Dr Ted's new website is:
ojwforweightcontrol.com
As of January 1, 2017, Dr. Rothstein has limited his practice to providing Orthodontic Jaw Wiring for Weight-Control: OJW®: Weight-control. He provides this service in Brooklyn, NY and will soon announce a new office location in Portland,OR where the Oregon Board of Dentistry on June 23 created history by ruling that Dental Professionals are at liberty to Provide Weight-control services. See www.ojwforweightcontrol.com
Contact: 718 808 2656; drted35@gmail.com

Category Archives: News

GIVING BACK THROUGH CONTINUAL EDUCATION

Winter ’11, #31  030411     Topic: Dental Implants:  Part 4     Part 5    Part 6:  PART 4:  Sequential photos of implant procedure;
PART 5:  Step-by-step preparation of the material required by the  lab to fabricate the
crown that will be screwed on to the implant PART 6    Attaching the abutment to the implant
and gluing the crown on to the abutment

Spring ’10, #29  051110    Topic:     Three part film series(YouTube) showing Dr. Ted having a tooth removed and a bone graft in preparation
for getting an implant Part 1   Part 2   Part 3

Spring, 10, #30  040310     Topic:    Orthodontic Jaw Wiring presented at the meeting of the American Association of Orthodontists in
Washington, DC: [SEE POWERPOINT PRESENTATION.  Documents referred to
in the PowerPoint presentation: E-Synopsis

Spring, 10, #29  03/21/10     Topic:   TMJ diagnosis and treatment plan basics

Winter, 10, #28  02/22/10    Topic:   Accelerated orthodontic treatment using “Piezocisons”

Winter, 10, #27  02/06/10    Topic:   Airing on YouTube: Placing an archwire on SmartClip braces: Just go “click-click”

Winter, 09, #26  12/28/09   Topic:   Obstructive Sleep Apnea: Surgical Update:  a seven page PDF from the AAOMS

Summer, 09, #25  08/22/09  Topic:   The article upon which is based the presentation to be given at 110th meeting of the AAO in Washington, DC

Winter, 09, #24  02/23/09  Topic:   What you can do when you didn’t paid: Read the article on Small Claims Court that I wrote for the American Journal of Orthodontics in March of ’99.

Winter, 08, #23   01/21/09  Topic:   The results of the OJW Questionnaire Survey

Summer, 08, # 22   08/25/08  Topic:  The development and application of OJW: 2 videos on YouTube

Summer, 08, # 21  09/22/08  Topic:  12 + Scenarios when you take your patient to Small Claims Court

Summer, 08, # 208/20/08  Topic:  Helping your patient to diminish the fear of having four teeth removed

Spring ’08 # 19  6/02/08  Topic:  The OJW Questionnaire Survey to measure the safety and effectiveness of OJW

Autumn ’07, # 18 10  10/30/07  Topic:  Article submitted to the AJO-DO October 29, 2007

Summer ’07, #17  9/22/07 Topic:  Orthodontic Jaw Wiring  (OJW) :The Protocol for Providing OJW to Your Patients: A New Service in Dentistrye

Summer ’07, #16  9/3/07 Topic:    How to make indirect bonding trays: detailed instructions

Summer ’07, #15  7/21/2007  Topic:    Communicating with your colleagues, your referring dentists and the patients in your practice by email en masse.

Fall ’02,  # 1  11/9/2002 Topics: Practice Management .. Dr. Ted: Growth and Development

Fall ’02,  # 2 11/27 Topics:  Preventing total data loss from your PC    Dr. Ted: Preventing
the extraction of the wrong teeth.

Winter  ’03,  # 3  1/5/03 Topics:  The Team meeting–Part I/4 .. Dr. Ted: KISS: A simple orthodontic appliance

Winter  ’03,  # 4  03/17/03  Topics:   The Team meeting “Passions”–Part 2/4 .. Dr. Ted: Lingual braces: Indirect arch formation

Spring ’03,  #5  5/3/03  Topics:  The staff meeting and practice management: Part 4 of 4 .. Dr. Ted: Removing acid etch, a better method…not rocket science

Summer ’03,  #6  08/30/03   Topics:   Case acceptance: You won’t get them all but do you know why? .. Dr. Ted: Patient’s Financial Memo form and Notice of Informed Consent–The two most important forms in your office.

 Fall ’03,  # 7  12/02/03  Topics:   Practice Management:  Save time and money on the web.     .. Dr. Ted: Clinical: Moments, Forces and Couples of Orthodontics

Winter ’04, # 8  1/9/04  Topics:   Practice Management:  CitiHealth Card a new third-party payment plan to encourage more patient starts. .. Dr. Ted: Diagnosis:  Interpreting the Panoramic X-ray

Winter ’04, # 9  3/5/04 Topic: Practice Management: Email:  Enhancing communication with patients and staff.  .. Dr. Ted:Topic:  A potpourri of reflections for the starting orthodontist…a series in four parts: Part I:  

Spring ’04,  # 10  4/27/04   Over the Wires is sanctioned by the American Association of Orthodontists
 Topic:  Practice Management:   Automatic deductions from checking and credit cards to cut accounts receivables  .. Topic::  A Potpourri of reflections for the starting orthodontist…a series in 4 parts: Part 2:

Summer ’04  # 11  7/9/04  Over the Wires is sanctioned by the American Association of Orthodontists   Topic:   Technology:   Why Broadband is a necessity for your practice   ..  Topic:  Dr. Ted’s approach to loss of retainers, relapse and retreatment: the Retainer Insurance Agreement 

Fall ’04  # 12  9/20/04  Dr. Ted:   Topic: Continuing education: An article by Dr. Michael Florman, NYU Post Graduate ortho 2004; A new appliance to help the overweight; Etiology of Class II is not mandibular retrusion, it is maxillary protrusion.  Topic:   Management / Self Improvement: How NOT to say YES when you really want to say NO!

 
Fall  ’04, # 14  11/11/04  Dr. Ted:  Topic:   Clinical: The dental profession’s role in the control of compulsive overeating: OJW (Orthodontic Jaw Wiring)…a service orthodontists are preeminently suited and can be proud to provide to selected candidates.    

Winter ’05, # 15  2/28/05  Dr. Ted:   Topic:  A potpourri of reflections for the starting orthodontist…a series in four parts: Part III/IV   and  Topic: Table clinic on Orthodontic Jaw Wiring for compulsive overeating at the 105th AAO meeting in San Francisco.     Topic:  Technology:  Spyware / Adware What is it? How do you protect yourself from it?

 

TMJ PAIN

Images of “normal gums”

Images of “overgrown gums

Case Study: Photos of a gingivectomy on RitaS. 113012 with her critique (Click here)

Sometimes gums overgrow the crowns of the teeth making them look too short at the end of treatment. We sculpt them to look normal

I am pleased to announce the addition of a new instrument/service in the office called the “Sapphire Diode Soft-tissue laser” and have completed the Advanced Diode online soft tissue laser training course granting an Associate Fellowship Certificate in the WCLI (World Clinical Laser Institute)* See below. This laser instrument will permit my office to offer an array of services to treat conditions that commonly arise at the start of orthodontic treatment or occur during and at the end of orthodontic treatment. One of the most common problems at the start of treatment is to expose the surfaces of teeth that are covered with gums to allow braces to be attached to them, and at the end of treatment is the need to resculpture/reshape the gums of patients whose gums have become bulbous/ overgrown/ uneven or misshapen. The Sapphire can accomplish this in most cases painlessly, without swelling and without surgery/bleeding and without the need for stitches. It has a variety of other useful applications. See Video

Below: list of YouTube videos demonstrating a variety of treatment applications using the soft-tissue diode laser for common problem seen before during and after orthodontic treatment as well as for use in treatment of some common gum diseases

The operations the 810 soft tissue diode laser can perform

  • Excision and incision biopsies
  • Hemostatic/Hemostasis assistance
  • Treatment of apthous ulcers
  • Gingival incision and excision
  • Gingivectomy
  • Gingivoplasty (reshaping)
  • Gingival troughing
  • Gingival recontouring
  • Tissue retractions for impressions
  • Oral papillectomy
  • Sulcular debridement
  • Sulcular tissue removal
  • Removal of granulation tissue
  • Frenectomy
  • Frenotomy
  • Abscess incision and draining excision
  • Operculectomy
  • Removal of fibromas
  • Soft tissue crown lengthening
  • Vestibuloplasty

 

The 810 Diode Soft Tissue Laser

Case Study: Photos of a gingivectomy on RitaS. 113012 with her critique

 

Informed Consent for Procedures in Which the Soft Tissue Laser is Used

 

Literature References (*Articles Available to  Read)

  1.  Am J Orthod Dentofacial Orthop. 2005 Feb;127(2):262-4.
    HERE AT AAO
    * Principles of cosmetic dentistry in orthodontics: Part 3. Laser treatments for tooth eruption and soft tissue problems.
    Sarver DM, Yanosky M.
    sarverd@aol.com
    PMID: 15750548  [PubMed - indexed for MEDLINE]
  2. Dent Clin North Am. 2007 Apr;51(2):525-45, xi.
    HERE AT AAO
    * Laser use for esthetic soft tissue modification.
    Magid KS, Strauss RA.
    Department of Cariology and Comprehensive Care, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA. drmagid@adfow.com In esthetic dentistry, expanding the evaluation beyond the teeth is necessary to achieve a truly desirable result. The lips, attached and unattached mucosa, free gingival margin, and osseous position and contours must be considered and changed if necessary. Although many treatment modalities are available to accomplish these modifications, the use of lasers of varying wavelengths provides advantages not possible by other means. Lasers are often thought of as generic instruments, but different laser wavelengths function differently, and each has its place in the esthetic continuum. Diode, neodymium:YAG, CO(2) and erbium lasers each have advantages that can be exploited to maximum effect and disadvantages that must be taken into consideration. A thorough understanding of their mechanism of action, their tissue effects, and laser safety is vital to obtaining excellent results.
    PMID: 17532926  [PubMed - indexed for MEDLINE]
  3. Dent Clin North Am. 2004 Oct;48(4):833-60, vi.
    HERE AT AAO
    * Lasers in aesthetic dentistry.
    Adams TC, Pang PK.
    Las Vegas Institute, 9501 Hillwood Drive, Las Vegas, NV 89134, USA. This article focuses on lasers and aesthetic dentistry and their unique parallel in history from their early development to their present day usage and application. The demand for aesthetic dentistry has had a major impact not only on treatment planning but also on the choice of materials, techniques, and equipment. It is this demand that has married the use of lasers with aesthetic dentistry. A short literature review on the five basic laser types precedes the basic premise of smile design and its critical importance in attaining the desirable aesthetic end result. A short review on biologic width and biologic zone reinforces their importance when manipulating gingival tissue. Four case reports highlight the use of diode, erbium, and carbon dioxide lasers. The end results show the power of proper treatment planning and the use of a smile design guide when using these instruments and confirm a conservative, aesthetic treatment without compromising the health and function of the patients.
    PMID: 15464555  [PubMed - indexed for MEDLINE]
  4. Dent Today. 2008 Feb;27(2):156-9.
    HERE AT AAO
    Soft-tissue surgery: use of the Er,Cr:YSGG laser.
    Tracey R.
    rtracey@yahoo.com
    PMID: 18330202  [PubMed - indexed for MEDLINE]
  5. Gen Dent. 2008 Nov-Dec;56(7):663-70; quiz 671-2, 767.
    HERE AT AAO
    * Lasers in cosmetic dentistry.
    Pang P.
    Academy of Laser Dentistry.
    Lasers have become a necessary instrument in the esthetic restorative armamentarium. This article presents smile design guidelines for soft tissue lasers, as well as an overview of hard tissue procedures that may be performed using all-tissue lasers. The goal is to help dentists determine the appropriate laser for a given clinical situations.
    PMID: 19014026  [PubMed - indexed for MEDLINE]
  6. Gen Dent. 1996 Jan-Feb;44(1):47-51.
    HERE AT AAO
    * Laser treatment of orthodontically induced gingival hyperplasia.
    Convissar RA, Diamond LB, Fazekas CD.
    New York Hospital Medical Center of Queens, USA.
    Several studies have shown that gingivitis is common in children and adolescents.
    Introduction of orthodontic devices may exacerbate the gingival inflammation.
    Orthodontically induced gingival hyperplasia in adolescents, its etiology, and treatment alternatives are discussed. Three instances in which laser therapy was used are described.
    PMID: 8940569  [PubMed - indexed for MEDLINE]
  7. J Am Dent Assoc. 1998 Jan;129(1):78-83.
    HERE AT AAO
    * Case report. Use of an argon laser to treat drug-induced gingival overgrowth.
    Mattson JS, Blankenau R, Keene JJ.
    Department of Periodontics, Creighton University School of Dentistry, Omaha, Neb.
    68178, USA.
    This article explores the use of an argon laser to treat severe drug-induced gingival overgrowth. The patient was being treated with phenytoin (Dilantin, Parke-Davis), cyclosporine and a calcium channel blocker. He had undergone a kidney transplantation and had insulin-dependent diabetes mellitus. He had severe gingival overgrowth, which prevented him from wearing his removable prostheses, and a superimposed Candida albicans infection. An argon laser was used to excise the gingival overgrowth so new maxillary and mandibular prostheses could be fabricated.
    PMID: 9448349  [PubMed - indexed for MEDLINE]
  8. J Clin Pediatr Dent. 2003 Winter;27(2):123-6.
    HERE AT AAO
    Cyclosporin-induced gingival overgrowth in a child treated with CO2 laser surgery: a case report.
    Guelmann M, Britto LR, Katz J.
    Department of Pediatric Dentistry, University of Florida, Gainesville, FL 32610-0426, USA. mguelmann@dental.ufl.edu
    A case of a 10 year-old boy with gingival overgrowth due to cyclosporin therapy after heart transplantation is described. Different treatment approaches are discussed and the surgical effect of CO2 laser is illustrated. The critical role of routine professional cleaning and good oral health maintenance for the healthy status of the gingival tissue is also emphasized in this paper. Replacement of cyclosporin by tacrolimus, another immunosuppressive agent associated with minimal to none gingival overgrowth, might be considered in cases with reported recurrences.
    PMID: 12597682  [PubMed - indexed for MEDLINE]
  9. N Y State Dent J. 2009 Jun-Jul;75(4):26-9.
    HERE AT AAO
    *  Laser gingivectomy for pediatrics. A case report.
    Kelman MM, Poiman DJ, Jacobson BL.
    Cedars-Sinai Medical Center, Los Angeles, CA, USA. michelle.kelman@gmail.com
    Republished in
    Todays FDA. 2010 Jan-Feb;22(1):41-5.
    Traditional gingivectomy procedures have been a challenge for pediatric dentists who confront issues of patient cooperation and discomfort. Treatment of pediatric patients must involve minimal operative and postoperative discomfort. Laser soft-tissue surgery has been shown to be well accepted by children. For the pediatric patient, the greatest advantage of the laser is the lack of local anesthesia injection and the associated pre- and postoperative discomfort. The following case report describes a gingivectomy procedure performed on a 14-year-old female.
    PMID: 19722478  [PubMed - indexed for MEDLINE]
  10. Pediatr Dent. 2009 Jan-Feb;31(1):8-13.
    HERE AT AAO
    Gingival overgrowth in a child with arthrogryposis treated with a Er,Cr:YSGG
    laser: a case report.
    Soares FM, Tarver EJ, Bimstein E, Shaddox LM, Bhattacharyya I.
    Department of Pediatric Dentistry, University of Florida College of Dentistry, Gainesville, Fla, USA.
    The present manuscript reports a case of a 21/2 year old girl, diagnosed with
    arthrogryposis, presenting increasing gingival hyperplasia which was treated with Er,Cr:YSGG Laser. The patient was treated under general anesthesia by the Pediatric Dentistry and Periodontics departments. Er,Cr:YSGG laser G6 tip was used at 1.50 watts, 20 pps, 8% water and 11% air, which is recommended by the manufacturer. Scalpel and periodontal curettes were used to complement the laser. Tissue samples from the anterior maxilla, anterior mandible and palatal sites were formalin-fixed and submitted for evaluation. The samples biopsied revealed prominent hyperplasia of the fibrous connective tissue with areas of theepithelium exhibiting pseudoepitheliomatous hyperplasia. At 1 week and 3 months follow up, oral examination showed appropriate healing of gingival tissue. The use of Er,Cr:YSGG laser in the present case proved to be effective in the removal of large amounts of hyperplasic gingival tissue and resulted in fast heeling and mild discomfort.
    PMID: 19320254  [PubMed - indexed for MEDLINE]
  11. Quintessence Int. 2007 Jan;38(1):e54-9.
    HERE AT AAO
    Combined treatment approach of gingivectomy and CO2 laser for cyclosporine-induced gingival overgrowth.
    Haytac CM, Ustun Y, Essen E, Ozcelik O.
    Department of Periodontology, Cukurova University, Faculty of Dentistry, Balcali/Adana, Turkey. cenkhaytac@cu.edu.tr
    The aim of this report is to present a combined treatment approach with gingivectomy and CO2 laser for the management of cyclosporine-induced gingival overgrowth in 4 cases. Four renal transplant patients were surgically treated for marked gingival overgrowth by means of gingivectomy and CO2 laser. Postoperatively, all patients were followed for bleeding, pain, infection during the early healing period, and recurrence of gingival overgrowth for 12 months. The healing was uneventful, and no signs of bleeding, postoperative pain, or infection were observed in any patient during the early healing period. In the 12th postoperative month, there was evidence of mild recurrence in 1 patient, while no sign of recurrence was observed in the other patients during the follow-up period. The advantages of this combined technique include satisfactory bleeding control and clear visibility during the procedure, as well as reduced postoperative pain and swelling.
    PMID: 17508077  [PubMed - indexed for MEDLINE]

 

Diode Soft Tissue Suggested Settings for a Variety of Common Procedures: Advanced Laser Training.com; 877-Laser66

  1. Setting Number One:  1.5-2.0 Watts continuous initiated
    Soft Tissue with anasthesia, Gingivectomy, frenectomy, gingival troughing around crown preps instead of using retraction cord, uncovering implants, fibroma removal, operculectomy
  2. Setting Number Two:  3.0 Watts pulsed initiated
    Soft Tissue without anasthesia, Gingivectomy, frenectomy, gingival troughing around crown preps instead of using retraction cord, uncovering implants, fibroma removal, operculectomy
  3. Setting Number Three:  1.0 Watt continuous initiated
    Sulcular Debridement-eliminates granulation tissue in periodontal pockets
  4. Setting Number Four:  1.5 Watts pulsed 30/30 uninitiated
    Sulcular decontamination, and tip initiation
    With uninitiated tip at 1.5 Watts pulsed 30/30 you can do the following,
  • Tooth desensitization, (Start 5 mm away and paint the area BUT DO NOT TOUCH THE AREA) with the tip, keep about 1-2 mm away from tooth contact at all times, if patient reports warmth or discomfort move fiber further away from tooth until comfort returns, paint 60 seconds then repeat for more profound effect
  • Hemostasis- paint the area until bleeding stops, 1-2 mm from touching tissue, tissue will turn bluish grey color
  • Ulcer treatment, herpetic lesions- 90 seconds of painting the area from 1-5 mm away from the lesion

 The above settings are a good place to set your 4 preset buttons on your diode laser system.  As operators learn more about the system and it’s capabilities, they can adjust the wattage up or down to fit individual preferences.  Please note that these settings are suggestions only and are not a replacement for clinical judgment or training.

LaserG8

Brooklyn Orthodontist Ted Rothstein demonstrates laser gum reshaping Gingivectomy

This film is intended to be shown as a 28 minute film on BCAT, and  as a  15-minute (or a two-part: 10-minutes each part) YouTube Video

Preparatory notes for videographer regarding filming the gum reshaping (“Gingivectomy”) procedure.

(Suggested subject of film Clip in red)

INTRODUCTION:

(Head shot: DrTed introduces subject)

Overgrown gums can substantially detract from an otherwise beautiful orthodontic treatment correction of a patient’s smile, and at times even impede the progress of orthodontic treatment dramatically. Consequently, one of the most common problems at the completion of orthodontic treatment is the need to resculpture/reshape the gums of patients whose gums have become bulbous/ overgrown/ uneven or misshapen. The soft tissue diode Laser can accomplish this in most cases painlessly, without swelling and without surgery/bleeding and without the need for stitches. It has a variety of other useful applications.

http://www.youtube.com/watch?v=YuuWzpm7nLI

(Here is normal gums look like)  Images of “normal gums”
Images of “overgrown gums

(shot revealing Kal-El’s overgrown- -BUT NOT INFLAMED–gums)

(Shot back to normal gums)

 (Shots of the Diode Laser)

Soft Tissue Laser Gum Reshaping Using the Diode 810 Laser: Kal-El Johnson– age 15y/o

The expected time to complete the reshaping is 45-60 minutes.

Family and patient have visited the drted.com laser gum reshaping page and previewed the pertinent videos. The INFORMED CONSENT is an especially useful document for it provides important and helpful information to both the Parent-Patient and the Doctor.  It should be included as part of the video.  http://drted.com/LaserGumTrimmingGingivectomy.htm

(Film Clip showing the informed Consent)

Parent must read and sign the Inform Consent which is located on the same page as the videos.

Kar-El is seated where Dr. Rothstein usually treats him.

Just in back of the patent’s dental chair is placed the Diode Laser in the top of the portable suction machine (which may or may not be used- usually not).

We will briefly acquaint Kal-El with the procedure and what he will experience.

(Medium Shot of Dr. Ted and Kal-El in the chair listening to DrTed describe the procedure and asking question as may be the case. Dr. Ted will show Kal-El the finger-up method to indicate he want DrTed to stop)

All members of the team will be wearing Laser safety-glasses including the videographer, Kal-El, Brian and myself. (Shot of Sign)

The Laser Safety Officer staff member will have posted a sign outside the treatment room warning that a laser procedure is being performed and “Please do not enter” during Laser Reshaping Gum Reshaping procedure.

(Close up of gums being painted)

We will begin by paint his gums high up with a gum numbing ointment and then wait for 5 minutes.

This will numb the area where I am going to give him an injection of local anesthetic “Novacaine”.  He will be given one injection to the right of his midline and one to the left of his midline.

The gum-numbing ointment greatly reduces the discomfort typically felt when an injection is given.

(Dr. Ted is shown administering the anesthetic)

We will then wait 10-15 minutes for the anesthesia to take effect on the gums that we are aiming to reshape.

During this wait we will test his gums with a semi-blunt instrument to be certain that he has achieved TOTAL /PROFOUND anesthesia.

(DrTed is shown pressing blunt instrument in to Kal-El’s gums to test that patient is profoundly anesthetized)

When anesthesia is completed and the patient assures us it is profound we can begin.

First we will photograph the gums to be reshaped the “BEFORE”

(Close-up of patient’s gums needing to be reshaped.)

We will then measure the depth and shape of the gums using a probing instrument with a small ruler and those measurements will be noted on the pre-operative sheet.

(Film showing how depth of overgrown tissue is measured with ruler-instrument, and gums marked to remove the correct amount of tissue.)

Typically Brian sits on the other side of the patient chair and assists in use of the laser reshaping since he has a perspective of the gums that reinforces our notion of the tissue that has to be reshaped (we use the term  “vaporizing the  tissue”

Upon marking out the tissue to be removed we set the laser machine to the watts of power we want to begin vaporizing the tissue at. Typically we choose 1.7 watts to 2.0 watts of “continuous” power. Sometimes we switch to the “pulsed” power setting and raise the wattage for more effective vaporizing.

(Shot of laser instrument control panel monitor).

Brian will “INITIATE” the tip of the laser’s electrode with carbon paper thereby effectuating a sufficient efficient energy level to effectuate the vaporizing action.

(DrTed introduce assistant Brian Millard)

(Shot of Brian “initiating” the laser vaporizing tip with carbon paper)

I will begin reshaping the gums on the patient’s right side. The power is activated and stopped by stepping on a foot-pedal.

When the laser is actively vaporizing/removing the overgrown gum tissue the laser cutting tip glows brightly and an audible beep will be heard every 3 seconds and a slight wisp haze can be noticed rising from the patient’s gums.

Where the gum tissue has been vaporized it turns color which will be visualized as being “caramel” color

(Various clips showing reshaping in action; cleaning tip of instrument and bathing surgical wound with peroxide)

We stop momentarily to take measurements to see how close we are getting to the target amount of tissue we planned on removing /reshaping.

We also stop momentarily to clean/remove the vaporizing tip of the tissue that was removed and is sticking to the tip.

We also stop momentarily to clean away tissue that has been cut but still adheres to the gums.

We frequently bathe the surgical wound with peroxide to keep it clean from tissue debris; it also disinfects and removes any tissue that shows charring.

(Various clips showing reshaping in action; cleaning tip of instrument and bathing surgical wound with peroxide)

 

The goal of setting the proper power level is to avoid charring and rather leave a caramel colored surgical wound.

Rarely is bleeding encountered; when bleeding is encountered it is minor and soon stops: this non-bleeding is because as the laser tip vaporizes it also cauterizes/seals the blood vessels and nerve endings.

During the procedure we constantly monitor the patient’s welfare. Indeed the patient has been previously advised to raise a finger if they want us to stop and they need to take some “timeout”

When we have completed the gums reshaping the diode laser is turned off and we can remove our glasses.

The surgical wound is thoroughly cleaned again with peroxide and covered over with a Vitamin E coating to soothe the tissue and promote healing.

(Final shot of gums reshaped to normal and back to shot of his gums at the start)

No “bandage”/covering of any kind is placed over the gums since there is no bleeding and the gums have been desensitized.

The anesthesia will wear off in 1-2 hours.

(DrTed addresses Kal-El re use of Listerine; wearing-off of anesthesia, avoidance of crunchy food and gentle use of soft toothbrush.)

Patient discomfort is generally mild when the anesthesia wears off.

Discomfort the following day, if any, is well tolerated by the patient.

We will provide 6 Advil in case discomfort exceeds patient’s tolerance which is rare in our experience.

Healing is typically uneventful over the next few days and by the 7th day the gums are back to normal.

We suggest that the patients begin brushing with a soft brush as soon as possible and to avoid foods that are crispy, crunchy and crusty so as to avoid aggravating the healing tissue.

We encourage Kal-El write about his experience with special attention to what he experienced in the days following the Laser Gum Trimming.

DrTed is shown speaking to Kal-El suggesting he write a narrative about his experience with special reference to the next seven days during which healing will take place.

Following 7-10 days of healing Kal-El returns to office.

(Shot of how gums looked BEFORE laser reshaping and how they look healed–AFTER)

(Some footage of DrTed offering a very short summary of what we have seen)

Cordially,

Dr. Ted Rothstein

September 28, 2012

MICROIMPLANTS-TADs

MICROIMPLANTS  (TADS: Temporary Anchorage Devices) in ORTHODONTICS

YOUTUBE VIDEOS:
Inserting a TAD
Inserting a TAD
Moving Back Teeth Forward with a TAD
Moving Lower Back Teeth Forward a TAD
Molar Intrusion
Correction of an Open Bite

Tomas page 1 and Tomas page 2: See how it’s done.

See where the implants can be placed in the jaw

See the anatomical information needed to place microimplants in the infrazygomatic crest

See selected illustrations  showing how TADs can be used

 Photo-documentation of the placement of a microimplant in the office

Ideal placement of TADs in the palate

May 21, 2006

Microimplants are temporary anchorage devices (TAD’s) that looks like a fancy albeit miniature version of a screw.

A common example of orthodontic anchorage (relatively immobile blocks of teeth) is the situation when the orthodontist wants to pull in your front teeth that are sticking out. He uses the back molar teeth to help him because they are large, multirooted, and move very little when they are used to pull back the front teeth.  The molar teeth are well anchored in your jaw.

Another simple way to think of anchorage: A fisherman is sitting in a row boat and has just caught a very 150 pound fish. if he has thrown an anchor overboard, and is strapped into the boat, he can, in time, reel the fish (tooth) in toward the boat without being pulled out to sea, or being pulled out of the boat, or the boat moving from its original position. Woe to the fisherman if he failed to anchor and was close to a waterfall.

What if the patient has no back teeth? Solution…the orthodontist places two microimplants, one on each side of the jaw toward the back where the molars used to be and attaches rubber bands to the front teeth he wants to move back.

The screw is about the about half the size of the width of your thumbnail, and no wider than the width of the head of a pin. It looks like this:  @— .It is generally made of Titanium steel, and is placed painlessly either with a mini-”screwdriver” or a mini-ratchet wrench following the painless creation of “starter” hole in the bone. See Tomas page 1 and Tomas page 2.

The microimplant screw is removed when orthodontic treatment is completed. It takes less than a  minute to remove it, and causes no pain.

In the last 3 years much attention has been paid to this subject as witnessed by an ever increasing number of journal articles and presentations by multiple speakers who have given  a host of presentations on the subject at the international meeting of the American Association of Orthodontist from during 2004, 2005 and just recently in May 2006 in Las Vegas.

Like a forest fire burning out of control orthodontists are coming to use them more and more to enable them to move teeth in ways they never could before.

It will not be long before the use of the microimplant  (miniscrew, TAD) is being taught and used in every post graduate orthodontic school in the country here and abroad.

They are placed into a variety of locations in the patient’s jaw bones usually between the roots of the teeth as well as other locations nearby the roots of the teeth and on the palate.

An article in the AJO-DO vol. 130, n. 2., Aug 2006 provides the reader with the thickness of the soft tissues and cortical bone at the most common areas of placement of pins in the maxillar alveolus and the thickness of the soft tissue at the mid-sagittal suture of the palate.   I am sure that soft and  hard tissue depth measurements will be forthcoming from the authors in relation to the common implant sites in the mandible. [See the article.]

Their use has made infinitely easier the movement of teeth in certain cases, that heretofore was accomplished with only the greatest difficulty.

The placement of the microimplant is becoming one that more and more frequently is being done by the orthodontist. However, there are many orthodontists who prefer to have their colleague, the oral surgeon, do it for them.

The procedure takes about 20-30 minutes and is accomplished painlessly since the patient is provided with local anesthesia.

You might think that driving a screw into the bone is very painful, however, bone in fact has no nerves inside it, so once the “operator” passes the screw through the skin that covers the bone, which is about as thick as this (H) it is done without any sensation except that of some pressure.

Dentaurum is without doubt one of the leaders in this field. Their principle spokesman for their microimplant “TOMAS” (Temporary Orthodontic Micro Anchorage System) is Professor Axel Bumann. He lectured at the AAO conference in Las Vegas, 2006. (www.dentaurum.com),  E-mail: info@dentaurum.de. This company has published some excellent material on this subject and you can request it as well as their DVD on the subject.

You can see the TOMAS approach to the insertion of their microimplant product on the following two pages: Tomas page 1 and Tomas page 2

Imtec is another leader in the field: www.imtec.com (click on “Products” then see “Orthoimplant”.) You will find the Imtec catalogue on microimplants to be most instructive.

 The following articles will provide the reader with a brief overview of the subject:

Comparison and measurement of the amount of anchorage loss of the molars with and without the use of implant anchorage during canine retraction.

Thiruvenkatachari B, Pavithranand A, Rajasigamani K, Kyung HM

Department of Orthodontics, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamil Nadu, India. badri_chari@yahoo.com

INTRODUCTION: The purpose of this study was to compare and measure the amount of anchorage loss…

http://www.stryker.com/microimplants/products/skeletalanchorage.php

Universal Skeletal Anchorage SystemThe Leibinger Micro Implants Universal Skeletal Anchorage System is intended to be placed in the mouth for use as an anchor in orthodontic procedures. The system encompasses three different styles of implants to give a comprehensive selection when facilitating tooth movement….

http://www.orthodonticproductsonline.com/article.php?s=ORP/2006/04&p=4

Miniscrew troubleshooting

By JOHN W. GRAHAM, DDS, MD, AND JASON B. COPE, DDS, PhD

How to manage potential complications of using temporary anchorage devices

p26f1 p26f2

As has been demonstrated in numerous case reports, miniscrew implant (MSI) placement is predictable and stable.1–5 However, implementation of the procedure by clinicians without adequate training in the basic biological and biomechanical fundamentals germane to miniscrews may lead to less-than-ideal treatment results or even complications. The goal of this article is to present potential complications that clinicians may encounter in the routine placement of miniscrews, and how they may be avoided and/or treated.
Inadequate Primary Stability

Primary stability refers to the movement, or the lack thereof, of a miniscrew upon initial placement. A lack of primary stability almost routinely leads to overt miniscrew mobility, with subsequent failure. Recent evidence suggests that the majority of primary miniscrew stability comes from cortical bone, with lesser stability coming from medullary bone.6…

 Related Problems:

Delayed Mobility…
Oroantral Communication…
Temporary Anchorage Periimplantitis…
Tooth-Root Impingement…
Soft-Tissue Injury…
Poor Miniscrew Emergence…
Soft-Tissue Impingement….
Soft-Tissue Infection…
Undesirable Tooth Movement…
Miniscrew Interference…
Miniscrew Fracture…
Postremoval Complications …
Summary

http://www.orthodonticproductsonline.com/article.php?s=ORP/2006/02&p=11

The Case For Microimplants

By Gaby Bahri, DDS

An orthodontist tells how he came to adopt this new technology, and how it can help your practice

p11_fig1Microimplants have become part of the standard of care in my practice today. I praise myself for having made the decision to include this treatment a few years back after reading an article by Kawamura.1 Since then, my team and I have offered solutions to a wider variety of orthodontic problems with more confidence and with a higher degree of certainty.

I remember the time when I left this technique for others to try on their patients and make the mistakes at their own expense; I regret every minute that I spent waiting to start on my first patient. This feeling repeats itself over and over when I hear that in Europe, like in Korea and Japan, microimplants and miniscrews are actually being used routinely by a great number of orthodontists.

Hurdles to Overcome…
Solving Day-to-Day Problems…
Start Small…
Common Uses of Microimplants…

 

http://www.healthmantra.com/ic/imp%20screw.htm

Micro implant Screw for Anchorage in Orthodontics
Now you get absolute Anchorage, Fixed appliance treatment will Never be same again

ASK an honest question to yourself, how many of your cases outcome is compromised because of loss of anchorage ? How much of your energy/time/money  is wasted in planning anchorage ? Half of orthodontic learning involves how to manage anchorage. No more of these Headaches, After Edward Angle the NEXT revolution is here. Call it Microimplant screw anchorage, Skeletal achorage (SAS) or Temporary Anchorage devices (TAD), name does not matter, but it sure has revolutionised orthodontic treatment.

Temporary Anchorage Devices – (TAD).

To see actual cases click here and to download instruction file in pdf format click here.

Some useful links to various manufactures websites:

www.dentosindia.com
http://www.dentalcompare.com/matrix/169/Orthodontic-Micro-Screw-Implant-Anchorage.html
http://www.klsmartin.com/
http://www.stryker.com/microimplants/products/skeletalanchorage.php
http://www.dentalcompare.com/
http://www.leone.it/E_leone/e_prodotti/pages/MINIIMPIANTI_eng.pdf
www.mondeal.de
www.orthotads.com

References:

Temporary Anchorage Devices
cases were shown where TADs were used to assist in the correction of antero-posterior and vertical discrepancies. In one case, TADs were used for direct inter-maxillary fixation following orthognathic surgery. However, a common concern was the stability of skeletal correction using TADs. Surgical correction is more likely to change neuromuscular imbalances, leading to a more stable correction. However this can not be proven at this time because of the lack of studies in this area. The group called for long-term stability studies using TADs. In category of correction of dental discrepancies, applications of TADs were shown for: (1) antero-posterior tooth movements, (2) molar uprighting, (3) intrusion/extrusion of single and multiple teeth. In most cases TADs were used to supplement dental anchorage, however in some applications TADs were used as the sole source of anchorage. Overall the group felt that there are many possible indications and applications for TADs and they serve as an invaluable component of the orthodontic armamentarium. In addition, it was noted that biomechanics need to be design to optimize the use of TADs.
The question re growing vs non growing patients was issued with voice of skepticism from some participants on placing TAD`s on young growing patients.

http://healthmantra.com/ic/purohit4web/index.htm

Micro implant Screw for Anchorage in Orthodontics
Case Examples

INVISALIGN PROVIDERS

nvisalign  orthodontic treatment: who is the preferred provider the specialist in orthodontics or the general dentist?
Safeguards to be aware of when choosing a general dentist as your Invisalign braces provider: Press Release

Overview of the debate: The specialist in orthodontist is far more likely to successfully correct an embarrassing smile using Invisalign than the general dentist because the specialist has the temperament to treat cases that may take as long as two years or more and has accumulated a vast knowledge and experience straightening teeth day in and day out while the general dentist has little or no experience in straightening teeth. Indeed his predominant role as a dental professional is to remove caries and place fillings, clean teeth, make crowns and bridges, remove teeth and do root canals.  The general dentist is dabbling in the “art and science” of orthodontics that competent specialist take years and years of practice to hone their expertise. Moreover, specialist are far more likely to achieve a satisfactory outcome for their patients which is less likely to “relapse” compared to the result achieved by the general dentist. Finally, the specialist can always fall back to using traditional braces when his Invisalign treatment is less than spectacular, but the general dentist rarely, if ever, has such expertise.  Since posting this caveat some time ago I have been consulted by five patients whose cases were mis-diagnosed and mishandled. The general dentist in each case simply lacked the know-how to bring the treatment to a successful conclusion.
Responses are invited: drted35@aol.com

Is Invisalign dangerous for General dentists? Answered by a general dentist who no longer provides Invisalign

My general dentist wants to do my Invisalign treatment which …My general dentist wants to do my Invisalign treatment which I have been told is not easy. What should I do? Our general dentist does everything including root canals… www.avvo.com/medical-advice/my-general-dentist-wants-to… 10 Dentists respond

First Read Dr. Rothstein’s perspective
June 12, 2010

A compendium of thoughts on the problems of general dentists providing Invisalign. What should the public know about choosing a general dentist to provide Invisalign treatment?

Hypothesis: General dentists, when they choose to be Invisalign providers, are more likely to make errors of omission or commission in diagnosis or treatment planning resulting in poor results to the patient’s detriment than are specialists in orthodontics.

Rationale for the Hypothesis: They do not have the years of training, experience and knowledge that a specialist has, hence, they are more likely to mistake a difficult case for an easy one. (Fools rush in where angels fear to tread). Indeed a general dentist HAS ONLY TO TAKE 7 HOURS OF “TRAINING” to become a certified Invisalgn provider. His real experience begins when  he treats his first patient in his office.  Would you want to be the first patient?  How about being the 10th patient?

The Invisalign laboratory located in Costa Rica provides general dentists, for an additional fee, with an advisory custom-support tech who is an orthodontist to “supervise” the general dentist during the course of the patient’s treatment.

Thus they are more likely to choose Invisalign when it is not warranted, or where other orthodontic solutions are more suitable (like perhaps the option not to treat at all). Moreover, they simply do not have the training to recognize the limitations of the Invisalign  treatment method.

Occasionally, the final result of Invisalign treatment does not meet the  expectations of the patients, and myself, the doctor, in which case I can simply place traditional fixed braces and fine-tune the Invisalign treatment plan.

What recourse does the general dentist have? Does he typically have the experience to place bonded braces?, Hardly!. It is likely the patient will have paid good money for a bad result and will never even realize that this has happened.

Finally, there remains the problem of caring for the patient after the teeth are straightened and the know-how needed just to inform the patient what is required to prevent the result from collapsing..”relapsing”.
Orthodontic treatment is almost always a long-term treatment plan (15 -30 months) wherein the the trained orthodontist applies his knowledge to effectuate the completion of his work. On the other hand the general dentist is accustomed to completing the care for his patients in a relative short time (one day to two weeks). His training and experience as a general dentist are not conducive to the measured patience and pace at which the orthodontist carries out his work as a specialist.

When the orthodontist sees a “problem” appearing to be occurring in the treatment plan he is better prepared to understand and correct that problem that is the general dentist.

Here is an analogy that addresses the dilemma: When you board a 747 Airbus to make a transatlantic flight to Europe you know that the Captain and the crew he commands are among the most experienced and respected professionals employed by the airlines. Only then do you feel assured that if some serious in-flight problem arises your captain will have the know-how to prevent your flight from going ”catawampus”. Remember Captain Sully and the “Miracle on the Hudson?

If you knew that your pilot had  limited training in the field of flying and even less knowledge about the particular plane you were boarding wouldn’t you have cause for concern? Would you even book a ticket with the airline?

In other words, if your young child has a dental problem, is it in your child’s best interest to bring him/her to the general dentist. Or, is it indeed preferable to bring them to a dentist who specialized in treating the dental problems of young children?

Moreover, if you had problem with an impacted wisdom tooth would you want a general dentist to diagnose and treat the problem?  In essence, the general dentist is best suited to treat problems of general dentistry not problems that the Oral surgeon is most suitably trained and experienced to provide the most appropriate treatment. Indeed, the general dentist might completely miss certain factors that the trained specialist would note in an instant.

Orthodontics is a unique and specialized field of dentistry.  Orthodontists spend 2-3 years  additional full-time post-graduate study in this specialty because it is so complicated. Indeed orthodontists have to be certified to call themselves a specialist.   General dentists who also ”do” orthodontics, viz. Invisalign often devote a few weekends to attend continuing education programs which touch on limited aspects of orthodontics. Consequently they are not fully trained to recognize the many nuances associated with effective treatment, or even foresee the potential problems lying in wait as they proceed.  There is absolutely no comparison regarding the training and experience of orthodontists vs. general dentists. Training and experience count really do make a difference.

Having said that, a general dentist can treat the simplest of problems with Invisalign.  So long as everything goes as hoped it is possible to achieve a reasonable result.  However, in a more complicated treatment it is hardly reasonable to expect everything to go as one would like.

Prescribing Invisalign is just one of many treatment methods the specialist has at his disposal to address a malocclusion.  There are many situations in which treatment does not go as expected. Ask yourself the question: if this happens to you, will your general dentist have the knowledge and experience to remedy the problem that arose and resolve it? Are general dentists skating on thin ice?

It’s your choice: orthodontist or general dentist? Caveat emptor!: Precautions you can take

Is it just a matter of time before we see a mounting number of legal cases involving general dentists who elected  to provide the Invisalign service without having the extensive skills, training and experience which the specialist in orthodontics has already achieved?

Yours truly,
Cc: President of the AAO, Editor-in-Chief of the AJODO, ESCO, Editor of Orthodontic Products Magazine

BUCK TEETH

The most common of all orthodontic problems is “Buck Teeth” (the subject of my doctoral dissertation)

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"Experience and reputation really count when it comes to providing quality patient care."