Ransomware at Colorado IT Provider Affects 100+ Dental Offices

A Colorado company that specializes in providing IT services to dental offices suffered a ransomware attack that is disrupting operations for more than 100 dentistry practices, KrebsOnSecurity has learned.
Multiple sources affected say their IT provider, Englewood, Colo. based Complete Technology Solutions (CTS), was hacked, allowing a potent strain of ransomware known as “Sodinokibi” or “rEvil” to be installed on computers at more than 100 dentistry businesses that rely on the company for a range of services — including network security, data backup and voice-over-IP phone service.

Reached via phone Friday evening, CTS President Herb Miner declined to answer questions about the incident. When asked about reports of a ransomware attack on his company, Miner simply said it was not a good time and hung up.
The attack on CTS, which apparently began on Nov. 25 and is still affecting many of its clients, comes little more than two months after Sodinokibi hit Wisconsin-based dental IT provider PerCSoft, an intrusion that encrypted files for approximately 400 dental practices.
From talking to several companies hit and with third-party security firms called in to help restore systems, it seems that CTS declined to pay an initial $700,000 ransom demand for a key to unlock infected systems at all customer locations.
Thomas Terronez, CEO of Iowa-based Medix Dental, said he’s spoken with multiple practices that have been sidelined by the ransomware attack, and that some CTS clients had usable backups of their data available off-site, while others have been working with outside experts to independently negotiate and pay the ransom for their practice only.

Many of CTS’s customers took to posting about the attack on a private Facebook group for dentists, discussing steps they’ve taken or attempted to take to get their files back.
“I would recommend everyone reach out to their insurance provider,” said one dentist based in Denver. “I was told by CTS that I would have to pay the ransom to get my corrupted files back.”
“My experience has been very different,” said dental practitioner based in Las Vegas. “No help from my insurance. Still not working, great loss of income, patients are mad, staff even worse.”
There is one aspect of this attack has massively complicated restoration efforts, even at practices that have negotiated paying the ransom demand: Specifically, two sources said that victim several offices were left with multiple ransom notes and encrypted file extensions.
As a result, the decryption key supplied by the attackers only unlocked some of the scrambled files, requiring affected dental practices to expend further time, effort and expense to obtain all the keys needed to fully restore access to their systems.
Gary Salman is CEO of Black Talon Security, a cybersecurity firm based in New York that assisted several CTS clients in the recovery process. Salmon said he wasn’t certain why the attackers chose to operate this way, but that the most likely explanation is that the attackers stand to gain more financially from doing so.
“For one network we recovered that had 50 devices in total, they had to turn in more than 20 ransom notes to fully recover,” Salman said, adding that the attackers may just be hedging against the possibility that different affected practices could save money by sharing the same decryption key. “In the end, [the attackers] are going to walk away with a lot more money than they would have gotten had [CTS] just paid the $700,000.”
Salman said the intruders seem to have compromised a remote administration tool used by CTS to configure and troubleshoot systems at client dental offices remotely, and that this functionality did not require additional authentication on the part of the client before that connection could be established.
“What a lot of these IT services companies do is have active sessions back to every single client computer, so that so when someone from a client calls the IT provider can log right in and resolve any of these issues,” he said.
“Many IT providers will use remote administration services that require a unique [one-time code] that the client has to type in before that remote session is initiated,” Salman continued. “But other [IT providers] don’t want to do that because then it’s harder for them to manage these systems after-hours or when the user is away from their system. But ultimately, it comes down to security versus ease-of-use, and a lot of these smaller businesses tend to move toward the latter.”
Medix’s Terronez said the dental industry in general has fairly atrocious security practices, and that relatively few offices are willing to spend what’s needed to fend off sophisticated attackers. He said it’s common to see servers that haven’t been patched for over a year, backups that haven’t run for a while, Windows Defender as only point of detection, non-segmented wireless networks, and the whole staff having administrator access to the computers — sometimes all using the same or simple passwords.
“A lot of these [practices] are forced into a price point on what they’re willing to spend,” said Terronez, whose company also offers IT services to dental providers. “The most important thing for these offices is how fast can you solve their problems, and not necessarily the security stuff behind the scenes until it really matters.”
Update, Dec. 8, 1:21 p.m. ET: Added additional perspective and details gathered by Black Talon Security.Also, an earlier version of this story incorrectly stated that the ransomware attack began this past week. Multiple source now confirm that the Sodinokibi ransomware was initially deployed in the early morning hours of Monday, Nov. 25, and that many victim dental offices are still turning away patients as a result of ongoing system outages.

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Digital Treatment Planning: Limits and Possibilities

\Current Oral Health Reports

Abstract

Purpose of Review

This study set out to demonstrate how the digital approach to prosthetic dentistry is able to guarantee better opportunity both in terms of diagnosis and planning and from the point of view of final prosthetic restoration.

Recent Findings

In recent years, the digital approach to prosthetic dentistry has certainly improved the predictability of treatments, giving clinicians and technicians the opportunity to cooperate in the best possible way. A crucial point in prosthetic rehabilitation is the creation of a treatment plan that can be generated through an analysis of facial aesthetics and a consequent orientation of the arches in space, in order to guarantee a restoration that combines aesthetics and function.

Summary

The digital approach capable of combining facial scans, intra-oral scans, laboratory scans and CBCT, as well as mandibular movements, is able to guarantee superior predictability compared to the traditional approach due to the possibility of generating a virtual patient accessible by all the members of the rehabilitation team.
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Effect of LOCATOR attachments with different retentive forces on the stability of 2-implant-retained mandibular overdenture

The Journal of Prosthetic Dentistry

Available online 25 November 2019

The Journal of Prosthetic Dentistry

Abstract

Statement of problem

The LOCATOR system has been widely used for 2-implant-retained mandibular overdentures (2-MOs), but the influence of different LOCATOR attachments on the stability of 2-MOs has not been assessed.

Purpose

The purpose of this in vitro study was to investigate the stability of 2-MOs anchored by LOCATOR attachments with different retentive forces.

Material and methods

An edentulous mandibular test cast with 2 bone-level implants inserted in the left and right mandibular canine regions was used. Twelve overdentures were then fabricated and anchored on the cast, following the instructions of the LOCATOR system. By replacing inserts of the 12 overdentures, the stability of 3 groups of LOCATOR inserts with different retentive forces was evaluated: blue group, pink group, and transparent group. With artificial saliva used on the cast and overdentures, vertical forces of 40 N, 55 N, and 100 N were loaded on the occlusal surface of the left incisor, left canine, and left molar, respectively. Under each loading condition, the vertical displacements at the loading point and the vertical and horizontal displacements of overdentures at the right distal edge were measured at the same time. One-way ANOVA and the post hoc Tukey honestly significant difference (HSD) test were used to compare the stability of 2-MOs with different LOCATOR attachments (α=.05 for all tests).

Results

When a force of 40 N was applied to the incisor, the largest vertical movement of the incisor loading point appeared in the blue group (P<.05), and the displacements of the pink group showed significant difference from those of the transparent group (P>.05). When 55 N was loaded on the canine, the blue group showed the largest vertical displacements of both the loading point and the right distal edge of the overdentures (P<.05). No significant difference was found in the vertical displacements between the pink group and the transparent group (P>.05). When a force of 100 N was loaded on the molar point, the transparent group indicated a smaller movement in the vertical direction at the edge of the overdentures than the blue group (P<.05) or the pink group (P<.05).

Conclusion

LOCATOR attachments with different retentive forces had a significant effect on the denture stability of 2-MOs. Compared with the blue inserts, the pink and transparent inserts can offer greater stability for 2-MOs and could therefore be suggested for clinical situations.
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Can 3D imaging and digital software increase the ability to predict dental arch form after orthodontic treatment?

Highlights

Software analysis of scanned 3D cast helped predict posttreatment dental arch form.
Clinicians predict posttreatment dental arch form better by using digital software.
The software improved agreement between the primary and final wire forms.
The software omitted human visual errors and increased agreement between clinicians.
Dental arch form changes were not highly predictable during treatment.

Introduction

This study aimed to evaluate the ability of dental clinicians to predict posttreatment dental arch forms in patients with malocclusion with the aid of 3D imaging and digital software in comparison with a conventional method.

Methods

Pretreatment and posttreatment dental plaster casts of 100 patients (200 maxillary models and 200 mandibular models) were selected. Three orthodontists selected the best-fitted archwires among 5 commercially available preformed nickel-titanium archwires using 2 methods. In the conventional method, they fit the archwires to pretreatment casts, and in the digital method, they fit the scanned wire to a 3D digital model, using Ortho-Aid, a locally developed 3D software, using clinical bracket points as reference for wire fitness. The predicted posttreatment archwire in each method was compared with the best-fit archwire on the actual posttreatment model of each patient in both methods, and the level of agreement was calculated. The interobserver agreement between the 3 orthodontists in each method was evaluated using intraclass correlation coefficient and the Dahlberg formula.

Results

Orthodontists predicted the final treatment outcome in 50% of cases using the conventional method and 58% using the digital method. However, the range of method error was significantly higher in the conventional method (0.425-3.853 mm for the conventional vs 0.451-0.584 mm for the digital).

Conclusions

Although the clinicians’ ability to predict the final dental arch form after orthodontic treatment and the agreement between clinicians increased by the use of digital equipment, orthodontists can predict the final arch form in about 60% of patients.
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Wear resistance of 3D-printed denture tooth resin opposing zirconia and metal antagonists

The Journal of Prosthetic Dentistry

Available online 27 November 2019
The Journal of Prosthetic Dentistry

Abstract

Statement of problem

Additive manufacturing technology can be used for denture bases and also denture teeth. Therefore, the mechanical properties of 3D-printed resin denture teeth should be evaluated.

Purpose

The purpose of this in vitro study was to compare the wear resistance of 3D-printed denture tooth resin with that of conventionally prefabricated denture teeth.

Material and methods

Eighty substrate specimens were prepared with 5 kinds of resin denture teeth: 3D-printed denture tooth resin (DENTCA denture tooth resin; DENTCA, Inc), Artic 6 (Kulzer GmbH), Preference (Candulor AG), Premium 6 (Kulzer GmbH), and Surpass (GC Corp). The 3D-printed denture tooth specimens were made of methacrylate-based photopolymerized resin by stereolithography 3D printing. Antagonistic surfaces were made from zirconia by milling and from cobalt-chromium (Co-Cr) alloy by 3D printing and casting. The specimens were loaded at 49 N for 30 000 cycles under thermocycling conditions in a mastication simulator. Wear resistance was measured by calculating the volume of substance lost. Wear surface characteristics were observed by using a scanning electron microscope (SEM). Two-way ANOVA was used to analyze the data (α=.05).

Results

The influence of the resin denture teeth and the type of antagonist were both statistically significant. The wear volume loss of the 3D-printed denture tooth resin was higher than that of Artic 6 and Preference when opposing the zirconia and the metal antagonists (P<.05). The 3D-printed denture tooth resin did not show a significant difference from Premium 6 with the zirconia and the metal antagonists or Surpass with the zirconia antagonist. From the SEM images, the specimens of the 3D-printed denture tooth resin showed a relatively smooth surface with the zirconia antagonist and exhibited cracks when opposed by the metal antagonist.

Conclusions

The results suggest that 3D-printing by using resin materials provides adequate wear resistance for denture tooth use.
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