Digital Impressions for Implants

 The latest edition of Chairside Magazine (digital version) has just been posted, and in it is my new article on Digital Impressions For Implants Using Scannable Abutments.

Digital impressions using intraoral scanners are going to be the way impressions will be done in the future.  They are here today, but due to the high cost of equipment and training, it is difficult for most dentists to afford them.

We have had digital impression systems since 1987 when the first Cerec machine became available, but we have not had the ability to scan implants the same way until recently.

The article explains the simplicity of the process using the Cerec red cam system of digital impressions.

Here is a link to the pdf version of the magazine:
http://www.glidewelldental.com/downloads/dentist/chairside/issues/V7-3.pdf
The flash version is here:
http://www.glidewelldental.com/flash/chairside/digital-media/V7-3/issue.swf

And the link to the article is here:

http://www.glidewelldental.com/dentist/chairside/issues/v7-3/clinical-techniques1.aspx
The first link (pdf version) is the best in my opinion.

If you are using a digital scanner or are planning to incorporate this technology in your practice, you may find this interesting.

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204

West Palm Beach, Florida. 33406

Website: http://www.boudetdds.com

Implant Blog: http://www.palm-beach-implants.com

Snoring, Is It Harmful To My Health?

The Relationship Between Snoring, Sleep Apnea And Your Health

I have been suddenly awoken more than once by my wife’s gentle nudging saying that I am snoring loudly and the noise wakes her up or doesn’t let her go to sleep.  Luckily it only happens when I have a problem with nasal congestion and I end up breathing through my mouth at night.  Sometimes snoring is so severe that it affects relationships and your sleeping partner chooses to go to another room in order to get a good night's sleep.

It is estimated that about half of the population in the states snore, and that percentage increases with age and obesity, so this is a very common problem.

So what! You might say, what is a little noise during sleep, it is only an annoyance that my wife (or husband)  has been able to accept about me and does not complain about it any more.  Well, it is well documented in the medical literature that a percentage of those of us that snore, do so because of a condition called Sleep Apnea.  In Sleep Apnea the individual stops breathing during sleep at frequent intervals, and this causes lack of oxygen to all parts of the body.  Over time the circulation to the brain is affected and leads to narrowing of blood vessels that can cause a stroke and even death.  This is not a minor nuisance anymore.

Sleep Apnea is diagnosed with a Sleep Study or polysomnogram requested by your physician that records the number of times that you stop breathing during the night, and how long your breathing stops.  Signs that may indicate that you suffer from sleep apnea are sleepiness during the day, irritability, lack of focus and decreased libido to name a few.  If you are diagnosed with sleep apnea, your physician will recommend a CPAP machine.  It looks like a small reversible vacuum cleaner and has a hose with a mask that attaches to your nose and forces air under pressure to keep your airway from closing so you can breathe without interruptions.

Those persons that have severe sleep apnea, need that machine and CPAP works great for them,  however, those with mild to moderate sleep apnea find the machine cumbersome and difficult to tolerate.  It is those individuals that can benefit from oral appliance therapy.  The appliance is made by your dentist, and moves the jaw forward opening up the airway to prevent an obstruction.  Many persons that tried and stopped using the CPAP machine resort to and do well with the oral appliances.

Here is a SLEEP APNEA QUESTIONNAIRE that may help you determine if you are at risk.

The purpose of this writing will be fulfilled  if I have made you aware of the fact that snoring may be an indication that you, your friend or relative have an undiagnosed condition called sleep apnea that may lead to serious and even life threatening health problems, and that this condition can be easily treated by your physician and dentist and result in an improved quality of life.

 Please talk to your physician or dentist if you think you are at risk.

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com

CBCT Scans in Dentistry - ADA Statement - August 2012

The recent publicity given to the subject of radiation exposure in dentistry and the new CBCT scan technology prompted the ADA's Council on Scientific Affairs to come up with a statement and principles for the safe use of CBCT scans in dentistry.
The statement explains that although CBCT scans produce a higher radiation dose that routine dental x-rays, this dose is significantly lower than the one produced by a medical CT scan.
The dental CBCT units are also capable of further reducing radiation exposure by reducing the area exposed ( also called FOV or field of view).
There have been many measures taken to provide guidance in the safe use of CBCT in dentistry, such as position statements^6,7 and professional guidelines for CBCT use.^4,8 Recommendations for adequate operator education have been published.^1,6
The guidelines state that children are more sensitive to radiation so "Additional considerations should be weighed prior to the exposure of children and adolescents".  Also that CBCT scans should be prescribed only when the diagnostic yield will benefit patient care, enhance patient safety, and significantly improve clinical outcomes.
Another term you may have heard is the ALARA Principle which means “as-low-as-reasonably-achievable” , so the radiation dose for dental patients should be optimized to achieve the lowest practical level for a specific image.
In our dental office, as it should be in general, we try to taylor the recommendations for radiographic images to each individual patient's needs, and patient safety.

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com

References

1. Horner K, et al. Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 2009;38(4):187–195. 
2. Pauwels R, et al SEDENTEXCT Project Consortium. Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol 2012;81(2):267–271.
3. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(1):106–114.↵
4. The SEDENTEXCT Project. Radiation Protection: Cone Beam CT for Dental and Maxillofacial Radiology: Evidence Based Guidelines 2011 (v2.0 Final). www.sedentexct.eu/files/guidelines_final.pdf. Accessed May 11, 2012.
5. Ludlow JB, Davies-Ludlow LE, White SC. Patient risk related to common dental radiographic examinations: the impact of 2007 International Commission on Radiological Protection recommendations regarding dose calculation. JADA 2008;139(9):1237–1243.
6. Carter L, et al. American Academy of Oral and Maxillofacial Radiology. American Academy of Oral and Maxillofacial Radiology executive opinion statement on performing and interpreting diagnostic cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(4):561–562.
7. Joint Position Statement of the American Association of Endodontists and the American Academy of Oral and Maxillofacial Radiology. Use of cone-beam computed tomography in endodontics. www.aaomr.org/resource/resmgr/Docs/AAOMR-AAE_postition_paper_CB.pdf. Accessed July 10, 2012.
8. Academy of Osseointegration. 2010 guidelines of the Academy of Osseointegration for the provision of dental implants and associated patient care. Int J Oral Maxillofac Implants 2010;25(3):620–627.
9. Scarfe WC “All that glitters is not gold”: standards for cone-beam computerized tomographic imaging (published online ahead of print Feb. 3, 2011). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111(4):402–408. doi:10.1016/j.tripleo.2011.01.006.
10. National Council on Radiation Protection & Measurements. Radiation Protection in Dentistry (Report No. 145). Bethesda, Md.: NRCP Publications; 2003.
11. American Dental Association; U.S. Department of Health and Human Services. The Selection of Patients for Dental Radiographic Examinations. Chicago: American Dental Association; 2004.www.ada.org/sections/professionalResources/pdfs/topics_radiography_examinations.pdf.
12. National Research Council of The National Academies, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board of Radiation Effects Research, Division on Earth and Life Studies. 2006. Health Risks From Exposure to Low Levels of Ionizing Radiation: BEIR VII phase 2. Washington: National Academy of Sciences, National Academies Press; 2006.
13. International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection (publication 103). Ann ICRP 2007;37(2–4):1–332.
14. National Council on Radiation Protection & Measurements. Structural Shielding Design for Medical Imaging Facilities (Report No. 147). Bethesda, Md.: NRCP Publications; 2004.