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 Latest news in dentistry

Teeth removed from eye: Orbital teratoma Nagabhushanam, 23, from Nellore in Andhra Pradesh, was born with a rare condition, orbital teratoma, causing a huge tumour to grow in her left eye. The tumour had blinded the eye. Doctors removed the teeth in a rare surgery but said she may not regain vision as the optic nerve was damaged. Nagabhushanam came to the hospital on July 16 and asked the doctors to remove the large tumour. The tumour, which was small at birth, grew large over a period of time. Her left eye was pushed inside and skin protruded, blocking her vision and damaging the optic nerve. Read more.....Source:Publication: The Times Of India Delhi; Date: Aug 4, 2012; Section: Times Nation; Page: 18 CDC issues advisory on soaring, deadly C. difficile infections March 08, 2012 By Jean Williams, ADA News staff While several other health care-associated infections rates are in decline, potentially fatal infections of Clostridium difficile, or C. difficile, not only persist but have climbed in the last decade, according to the Centers from Disease Control, which recently issued a call to action on preventive measures. The CDC is urging workers in health care settings to take stringent precautions to prevent these types of infections, which are linked to about 14,000 American deaths annually. The urging is based on a report in CDC Vital Signs, which offers recent data and calls to action for important public health issues. According to the report, among C. difficile infections identified in Emerging Infections Program data in 2010, 94 percent were associated with receiving health care. It’s an important problem: 94 percent of all the C. difficile that’s happening in the country is related to health care in some way, and that includes dental care, said Dr. L. Clifford McDonald, a medical epidemiologist with CDC’s Division of Health Care Quality Promotion and lead author of the report. Read more: Novel Method to Enhance Gum Healing A new method developed by scientists makes use of bovine collagen to enhance gum healing. New research published in BioMed Central's open access journal Head & Face Medicine resulted in thicker margins around the tooth and, in over half the cases, complete coverage of exposed roots. Researchers across Germany and Switzerland led by Dr Shahram Ghanaati and the dentist Dr Markus Schlee investigated the possibility of using collagen, extracted from bovine pericardium, to form a support for mending receding gums and exposed roots. The collagen was extracted by a process involving osmotic, oxidative and alkaline treatment. This ensured that the cell walls were broken down, proteins and fats dissolved, and that bacteria, viruses and other pathogens were inactivated and removed. The study followed 14 otherwise healthy patients with over 60 'recessions' between them. Their damaged teeth were cleaned before surgery and the collagen implants held in place with loops of surgical thread around the affected tooth. Two weeks later the sutures were removed. None of the patients needed antibiotics. The patients were re-examined after six months to see how well they had recovered. Dr Schlee described the results, "In all cases the healed-over implant improved the look and severity of the recession, and, in over half of all treatments, resulted in total coverage of the exposed root. We would not have expected any of these patients to get better without surgery." The collagen seems to be able to act as a scaffold for the body's own cells to repair the damage leading to results on a level comparable to that of connective tissue grafts. Bovine collagen is a possible solution for patients with little available donor tissue or for whom multiple surgeries are not an option. Source-Eurekalert New Crowing Technique for Treating Tooth Decay Scientists have come up with a novel technique for treating decayed tooth to end painful fillings. Experts are testing a pain-free way dealing with rotten teeth that dispenses with the dentist's drill. It is also done without the need for anaesthetic jabs and appears to be more effective than a conventional filling. The results of pilot studies have been so promising that the NHS has pumped 3million dollars into a nationwide study of the technique, which involves sealing decay in, rather than scraping it out, the Daily Mail reported.owever, the technique is only suitable for milk teeth and so for children, rather than adults. Normally, having a filling involves being given an injection of local anaesthetic. The rotten part of the tooth is then removed using the drill and the hole packed with filling.nder the Hall technique, named after Aberdeenshire dentist Norna (CORR) Hall, no effort is made to remove the decayed part of the tooth. Instead, a metal crown is simply slipped over the tooth and cemented in place.o anaesthetic is needed and, starved of bacteria and oxygen, the decay stops or slows down to such a rate that it doesn't cause any pain. The crown stays in place until it falls out naturally with the tooth, at around the age of ten. Nicola Innes, a lecturer in paediatric dentistry at Dundee University, has carried out two studies into the 'child-friendly' technique. "The Hall Technique is now taught as a standard part of the undergraduate dental programme in almost all dental schools now," she said. "Sealing in decay is getting a lot of interest but we know that although it has been investigated for more than 30 years and there is a strong body of evidence supporting it, many dentists still view decay as a gangrenous type of disease that needs to be cut out surgically," she added. In a two-year trial of 132 children aged between three and ten, children, parents and dentists all preferred the Hall technique. Teeth treated this way also caused fewer problems in the future.or instance, just 2 per cent of teeth treated through the Hall technique went on to develop major problems such as abscesses or become do badly decayed that they were beyond repairing. In the group giving fillings, the figure was 15 per cent. A five-year trial produced similar 'astonishing' results. The NHS-funded trial will study almost 1,500 children treated at 50 dental practices in the north of England, inner-city London and Scotland and Wales. The National Institute for Health Research, the NHS's research arm, said: "A successful outcome for the study will be the ability to make a firm recommendation regarding the most effective approach for managing decay in children's teeth." "This is challenging what has been conventional wisdom for 150 years," Professor Jimmy Steele, of the NIHR, told the Sunday Times. The technique is, at the moment, only suitable for baby teeth. But a version suited to long-lasting adult teeth is being worked on. Source-ANI Bad Breath Could Speed Up Development of Stem Cells in Dental Pulp Bad breath could be beneficial after all with a new study published in the Journal of Breath Research suggesting that the compound responsible for bad breath could be used to speed up the development of stem cells in dental pulp. Researchers led by Dr Ken Yaegaki, from Nippon Dental University in Japan, found that hydrogen sulphide (H2S) speeds up the development of teeth stem cells into liver cells. The researchers tested the effect of H2S by collecting stem cells from the dental pulp from teeth obtained from patients who underwent tooth extractions. The researchers then divided the stem cells collected into two groups. The first group was incubated in a H2S chamber while the second was used as a control group. The researchers found that stem cells that were incubated in the H2S chamber developed into liver cells faster than those in the control group. Dr Yaegaki said that not only did the cells develop sooner but they were also of high purity. Until now, nobody has produced the protocol to regenerate such a huge number of hepatic cells for human transplantation. Compared to the traditional method of using fetal bovine serum to produce the cells, our method is productive and, most importantly, safe, Dr Yaegaki said. Source-Medindia Read more: MedIndia Latest on Stem Cell Technology New Jersey Family interviewed President-Elect, Dr. Joel H. Berg (Wash.) regarding the latest on stem cell technology. According to Berg, parents seem to be interested in the possibility of identifying sources of stem cells from their child, and then harvesting and storing them so they might be able to use them to treat a yet-unforeseen condition. We’re doing the right thing in developing this technology. Dental stem cells may become cells that can heal your child. Science improves every year, and so does our understanding of what they can do. If a child develops a certain kind of cancer, they may be able to help kill the tumor and direct healthy cells to grow, Dr. Berg says. Whatever we think stem cells can do today is only going to improve with time. The article, Harvesting Stem Cells from Children's Teeth was posted online for the February issue of New Jersey Family Magazine. Quick Facts * Discovery of stem cells in dental pulp occurred in 2000 * Stem cells may be taken from a child’s primary teeth, as well as young permanent teeth extracted for reasons other than tooth decay or dental infection * Dental stem cells may become cells that can heal your child . . . If a child develops a certain kind of cancer, they may be able to help kill the tumor To read the piece in its entirety, visit How bacteria fight fluoride in toothpaste and in nature Bill Hathaway December 22, 2011 Yale researchers have uncovered the molecular tricks used by bacteria to fight the effects of fluoride, which is commonly used in toothpaste and mouthwash to combat tooth decay. In the Dec. 22 online issue of the journal Science Express, the researchers report that sections of RNA messages called riboswitches which control the expression of genes detect the build-up of fluoride and activate the defenses of bacteria, including those that contribute to tooth decay. These riboswitches are detectors made specifically to see fluoride,said Ronald Breaker, the Henry Ford II Professor and chair of the Department of Molecular, Cellular and Developmental Biology and senior author of the study. Fluoride in over-the-counter and prescription toothpastes is widely credited with the large reduction in dental cavities seen since these products were made available beginning in the 1950s. This effect is largely caused by fluoride bonding to the enamel of our teeth, which hardens them against the acids produced by bacteria in our mouths. However, it has been known for many decades that fluoride at high concentrations also is toxic to bacteria, causing some researchers to propose that this antibacterial activity also may help prevent cavities.................... More..... PREVENTING BACTERIA FROM FALLING IN WITH THE WRONG CROWD COULD HELP STOP GUM DISEASE 8 February 2012 News:Media release: Society for general microbiology Stripping some mouth bacteria of their access key to gangs of other pathogenic oral bacteria could help prevent gum disease and tooth loss. The study, published in the journal Microbiology suggests that this bacterial access key could be a drug target for people who are at high risk of developing gum disease. Oral bacteria called Treponema denticola frequently gang up in communities with other pathogenic oral bacteria to produce destructive dental plaque. This plaque, made up of bacteria, saliva and food debris, is a major cause of bleeding gums and gum disease. Later in life this can lead to periodontitis and loss of teeth. It is this interaction between different oral pathogens that is thought to be crucial to the development of periodontal disease. Researchers from the University of Bristol have discovered that a molecule on the surface of Treponema called CTLP acts as the key pass that grants the bacterium access to the community, by allowing it to latch onto other oral bacteria. Once incorporated, CTLP in conjunction with other bacterial molecules can start to wreak havoc by inhibiting blood clotting (leading to continued bleeding of the gums) and causing tissue destruction. Professor Howard Jenkinson, who led the study, said that periodontal disease and bleeding gums are common ailments, affecting many groups of people, including the elderly, pregnant women and diabetics. Devising new means to control these infections requires deeper understanding of the microbes involved, their interactions, and how they are able to become incorporated into dental plaque, he said. The study shows that CTLP could be a good target from which novel therapies could be developed. CTLP gives Treponema access to other periodontal communities, allowing the bacteria to grow and survive. Inhibiting CTLP would deny Treponema access to the bacterial communities responsible for dental plaque, which in turn would reduce bleeding gums and slow down the onset of periodontal disease and tooth loss. The team is now working to find a compound that will inhibit CTLP. If a drug could be developed to target this factor, it could be used in people who are at higher risk from developing gum disease, explained Professor Jenkinson. The latest study backs up previous work in Professor Jenkinson’s lab on the workings of harmful oral bacteria. The overarching message from our latest study as well as previous work is that regular tooth brushing and maintaining a healthy mouth is vitally important to keep harmful mouth bacteria at bay, he stressed. In the Mouth, Smoking Zaps Healthy Bacteria Ohio State University Feb 15,2012 According to a new study, smoking causes the body to turn against its own helpful bacteria, leaving smokers more vulnerable to disease. Despite the daily disturbance of brushing and flossing, the mouth of a healthy person contains a stable ecosystem of healthy bacteria. New research shows that the mouth of a smoker is a much more chaotic, diverse ecosystem and is much more susceptible to invasion by harmful bacteria. As a group, smokers suffer from higher rates of oral diseases -- especially gum disease -- than do nonsmokers, which is a challenge for dentists, according to Purnima Kumar, assistant professor of periodontology at Ohio State University. She and her colleagues are involved in a multi-study investigation of the role the body’s microbial communities play in preventing oral disease. The smoker’s mouth kicks out the good bacteria, and the pathogens are called in, said Kumar. So they’re allowed to proliferate much more quickly than they would in a non-smoking environment.... More........ U-M Human Embryonic Stem Cell Line Placed on National Registry University of Michigan Health System Feb 14,2012 The University of Michigan’s first human embryonic stem cell line will be placed on the U.S. National Institutes of Health’s registry, making the cells available for federally-funded research. It is the first of the stem cell lines derived at the University of Michigan to be placed on the registry. The line, known as UM4-6, is a genetically normal line, derived in October 2010 from a cluster of about 30 cells removed from a donated five-day-old embryo roughly the size of the period at the end of this sentence. That embryo was created for reproduction but was no longer needed for that purpose and was therefore about to be discarded. This is significant, because acceptance of these cells on the registry demonstrates our attention to details of proper oversight, consenting, and following of NIH guidelines established in 2009, says Gary Smith, Ph.D., who derived the line and also is co-director of the U-M Consortium for Stem Cell Therapies, part of the A. Alfred Taubman Medical Research Institute...... More........ NYU Study: Blood from Periodontal Disease Can be Used to Screen for Diabetes New York University Feb 14,2012 Oral blood samples drawn from deep pockets of periodontal inflammation can be used to measure hemoglobin A1c, an important gauge of a patient’s diabetes status, an NYU nursing-dental research team has found. Hemoglobin A1c blood glucose measures from oral blood compare well to those from finger-stick blood, the researchers say. The findings are from a study funded by an NYU CTSI (Clinical and Translational Science Institute) grant awarded to the research team last year. Hemoglobin A1c is widely used to test for diabetes. According to guidelines established by the American Diabetes Association, an A1c reading of 6.5 or more indicates a value in the diabetes range. The NYU researchers compared hemoglobin A1c levels in paired samples of oral and finger-stick blood taken from 75 patients with periodontal disease at the NYU College of Dentistry. A reading of 6.3 or greater in the oral sample corresponded to a finger stick reading of 6.5 in identifying the diabetes range, with minimal false positive and false negative results. The findings were published in November 2011 in the Journal of Periodontology........ More........ Study Pinpoints Genetic Variation that Raises Risk of Serious Complication Linked to Osteoporosis Drugs Columbia University Medical Center Jan 27,2012 Researchers at the Columbia University College of Dental Medicine have identified a genetic variation that raises the risk of developing serious necrotic jaw bone lesions in patients who take bisphosphonates, a common class of osteoclastic inhibitors. The discovery paves the way for a genetic screening test to determine who can safely take these drugs. The study appears in the online version of the journal The Oncologist. Oral bisphosphonates are currently taken by some 3 million women in the United States for the prevention or treatment of osteoporosis. In addition, intravenous bisphosphonates are given to thousands of cancer patients each year to control the spread of bone cancer and prevent excess calcium (hypercalcemia) from accumulating in the blood. Bisphosphonates work by binding to calcium in the bone and inhibiting osteoclasts, bone cells that break down the bone’s mineral structure. These drugs have been widely used for years and are generally considered safe and effective,said study leader Athanasios I. Zavras, DMD, MS, DMSc, associate professor of Dentistry and Epidemiology and Director of the Division of Oral Epidemiology & Biostatistics at the Columbia University College of Dental Medicine. But the popular literature and blogs are filled with stories of patients on prolonged bisphosphonate therapy who were trying to control osteoporosis or hypercalcemia only to develop osteonecrosis of the jaw. Osteonecrosis of the jaw, or ONJ, often leads to painful and hard-to-treat bone lesions, which can eventually lead to loss of the entire jaw. Among people taking bisphosphonates, ONJ tends to occur in those with dental disease or those who undergo invasive dental procedures. More........ Filling Without Drilling: Pain-Free Way of Tackling Dental Decay Reverses Acid Damage and Re-Builds Teeth ScienceDaily (Aug. 23, 2011) Researchers at the University of Leeds have discovered a pain-free way of tackling dental decay that reverses the damage of acid attack and re-builds teeth as new. The pioneering treatment promises to transform the approach to filling teeth forever. Tooth decay begins when acid produced by bacteria in plaque dissolves the mineral in the teeth, causing microscopic holes or 'pores' to form. As the decay process progresses these micro-pores increase in size and number. Eventually the damaged tooth may have to be drilled and filled to prevent toothache, or even removed. The very thought of drilling puts many people off going to see their dentist, whether or not they actually need treatment. This tendency to miss check-ups and ignore niggling aches and pains means that existing problems get worse and early signs of decay in other teeth are overlooked. It's a vicious cycle, but one that can be broken, according to researchers at the University of Leeds who have developed a revolutionary new way to treat the first signs of tooth decay. Their solution is to arm dentists with a peptide-based fluid that is literally painted onto the tooth's surface. The peptide technology is based on knowledge of how the tooth forms in the first place and stimulates regeneration of the tooth defect. "This may sound too good to be true, but we are essentially helping acid-damaged teeth to regenerate themselves. It is a totally natural non-surgical repair process and is entirely pain-free too," said Professor Jennifer Kirkham, from the University of Leeds Dental Institute, who has led development of the new technique ....... More Cognitive Behavioral Therapy Can Help Treat Patients With Dental Phobia Medical News Today According to a study published in the latest issue of the British Dental Journal (BDJ), a single session of Cognitive Behavioral Therapy (CBT) could help individuals who suffer from severe dental phobia to overcome their anxieties. ... "Dental phobia is a serious problem because it deters some people from ever going to the dentist, except when they are in severe pain. At this stage, they may require more invasive treatment than might be the case if they went to the dentist regularly. Sadly, this cycle of anxiety, non-attendance and pain is often repeated in the children of those with dental phobia, perpetuating the problem and feeding another generation of oral health problems. ....... More Dental students in India face changed regulations NEW DEHLI, India: The Indian Ministry of Health and Family Welfare recently approved a revision of course regulations for Bachelor of Dental Surgery (BDS) programmes, making it mandatory for dental undergraduates to participate in a paid, rotating one-year internship after four years of theoretical training. The new regulations will first be applied to students who started their BDS in 2008/2009 and be implemented in dental schools around the country in Autumn. .....More Bone Fluoride Levels Not Associated With Osteosarcoma The International and American Associations for Dental Research have released in its Journal of Dental Research a study that investigated bone fluoride levels in individuals with osteosarcoma, which is a rare, primary malignant bone tumor that is more prevalent in males. Since there has been controversy as to whether there is an association between fluoride and risk for osteosarcoma, the purpose of this study, titled "An Assessment of Bone Fluoride and Osteosarcoma," was to determine if bone fluoride levels were higher in individuals with osteosarcoma. No significant association between bone fluoride levels and osteosarcoma risk was detected in this case-control study, based on controls with other tumor diagnoses. In the case-control study, by lead researcher Chester Douglass of Harvard University, patients were identified by physicians in the orthopedic departments from nine hospitals across the U.S. between 1993 and 2000. In this report, the study sample included incident cases of primary osteosarcoma and a control group of patients with newly-diagnosed malignant bone tumors. Specimens of tumor-adjacent bone and iliac crest bone were analyzed for fluoride content. The study was approved by the Institutional Review Boards of the respective hospitals, Harvard Medical School and the Medical College of Georgia. Logistic regression of the incident cases of osteosarcoma (N=137) and tumor controls (N=51), adjusting for age and sex and potential confounders of osteosarcoma, was used to estimate odds ratios (OR) and 95% confidence intervals (CI). There was no significant difference in bone fluoride levels between cases and controls. The OR adjusted for age, gender, a history of broken bones was 1.33 (95% CI: 0.56-3.15). "The controversy over whether there is an association between fluoride and risk for osteosarcoma has existed since an inconclusive animal study 20 years ago," said IADR Vice-president Helen Whelton. "Numerous human descriptive and case-control studies have attempted to address the controversy, but this study of using actual bone fluoride concentrations as a direct indicator of fluoride exposure represents our best science to date and shows no association between fluoride in bone and osteosarcoma risk." Notes: The study design was approved by the National Institutes of Health's National Cancer Institute (NCI), with funding provided by the National Institute of Environmental Health Sciences, National Institute of Dental and Craniofacial Research and NCI. Source: Ingrid L. Thomas, International & American Associations for Dental Research Pain-Free Repair Of Teeth With New Peptide Fluid 24 August 2011 Researchers at the University of Leeds have discovered a pain-free way of tackling dental decay that reverses the damage of acid attack and re-builds teeth as new. The pioneering treatment promises to transform the approach to filling teeth forever... Read more.... Most Naturally Variable Protein In Dental Plaque Bacterium Discovered By Chemists 23 August 2011 Two UC San Diego chemists have discovered the most naturally variable protein known to date in a bacterium that is a key player in the formation of dental plaque. The chemists, who announced their discovery in this week's...Read more.... Sports Dental Injuries Are No Laughing Matter 23 August 2011 The crunch of helmets as players tangle for a loose football, the swoosh of the net as an outside jumper is made and the crack of the bat as a guaranteed double sails into right center field are awesome sounds to sports fans... Read more.... Japanese dental school unveils new life-like practice robot with "love doll" skin and mouth June 30, 2011 Japan's Showa University announces the latest generation of its Hanako robot, a life-like training dummy for dental students. Japan's Showa University unveiled their latest training dummy, a life-like robot dental patient with a moving head and arms, and facial and oral features that react to pain and fatigue the way a real patient might. Named Hanako 2, this latest robot incorporates skin, mouth and tongue features built by the country's top sex doll manufacturer, Orient Industry. Hanako 2 represents significant improvements over the prior model. It can blink, sneeze, shake its head, cough, gag and engage in simple conversation using voice recognition software. "If you don’t try to make a robot's face look realistic, it doesn't have the same effect on users psychologically. How doctors and students actually feel in the presence of a patient is a really big factor. It makes quite a difference if students can train while experiencing the same kind of tension they'd feel about a human patient," university officials said. Orient Industry was instrumental in developing Hanako 2's silicone skin, and the inside of the mouth has been formed into one piece to help prevent liquids from leaking into the machinery. The robot was fabricated by Tmsuk and will be sold by Yoshida Dental Manufacturing, although price points have not yet been disclosed. Food-Borne Bacteria Causes Potentially Fatal Heart Infection ScienceDaily (Jan. 26, 2011) Researchers at the University of Illinois at Chicago College of Medicine have found that particular strains of a food-borne bacteria are able to invade the heart, leading to serious and difficult-to-treat heart infections. The study is available online in the Journal of Medical Microbiology. The bacteria Listeria monocytogenes is commonly found in soft cheeses and chilled ready-to-eat products. For healthy individuals, listeria infections are usually mild, but for susceptible individuals and the elderly, infection can result in serious illness, usually associated with the central nervous system, the placenta and the developing fetus. About 10 percent of serious listeria infections involve a cardiac infection, according to Nancy Freitag, associate professor of microbiology and immunology and principle investigator on the study. These infections are difficult to treat, with more than one-third proving fatal, but have not been widely studied and are poorly understood. Freitag and her colleagues obtained a strain of listeria that had been isolated from a patient with endocarditis, or infection of the heart. "This looked to be an unusual strain, and the infection itself was unusual," she said. Usually with endocarditis there is bacterial growth on heart valves, but in this case the infection had invaded the cardiac muscle. The researchers were interested in determining whether patient predisposition led to heart infection or whether something different about the strain caused it to target the heart. They found that when they infected mice with either the cardiac isolate or a lab strain, they found 10 times as much bacteria in the hearts of mice infected with the cardiac strain. In the spleen and liver, organs that are commonly targeted by listeria, the levels of bacteria were equal in both groups of mice. Further, the researchers found that while the lab-strain-infected group often had no heart infection at all, 90 percent of the mice infected with the cardiac strain had heart infections. The researchers obtained more strains of listeria, for a total of 10, and did the same experiment. They found that only one other strain also seemed to also target the heart. "They infected the heart of more animals and were always infecting heart muscle and always in greater number," Freitag said. "Some strains seem to have this enhanced ability to target the heart for infection." Freitag's team used molecular genetics and cardiac cell cultures to explore what was different about these two strains. "These strains seem to have a better ability to invade cardiac cells," she said. The results suggest that these cardiac-associated strains display modified proteins on their surface that enable the bacteria to more easily enter cardiac cells, targeting the heart and leading to bacterial infection. "Listeria is actually pretty common in foods," said Freitag. "And because it can grow at refrigerated temperatures, as foods are being produced with a longer and longer shelf life, listeria infection may become more common. In combination with an aging population that is more susceptible to serious infection, it's important that we learn all we can about these deadly infections." The study was supported by a Public Health Service Grant; by Public Health Service post-doctoral training fellowships; and an American Heart Association Predoctoral Fellowship More.... Dental Magnetic Resonance Imaging: Making the Invisible Visible Djaudat Idiyatullin, PhD,* Curt Corum, PhD,* Steen Moeller, PhD,* Hari S. Prasad, BS, MDT,† Michael Garwood, PhD,* and Donald R. Nixdorf, DDS, MS‡§ Source: JOE Volume 37, Number 6, June 2011 Abstract Introduction: Clinical dentistry is in need of noninvasive and accurate diagnostic methods to better evaluate dental pathosis. The purpose of this work was to assess the feasibility of a recently developed magnetic resonance imaging (MRI) technique, called SWeep Imaging with Fourier Transform (SWIFT), to visualize dental tissues. Methods: Three in vitro teeth, representing a limited range of clinical conditions of interest, imaged using a 9.4T system with scanning times ranging from 100 seconds to 25 minutes. In vivo imaging of a subject was performed using a 4T system with a 10-minute scanning time. SWIFT images were compared with traditional two-dimensional radiographs, three-dimensional cone-beam computed tomography (CBCT) scanning, gradient-echo MRI technique, and histological sections. Results: A resolution of 100 mm was obtained from in vitro teeth. SWIFT also identified the presence and extent of dental caries and fine structures of the teeth, including cracks and accessory canals, which are not visible with existing clinical radiography techniques. Intraoral positioning of the radiofrequency coil produced initial images of multiple adjacent teeth at a resolution of 400 mm. Conclusions: SWIFT MRI offers simultaneous three-dimensional hard- and soft-tissue imaging of teeth without the use of ionizing radiation. Furthermore, it has the potential to image minute dental structures within clinically relevant scanning times. This technology has implications for endodontists because it offers a potential method to longitudinally evaluate teeth where pulp and root structures have been regenerated. (J Endod 2011;37:745 -752) Key Words: Caries, dentin, enamel, imaging, MRI, pulp Diagnostic imaging in dentistry depends mostly on x-ray based techniques that carry some risks and limitations such as exposure to ionizing radiation and its associated increased risk of cancer (1) and the inability to visualize the pulpal tissue (2). The application of x-ray based three-dimensional diagnostic imaging is likely to increase in endodontics as cone-beam computed tomography (CBCT) imaging systems become more available (3, 4). However, besides exposure to radiation, such systems cannot simultaneously image calcified and noncalcified dental tissues, which is a significant limitation, particularly as regenerative endodontic procedures become more common in clinical practice (5). In a recent review of parameters used in diagnostic testing for assessing pulpal and periapical tissues, the following conclusion was highlighted: ‘‘.diagnosis of dental pulp diseases suffers from the operator’s inability to test/or image that tissue directly because of its location within a relatively hard tissue, dentin’’ (2). This review also outlined technical advances underway to address these limitations but did not include magnetic resonance imaging (MRI) techniques. This is justified because of the technical challenges with this diagnostic technique that severely inhibit endodontic application at this time, which is likely the reason behind the paucity of research on the topic Mandibular right second molar swift images Figure 1. A mandibular right second molar (tooth 1) with obvious interproximal and questionable occlusal caries imaged with different modalities. Two SWIFT images with different scanning times (24 minutes and 100 seconds) are presented. The image acquired in 100 seconds has more noise, but the tooth structure and dental caries are still well recognizable. The application of an additional filtering step is a potential way to increase the SNR ratio and, thus, produce satisfactory quality images at shorter scanning times (SWIFT: selected slices with an FOV diameter of 25 mm and an isotropic voxel size of 98 mm; CBCT: an isotropic voxel size of 200 mm). Swift, histology and CBCT Figure 2. Three cross-sectional slices of tooth 1 (marked as S1a, S1b, and S1c in Figure 1) are presented. Graphs located on the top of figure with arbitrary gray value present the profiles of slice S1a at the position depicted with a light blue line. The colored arrows delineate the surface of the tooth enamel (red), sound dentin (green), and the signal level of caries (dark blue), respectively. Note that the signal from enamel tissue in SWIFT image is clearly greater than background noise (black arrows). The presence of occlusal caries is observed in S1a within the SWIFT and nondecalcified histology sections, which is the gold standard measure, but not observed in the CBCT scan. The extent of the interproximal caries toward the dental pulp, in S1b and S1c, are more completely delineated in the SWIFT sections than the CBCT when compared with histology. The slice thickness is equal to 98 mm for SWIFT and 200 mm for CBCT images. Swift, histology and CBCT Figure 6. A schematic illustration of the position of intraoral RF coil for in vivo dental imaging experiments on the top of selected slice of a SWIFT image. Source: JOE Volume 37, Number 6, June 2011 Genetic Testing for Oral Disease; New Frontiers in Dental Care April 28th, 2010, posted by Dental Health Magazine staff For years, dentists have always told their patients that if they took care of their teeth and their health, they could avoid problems like gum disease and oral cancer. As it turns out, it’s not so simple. Recent research has revealed that genetic factors play a bigger role one may think. Gum disease, for example, is now known to be strongly linked to a common genetic mutation that causes the immune system to react to certain bacteria in the mouth. Oral cancer is another disease in which viral DNA is a factor. Recently, several genetic tests have become available that use information from DNA to diagnose and personalize treatment for oral disease. Dr. Mike Koczarski of Koczarski Aesthetic and Laser Dentistry in Woodinville, Wash., is among the first to offer these cutting-edge tests to his patients. Early diagnosis and treatment are key to preventing problems, he says. Genetic tests give us a huge advantage in diagnosing and treating people most at risk. Dr. Koczarski currently offers three tests from OralDNA® Labs. Two of the tests focus on periodontal disease, while the third focuses on oral cancer. More......... Researchers Differentiate Dental Stem Cells into Dystrophin-Producing Muscle Cells Dec 1, 2010 A new study has differentiated dental stem cells, further demonstrating their plasticity, into dystrophin producing multi-nucleated muscle cells. The research, published in PLoS One, was led by Jeremy Mao, DDS, PhD, professor and director of the Tissue Engineering and Regenerative Medicine Laboratory (TERML) at Columbia University Medical Center. Mao utilized myogenic progenitor cells derived from dental stem cells to demonstrate significantly higher numbers of dystrophin-producing cells than the parent heterogeneous stems cells from which they were derived. The findings suggest therapeutic potential for muscle regeneration and have implications for disorders such as Muscular Dystrophy, in which the body’s inability to produce dystrophin results in health complications. According to the study’s authors, the latest research, along with recently published research demonstrating the ability of dental stem cells to differentiate into bone, myocardiocytes (heart muscle), and insulin-producing pancreatic beta cells, supports the wisdom of banking stems cells. More......... Dental Implants That can Reduce Costs Developed - 22nd Nov 2010 A group of Indian dentists have successfully created a new dental implant which could cut down the cost for dental treatment by more than 60 percent. The titanium based implant was the product of a five year research funded by the Council of Scientific and Industrial Research and developed in collaboration with the Indian Institute of Technology, Delhi. Lead researcher Professor Mahesh Varma revealed that the new implants not only replace a lost tooth, but also allow the users to chew with as much force as it could have been possible with natural teeth. The implants can not only replace missing teeth, they allow the individual to bite with a force equal to, if not more than, that possible with natural teeth. Toothless people no longer need to struggle with their complete dentures. Implant supported dentures address all the common complaints of instability and looseness, he said. Currently the price for a dental implant is anywhere between Rs 25,000 to Rs 30,000 but the new dental implant could cut down the cost to as low as Rs 7,000. According to latest reports, more than 12 percent of the population over 60 years of age have no teeth with many unable to afford the expense of teeth replacement. Source-Medindia Those with stress are more likely to develop dental problems - 13th July 2010 One dental-related issue linked to too much stress is developing mouth sores. Bacteria and viruses that develop in the mouth can lead to fatigue, allergies and immune system complications, according to   More.. ..... Dentist seeks U.S. class action suit vs. Nobel Biocare - 5th July 2010 STOCKHOLM (Reuters) Swiss dental implant maker Nobel Biocare has been sued by a California dentist seeking class-action status on behalf of dentists whose patients have suffered complications such as bone loss from one of its products.   More.. New dental treatment may benefit special needs and elderly patients - 28th June 2010 While typical dental treatments prove beneficial for most patients, they can be more difficult for mentally challenged individuals and older people with poor eye sight. If these patients aren't able to use standard preventative treatments, they can become at risk for dental complications and other health issues. When it was first developed, carbamide peroxide, the tooth-bleaching compound was used to remove plaque, kill bacteria and improve the mouth's pH level, which protects against enamel degeneration and cavities. Today, oral hygiene specialists use it to whiten teeth.  More.. Dentists have found that the use of a custom-made mouth tray that can worn during the day or at night and carbamide peroxide gel may help these patients take better care of their teeth Innovations... what's new in dentistry? "Hope from Science and Technology" "Remarkable advances in human molecular genetics are developing therapeutic approaches to many oral health diseases, ranging from passive immunization for dental caries, induction of new bone and cartilage tissues, to the artificial synthesis of saliva for patients suffering from xerostomia." "Additional scientific progress in the neuro-sciences will have broad implications for the diagnosis of ... neuromuscular related conditions e.g. facial and dental trauma, bruxism, Bell's palsy, temporomandibular joint disorders and the management of facial pain." "Innovative developments in biotechnology are to design and fabricate bioceramics to be used in the replacement of human enamel or dentin on the surface of teeth." - U.S. Surgeon General's Report We review some of the current advanced technologies and procedures used in dentistry. Treatment of decay with air abrasion Treatment of decay and gum problems with the dental lasers Digital x-ray imaging Intra-oral computer camera Tissue engineering More.......
Multiple Dental X-Rays Raise Risk Of Thyroid Cancer - (6 June 2010) Researchers from Brighton (England), Cambridge (England) and Kuwait have demonstrated that thyroid cancer risk increases as the number of dental x-rays taken grows. The researchers report that the incidence rates of thyroid cancer have doubled from 1.4 per 100,000 in 1975 to 2.9 per 100,000 in 2006 in the UK. More.......
Little-Known Mouth Fluid May Lead to Test for Gum Disease ScienceDaily (May 28, 2010) A little-known fluid produced in tiny amounts in the gums, those tough pink tissues that hold the teeth in place, has become a hot topic for scientists trying to develop an early, non-invasive test for gum disease, the No. 1 cause of tooth loss in adults. It's not saliva, a quart of which people produce each day, but gingival crevicular fluid (GCF), produced at the rate of millionths of a quart per tooth. More ..... Bisphosphonates - Possible Side Effects On Oral Health People undergoing bisphosphonate therapy to prevent or treat osteoporosis (a thinning of the bones) may be unfamiliar with the drug and possible adverse side effects on oral health, according to a study in the May issue of the Journal of the American Dental Association (JADA) More ..... Clinical study shows dental stem cells regrow bone NEW YORK--StemSave, a leader in the field of stem cell recovery and cryo-preservation, has lauded research published in the November issue of the European Cells and Materials Journal that cites reconstruction of the human mandible bone with autologous dental pulp stem cells. StemSave commends Italian researchers from the 2nd University of Naples for their work. This marks the first time dental stem cell research has moved from the laboratory to human clinical trials. The repair and regeneration of bone is particularly significant for the oral maxillofacial field because the repair of these bones, which aid in orofacial functions like speech, chewing, swallowing and facial expressions, are intricate and complex. According to Dr. David Matzilevich, MD, PhD, science advisor to StemSave, "These clinical studies are so significant because autologous dental stem cells were expanded in vitro and for the purpose of oro-maxillofacial bone repair. These cells also facilitated the graft, eliminating immunologic complications such as rejection or excessive inflammation. This is compelling because it creates an environment which proves to be more favorable and successful for new mandibular bone to grow. "This approach," continued Dr. Matzilevich, "also appears superior to current methodologies utilizing cadaverous tissue or grafting tissue from another part of the body. I am very excited that dental stem cells have emerged as critical players in tissue engineering and regenerative medicine now that they have been proven to differentiate into multiple lineages." Added Art Greco, CEO of StemSave: "This breakthrough clinical study, which uses the patient's own stem cells harvested from their teeth to repair bone, is the first of what we believe will be an expanding number of applications to treat a broad array of disease, trauma and injury. And because dental stem cells are easy to recover as part of routine dental procedures, this represents the first of many upcoming uses in the field of personal and regenerative medicine and supports the wisdom of banking your own stem cells from your teeth."

Mom's kiss can spread cavities to baby
What is informed consent? - Dr David Leader(Jan 04, 2010)
Avoid Infection by Avoiding Antibiotics - Dr David Leader(Dec 22, 2009)
Bridge or Implant - What is the Best Way to Replace a Tooth? - Dr David Leader(Nov 24, 2009)
Colorectal Cancer Screening - Dr David Leader(Oct 27, 2009)
Removable Partial Dentures - Dr David Leader(Oct 15, 2009)
Mentally impaired woman dies from dental infection in Michigan - Oct 14, 2009
Blue curing light used to harden dental fillings may stunt tumour growth as well
Dental corneal prosthesis gaining ground in India
Is saliva the magic diagnostic fluid we were waiting for?
A Good Dentist Sees More than Teeth - 29 June 2009
ADA guidelines for Swine Flu
NSW patients 'waiting 2 years' for dental care
Record Number of Volunteers Provided Free Dental Care to Needy Children in Minnesota
New tool to detect early signs of plaque build-up...
Classifying Obturation Techniques : Making clinical choices
Faster Dental Digitizer Promises to Speed Up Appointments
BPA in dental sealants - Jan 16, 2009
chemical bisphenol A is safe, FDA says
Dental, diabetes link tops the bill at American meet
New guidance for dental tourism
Clove - pain killer for dental emergencies
Pendle Council 'no' to fluoride in tap water
Phase III Trial Shows Positive Results for Phentolamine Mesylate ...
New species of bacteria found in human mouth
DIAC's Annual "Future of Dentistry" Survey Results
Will Lumineers Replace Traditional Veneers
Xylitol bears show dental health potential - study
Valium doses for conscious sedation with dental
Dental Marketing Failing? Take A Look At Your Wheel
Scared of the drill? Dental spa gets to the root of the problem
Alternate Pathway That Leads To Palate Development
Preventing and halting tooth decay with sealants (March 2008)
What causes bad breath? (March 2008)
A lollipop for your oral health? (February 2008)
There are many ways to refresh your smile (February 2008)
Early dental visits essential to children's health (February 2008)
Dentures Can Restore A Missing Smile (February 2008)
Morning sickness and oral health - Dr David Leader(Feb 13, 2008)
How Dental insurance improves subscriber's health - Dr David Leader(Feb 13, 2008)
Bad Tastes in Your Mouth in the Morning? Patients Beware of GERD! - Dr David Leader(Sep 13, 2007)
Root canal treatment of Dental implant - Which is the best? - Dr David Leader(Aug 15, 2007)
Whiplash May Produce Delayed Jaw Pain(Aug 17, 2007)
Acetaminophen safe, effective after wisdom tooth removal (July 29, 2007)
Wait is over for orthodontic patients in UK (July 25, 2007)
Adolescent Orthodontic Treatment Alone Better Than Two Interventions (July 19, 2007)
Fluoride Damages Teeth, New Warning By Dentists (July 17, 2007)
Another Way To Customize Your Smile (July 13, 2007)
Laser Used To Help Fight Root Canal Bacteria (July 13, 2007)
Viewing positive images of dentistry reduces anticipatory anxiety in children (July 12, 2007)
Health Alert: Modern dentistry (July 12, 2007)
Cosmetic Dentistry: Implants Versus Dentures (July 10, 2007)
Periodontal Bacteria Found In Amniotic Fluid (July 5, 2007)
Expert Shares Ways To Prevent And Manage Tooth Erosion (June 29, 2007)
Bone Regeneration Could Be Triggered By A Gene-Activated Matrix (June 28, 2007)
A healthy lifestyle can have an unhealthy effect on teeth (June 27, 2007)
Women Advised To Speak Up And Talk To Their Dentists (June 26, 2007)
Ways to prevent significant patient complications during sedation (June 24, 2007)
Gum Disease In Postmenopausal Women Linked To Oral Bone Loss (June 20, 2007)
2 Studies Suggest That Periodontal Diseases Should Be A Concern To Women Of All Ages (June 15, 2007)
Making New Teeth (June 12, 2007)
New Guidance To PCTs On Single-use Instruments For Endodontic Procedures, UK (June 6, 2007)
Dentists Need More Training In Oral Cancer Detection (May 30, 2007)
Chronic Gum Disease Associated With Tongue Cancer (May 24, 2007).
Chocolate Toothpaste? Extract Of Tasty Treat Could Fight Tooth Decay (May 19, 2007)
Smoking And Sleep Top The List Of Lifestyle Factors Impacting Oral Health (May 17, 2007)
Molecule That Destroys Bone Also Protects It, New Research Shows (May 9, 2007)
Periodontal Diseases Are Blind To Age

Gum Disease In Postmenopausal Women Linked To Oral Bone Loss
New Nanocomposites May Mean More Durable Tooth Fillings
Most Patients Don't Need Antibiotics Before Dental Procedures
Scientists Decode Genome Of Oral Pathogen
Rare Case Of Dental Patient-to-patient Hepatitis B Virus Transmission Recorded
Secondhand Smoke Linked To Risk Of Tooth Loss

Stem Cells Research

Scientists grow teeth in lab (Dec 11, 2002)
Scientists Discover Unique Source Of Postnatal Stem Cells in 'Baby' Teeth (Apr 22, 2003)
Stem cells in tooth pulp could be used in research (May, 2003)
New Insight into Progenitor/Stem Cells in Dental Pulp Using Col1a1-GFP Transgenes ( 2004 )
Dental researchers have been working with stem cells to help address ...
Grow-your-own to replace false teeth(May 3, 2004)
Human Periodontal Ligament Stem Cells Isolated for the First Time (Jul 8,2004)
Scientist signals for Stem Cell studies (Feb 2005)
Banking Baby, Wisdom Teeth For Stem Cells (June 8, 2005)

Osteoporosis drugs could have devastating effect on dental work (Nov 13, 2005)
Bacteria From Patient's Dental Plaque Causes Ventilator-associated Pneumonia
Tooth Decay And Gum Infections Linked To Ethnicity And Country Of Origin
How Estrogen Protects Bones
Scientists Re-grow Dental Enamel From Cultured Cells
Using Dental X-rays To Detect Osteoporosis

Root Beer May Be 'Safest' Soft Drink For Teeth
Periodontal Diseases May Aggravate Pre-diabetic Characteristics
Effects of alcohol, tobacco on head and neck cancers studied - latest oral health news from ADA
Deadly Chemical Found in Chinese Toothpaste
Osteoporosis Medications Linked to Jaw Bone Disease

Infective Endocarditis 
For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. The AHA’s latest guidelines were published in its scientific journal, Circulation, in April 2007 and there is good news: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment - Click here for more details

  • Bioethics and biosafety: the use of biomaterials in dental practice 
  • In support of dental research and education programs  
  • Trial of Antioxidants
  • New Study Further Strengthens Link Between Gum Disease And Early Indicators Of Cardiovascular Disease
  • Jones on Dental Technology: Genetics - A new way to make teeth in the lab
  • Volan Design wins 2001 Medical Design Excellence Award for Waterpik Flosser
  • Dental problems go unresolved in many HIV patients
  • Undergraduate conducts high-tech tests on dental enamel
  • Early Dental and Vision Care: A crucial component of children's health
  • Risk Management: Curing the risk of sick building syndrome
  • Jones on Dental Technology: Going through a midline crisis
  • Federal Measure Preventing Needlestick Injuries Takes Effect
  • AACD Announces Its New Dental Protocol For Accreditation
  • Chronic Periodontal Disease Could Lead to Diabetes
  • Sweet Tooth Gene Identified
  • Preventing Needlestick Injuries
  • A Simple genetic test to identify oral cancer
  • Canadian study: Stop fluoridation in water
  • New Butler GUM(R) Toothbrush Gives Germs the Brush Off

  • 1) Jones on Dental Technology: Genetics - A new way to make teeth in the lab Trying to create a natural-looking tooth is the goal of most dental technicians. But, what many dental technicians don't know is that natural teeth are already being creating in a lab in the United States ... a scientific lab, that is. For more, visit here... 2) Volan Design wins 2001 Medical Design Excellence Award for Waterpik Flosser - Volan Design and Waterpik Technologies, Inc. won a top award for the product design of the Waterpik Flosser in the category of dental instruments, equipment, and supplies. For more, visit here... 3) Dental problems go unresolved in many HIV patients Oral infections, mouth ulcers, and other severe dental conditions associated with HIV infections go untreated more than twice as often as other health problems related to the disease. For more, visit here... 4) Undergraduate conducts high-tech tests on dental enamel A undergraduate biomedical engineering major at The Johns Hopkins University is conducting ground-breaking research to help scientists find out how human tooth enamel is affected by acids that reach the mouth through acid reflux. For more, visit here... 5) Early Dental and Vision Care: A crucial component of children's health PacifiCare Dental & Vision Administrators is supporting educational programs that keep dentists abreast of methodologies to better serve children in dentistry, along with community-based public health efforts to promote fluoridation of water supplies. For more, visit here... 6) Risk Management: Curing the risk of sick building syndrome Is your dental office making you or your staff ill? It could be sick building syndrome. Sick building syndrome occurs when building occupants suffer acute health effects associated with time spent indoors, but with no specific identifiable illness or cause. For more, visit here... 7) Jones on Dental Technology: Going through a midline crisis Dentists often find it difficult to communicate the angle of a patient's midline and incisal plane to their labs, especially when the patient's skeletal features are asymmetrical. The problem is so common that it has led some dentists and labs to search for a solution to the midline crisis. >For more, visit here... 8) Federal Measure Preventing Needlestick Injuries Takes Effect A federal measure takes effect that will potentially save the lives of thousands of nurses and other front-line health care workers each year by protecting them from dangerous needlestick injuries. 9) AACD Announces Its New Dental Protocol For Accreditation The American Academy of Cosmetic Dentistry (AACD) is proud to announce the new dental protocol for Accreditation on Thursday May 24, 2001 during the AACD's 17th Annual Scientific Session in Boston, Mass. 10) Chronic Periodontal Disease Could Lead to Diabetes Chronic periodontal disease may contribute to diabetes. While it has been established that people with diabetes are more prone to developing periodontal disease, new research is suggesting that periodontal disease may, in turn, be a risk factor for diabetes. 11) Sweet Tooth Gene Identified Preference for sweetness over bitterness is not just a matter of taste. Over the past few years, receptors and signaling proteins responsible for bitter taste have been identified but, until now, the identity of the 'sweet' taste receptor has been a mystery. 12) Preventing Needlestick Injuries How can I work in my institution to prevent needlestick injuries?" someone asked herself this question five years ago after learning that a needlestick injury had infected her with the human immuno- deficiency virus (HIV). She has since launched the National Campaign for Healthcare Worker Safety, in order to educate nurses and facilities on needlestick injuries, and to urge hospitals to implement safer devices. Like this, you may be among the thousands of health care workers who annually receive a needlestick contaminated with HIV. According to the a recent report, more than one million needlestick injuries to health care workers occur every year. ..... 13) A simple genetic test may help doctors accurately predict whether people with common white patches inside their mouths are likely to develop deadly oral cancer. The technique developed at the University of Oslo could help physicians assess patients with the patches, called oral leukoplakia, so they can be treated early if cancer appears likely. 14) Canadian study: Stop fluoridation in water Big news out of Canada: a new report from the Canadian government claims that fluoridation in water probably does more harm than good. Report author Dr. David Locker, a professor of dentistry at the University of Toronto, suggests that the best solution is to cease fluoridation. 15) New Butler GUM(R) Toothbrush Gives Germs the Brush Off CHICAGO, May 1 /PRNewswire/ -- Every day millions of germs make the average toothbrush their home. Now there's a toothbrush that gives bacteria an eviction notice. Butler GUM® announces the first-ever antibacterial bristle toothbrush with replaceable heads
    Protaper flaring
    6 yr old Empress
    Cvek pulpotomy
    Middle mesial
    Endo misdiagnosis
    MTA retrofill
    Resin core
    BW importance
    Bicuspid tooth

    Necrotic #8 treatment
    Finding MB2 / MB3
    Deep in a canal
    Broken file retrieval
    Molar cases
    Pushed over apex
    MB2 and palatal canal
    Long lower third
    Veneer cases
    CT Implant surgury

    Weird Anatomy
    Apical trifurcation
    Canal and Ultrasonics
    Cotton stuffed chamber
    Pulp floor sandblasting
    Silver point removal
    Difficult acute curve
    Marked swelling
    5 canaled premolar

    Sealer overextension
    Complex anatomy
    Secondary caries
    Zygomatic arch
    Confluent mesials
    LL 1st molar (#19)
    Shaping vs Cleaning
    First bicuspid
    In Vivo mesial view
    Inaccesible canals

    Premolar 45
    Ortho and implant
    Lateral incisor
    Churning irrigant
    Cold lateral
    Tipped to lingual
    Acute pulpitis images

    Middle distal canal
    Silver point
    Crown preparation
    Epiphany healing
    Weird anatomy
    Dual Xenon
    Looking for MB2
    Upper molar resorption
    Acute apical abcess
    Finding MB2

    Gingival inflammation
    Irreversible pulpitis
    AG BU ortho band
    TF Files
    using TF files
    Broken bur
    Warm technique
    Restorative prognosis
    Tooth # 20 and #30

    Apical third
    3 canal premolar
    Severe curvature
    Interesting anatomy
    Chamber floor
    Zirconia crown
    Dycal matrix
    Cracked tooth
    Tooth structure loss
    Multiplanar curves