystem.com to request additional informatio
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Improved Root Canal Instrumentation to Reduce Dental Work Complications

Doctors suggest that the "adaptive" motion of nickel-titanium rotary files used for root canal procedures decreases the instrument’s torque generation, thereby reducing the risk of tooth damage and file fracture

YANGSAN, South Korea, Oct. 7, 2019 /PRNewswire/ — Reducing dental work complications is in best interest of dentists as well as patients. To improve clinical performance of root canal instruments, a research team, led by Dr. Sang Won Kwak from Pusan National University, South Korea, tested instrumentation with specially designed rotary movements. Their study, published in Journal of Endodontics, suggests that adaptive movement of nickel-titanium (NiTi) files improves the success rate of root canal treatment by lowering the torque generation of the instruments. A lower torque will help reduce the risk of tooth damage and file fracture.

As shown in this infographic, adaptive movement of the NiTi files was better than continuous rotary movement; this was reflected in lower total torque (Ncm) and shorter preparation times (seconds)
As shown in this infographic, adaptive movement of the NiTi files was better than continuous rotary movement; this was reflected in lower total torque (Ncm) and shorter preparation times (seconds)

Over the years, root canal dental work has been improved with the use of engine-driven NiTi files. Compared with stainless-steel manual files, NiTi instruments offer better flexibility and cutting efficiency, in addition to reduced iatrogenic errors. However, the NiTi files may have cyclic fatigue and torsional failure problems during the root canal procedure. To reduce the risk of file fracture, Dr. Kwak tested heat-treated NiTi alloy files with specially designed rotary movements.

The scientists tested three types of instruments/movements for the root canal procedure:  The K3XF rotary system with 1) continuous rotary movement (XFC) or 2) adaptive movement (XFA), and 3) the Twisted File with adaptive movement (TFA), all from the endodontic product manufacturer Kerr Endodontics. "Adaptive motion" combines continuous and reciprocating (clockwise and counterclockwise directions) movements rotating 600˚, stopping when the file is exposed to minimal or no load. According to Dr Kwak, "Adaptive movement helps to reduce torque generation during instrumentation with NiTi rotary files." Torque generation occurs while removing root dentin by engine-driven NiTi files. The generated torque implies the energy required to cut root dentin, but also represents the reaction stress to NiTi files as well as the root dentin.
To ensure consistent test conditions, endo-training resin blocks—acrylic blocks used in dentistry to simulate a root canal—were used for all instruments. Each block contained an S-shaped artificial canal, with a working length of 16 mm. The instrumental procedure was performed by a single, experienced endodontist to reduce operator errors, for a total of 45 tests (15 per instrument).
The researchers found that TFA generated the lowest torque. Dr. Kwak and colleagues thus concluded that the adaptive movement for NiTi files may reduce torque generation without increasing preparation time. Dr. Kwak also suggests that the "torque generation is more likely to be affected by the cross-sectional area rather than the movement of the file system." A smaller cross-sectional area may account for the lower torque generation in the TFA file system.
These findings are promising for instrumentation in root canal procedures in the future. The next steps would be to assess the feasibility of these improved instruments in real-life situations in patients in the OR, as opposed to the well-controlled laboratory conditions of this study.

Reference  
Titles of original paper: Comparison of In Vitro Torque Generation during Instrumentation with Adaptive Versus Continuous Movement
DOI:
Name of author:
Affiliation:
https://doi.org/10.1016/j.joen.2019.02.010  
Sang Won Kwak
Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Korea

Pusan National University website
https://www.pusan.ac.kr/eng/Main.do

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Swift Health Systems Raises $45 Million in Series C Funding


IRVINE, CA., October 8, 2019 – Swift Health Systems, Inc., makers of INBRACE®, today announced the company has raised $45MM in series C funding to help bolster commercialization of INBRACE. Financing was co-led by Vivo Capital, Novo Holdings and venBio Partners and brings the total capital raised by the company to more than $70MM. Series C funds will be directed at broadening commercial availability of the innovative INBRACE solution through expanded orthodontist onboarding and training, increased sales and marketing resources and consumer demand generation programs in support of existing and new INBRACE providers.

The orthodontic industry is experiencing a huge increase in do-it-yourself (DIY) aligner therapy, which is raising concerns among dental professionals over potential health risks from unsupervised treatment. INBRACE addresses both consumer and orthodontist needs in this evolving market, as a discrete, aesthetic and convenient solution that delivers the health benefits of light-force tooth movement.

INBRACE truly invisible braces sit unseen behind patient teeth, leveraging an all-digital platform and innovative wire and bracket designs to create the ideal smile for each patient’s unique situation. Patented INBRACE Smartwires® are programmed using data captured from digital scans of patient teeth and automate many steps in orthodontic treatment. The INBRACE system allows patient anatomy to naturally dictate the most efficient path for all tooth movements, resulting in increased practice efficiency and reduced overall treatment time – a true win-win for patients and orthodontists.

"Vivo is delighted to join the Swift Health Systems team,” said Andrew D. Goldberg, MD, principal at Vivo Capital and future Swift board member. “We believe that the advanced technologies behind INBRACE truly invisible braces will revolutionize the future of orthodontic treatment. The capital raised will enable Swift to advance the ways it supports patients and orthodontists around the globe."

Joining Dr. Goldberg on the Swift board are accomplished med-tech professionals and venture capitalists Peter Moldt, PhD, partner at Novo Ventures; and Aaron Royston, MD, partner at venBio.
 
About Vivo Capital
Vivo Capital (“Vivo”) is a healthcare-focused investment firm formed in 1996 with over $3 billion under management. Vivo is currently making investments out of its growth and private equity fund into promising late-stage private and public healthcare companies in the U.S., Europe, and Greater China, from its Opportunity Fund into promising public healthcare companies, and from its PANDA Fund into promising early-stage innovative healthcare companies. For more information visit http://vivocapital.com/.
 
Novo Holdings A/S is a private limited liability company wholly owned by the Novo Nordisk Foundation. It is the holding and investment company of the Novo Group, comprising of Novo Nordisk A/S and Novozymes A/S, and is responsible for managing the Novo Nordisk Foundation’s assets. Novo Holdings is recognized as a leading international life science investor, with a focus on creating long-term value. As a life science investor, Novo Holdings provides seed and venture capital to development-stage companies and takes significant ownership positions in growth and well-established companies. Novo Holdings also manages a broad portfolio of diversified financial assets. Novo Ventures is a wholly owned subsidiary of, and provides certain consulting services to, Novo Holdings. For more information visit: www.novoholdings.dk.
 
About venBio
venBio Partners is a life sciences investment firm that partners with industry leaders to build innovative medicines and technologies, with a focus on novel therapeutics for unmet medical needs. For more information, please visit www.venbio.com.
 
About INBRACE
Hidden behind your teeth, INBRACE® is the new name for truly invisible braces and the aesthetic solution that patients love and doctors trust. The patented Smartwire® system with GentleforceTM technology is tailored to each patient’s unique smile, promoting good oral health through light-force tooth movement and allowing patients to brush and floss normally. Orthodontists appreciate the health benefits of light-force tooth movement and the practice growth opportunities that INBRACE creates. Learn more at www.myinbrace.com or connect with your nearest INBRACE provider with the easy-to-use doctor finder at www.myinbrace.com/doctor-finder.
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Effects of centric mandibular splint therapy on orofacial pain and cerebral activation patterns

Original Article

First Online:

Abstract

Objectives

To investigate the effects on pain, movement kinematics, and cerebral representation by a 3-month mandibular splint therapy.

Material and methods

Thirteen patients with temporo-mandibular joint disease (TMD) and moderate pain intensity were investigated before (PRE), within (after 2 weeks, POST1) and after a period of 12 weeks (POST2) using functional magnetic resonance imaging (fMRI) of representation of occlusal movements on natural teeth and on an individually fitted mandibular splint. In addition, kinematic investigations of jaw movements, muscle electromyography and pain ratings using a pain diary (VAS-scale 0–100) were measured.

Results

Although the patient’s pain ratings decreased about 60%, kinematic and electromyographic characteristics over therapy were not significantly altered. Over therapy, we observed a decrease of fMRI activation magnitude in the primary somatosensory cortex (S1) and secondary somatosensory cortex (S2) and insular cortex during occlusion. Left hemispheric anterior insula and the cerebellar fMRI activation decrease were associated with decrease in pain over time.

Conclusions

Within the limitations of this pilot study, a reduction in both discriminative (primary and secondary somatosensory cortex) and affective (anterior insula) areas for pain processing suggest that altered pain anticipation is critical for the therapeutic effects of mandibular splint therapy after TMD.

Clinical relevance

A 3-month mandibular splint therapy moderately decreases pain and anticipatory anterior insular activation.
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DOSIMETRY AND DIAGNOSTIC ACCURACY OF INTRAORAL AND EXTRAORAL BITEWINGS IN DETECTING APPROXIMAL CARIES

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Background

Traditionally, interproximal caries has been diagnosed radiographically by intraoral bitewing radiographs. Although this has been the conventional practice, the challenge of accommodating the film/ image receptor in the mouth, especially in patients with a gag reflex, has affected image acquisition and quality. A new method of acquiring bitewings with an extraoral approach has been recently introduced but the quality and diagnostic efficacy along with the radiation dosage of these techniques have not been well studied.

Objective(s)

The aim of this study was to evaluate the diagnostic accuracy of intraoral and extraoral bitewings (IOBs and EOBs) in their ability to detect proximal caries and to compare the effective doses from both techniques.

Study Design

Human teeth with or without proximal caries were used in this study. Carious lesions were created with different degrees of decalcification on 60 teeth (120 surfaces). These teeth were then placed into sockets of dry human skulls. Intraoral bitewings were acquired using a Kavo LM/CM109 wall-mounted X-ray tube with exposure parameters of 70 KVp, 7 mA, and 0.125 second. Extraoral bitewings were acquired with a Planmeca Promax at 74 kVp,7 mA, and 7.5 seconds. Two radiologists and a general dentist scored the radiographs using standardized software (MiPACS) and display monitors. Dose measurements were done on an anthropometric RANDO phantom. OSLdot dosimeters were used at 24 sites for radiation dose measurements. Fifteen exposures were performed for each dosimeter, and absorbed dose was calculated as an average of the15 exposures using the International Commission on Radiological Protection (ICRP, 2007) tissue weighting factors.

Results

For the diagnosis of interproximal caries, extraoral bitewings showed a sensitivity of 92.3% and specificity of 93.4%, whereas intraoral bitewings showed sensitivity of 94.5% and specificity of 96.8%, Interim dosimetry analysis showed that the doses for IOBs and EOBs were comparable but were slightly different for intraoral membranes.

Discussion/Conclusions

EOBs showed comparable results to IOBs in the detection of approximal caries and had similar effective doses.
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DIAGNOSTIC PERFORMANCE OF INTRAORAL AND EXTRAORAL RADIOGRAPHS DISPLAYED ON TABLET COMPUTER AND LED MONITOR RETRIEVED USING VIRTUAL DESKTOP APPLICATION AND CLOUD-BASED PACS

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Background

Information retrieval and sharing is key for today’s multidisciplinary patient care. Radiographic interpretation of conventional 2-D images is the standard protocol for most dental schools across the United States, and it is imperative to assess image quality on various display devices as well as image retrieval systems.

Objective(s)

The purpose of this study was to investigate whether common dental conditions seen on conventional 2-D intraoral and extraoral radiographs can be diagnosed with the similar accuracy on handheld tablet computer and LED display as on a dedicated radiology diagnostic display. In addition, to investigate the diagnostic and image quality of the radiographs retrieved over a virtual desktop application and a network computer.

Study Design

A total of 15 intraoral and 5 panoramic deidentified radiographs selected for this study showed a variety of common dental conditions and anatomic landmarks. Assessments were performed on a desktop computer and a tablet computer 10.5-Inch iPad Pro. All radiographs were retrieved on MiPACS and a virtual desktop application, Citrix Receiver. Each radiograph was assigned a case number and only a specific tooth was marked for diagnostic assessment. A total of 240 radiographs were assessed for general dental conditions and anatomic landmarks on panoramic radiographs.

Results

Cohen’s kappa was calculated and the kappa value ranged from 0.79 to 0.89, which indicated good to very good agreement between raters. A Kruskal-Wallis H test was performed, and distributions of identification of caries, caries surfaces, bone loss, and presence of periapical lesions were similar for all groups. Median scores were not statistically significantly different between groups as below (P > .05).

Discussion/Conclusions

IPad and LED monitor display performed equally on their ability to diagnose common dental conditions. In addition, there were no statistically significant differences between the diagnostic ability of dentists examining images retrieved over a virtual desktop application (Remote electronic health record [EHR]) and a network desktop computer.
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