REPOST: Dental laser from Convergent Dental gets funding, raves

Convergent Dental of Natick has recently raised $21.5 million in funding for its Solea laser, a pain-free, drill-free, needle-free device that allows dentists to perform surgery better. This article on The Boston Globe discusses details as the company now prepares for the laser’s broader commercial release.

Dr. Mark Mizner of Commonwealth Dental Group in Boston performed the first
cavity filling using the Solea laser last year on Convergent chief executive Mike Cataldo.
Image Source: bostonglobe.com

For decades Dr. Ronald Plotka had to coax patients into getting over their fear of the most basic tool of his trade: the drill.

But lately people needing oral care have eagerly sought out the Swampscott dentist because he is among the early adopters of a new tool: the Solea laser, made by Convergent Dental of Natick.

In many cases, the laser means a needle-free, pain-free, drill-free trip to the dentist, as Plotka and others use it in place of a drill to perform routine procedures such as filling cavities and shaving teeth to be fitted for crowns.

“Patients love it,” Plotka said. “It eliminates the fear factor, which helps us do better preventive dentistry because people aren’t going to have that fear of the drill or the needle that they used to have.”

This week, four months after bringing the Solea laser to market, Convergent raised $8 million in venture capital, led by Long River Ventures of Boston, bringing total investments in the three-year-old company to $21.5 million.

The Solea, which retails for $85,000, is the first dental laser to gain approval from the Food and Drug Administration for use on both hard tissue, such as teeth, and soft tissue, or gums.

The laser’s rapid pulses of green light — as many as 10,000 per second — not only make cuts but also have a numbing effect, enabling dentists to skip anesthesia in 96 percent of cases, according to Convergent surveys of clients. Patients often feel a slight cold sensation but typically report no pain.

Lasers are not new to dentistry. They are often used to whiten teeth, perform biopsies, and harden fillings.

Convergent also has competition in the quest to replace drills, most notably from Biolase of Irvine, Calif., which makes a laser device called the Waterlase. The Waterlase makes cuts by vaporizing water particles in a targeted area of a tooth and then chipping away at the weakened enamel.

Convergent’s Solea, on the other hand, beams light at a precise wavelength that vaporizes a mineral called hydroxyapatite — a major advantage, according to the company, because tooth enamel is roughly 90 percent hydroxyapatite and only about 5 percent water.

Plotka has used both the Solea and the Biolase at his practice, North Shore Center for Cosmetic Dentistry, and said he prefers Convergent’s device because it enables him to work faster and with greater precision.

The Solea is a finalist in the dental instrument category of the 2014 Medical Design Excellence Awards, a global competition for medical technology. The Waterlase won a bronze medal in the same category in 2012.
Convergent designed the Solea to mimic the look and feel of a drill. Its handheld arm resembles that of a drill, and it even operates the same way — with a foot pedal to control cutting speed.

Convergent chief executive Mike Cataldo said he was so confident dentists could easily transition from the drill to the Solea that he volunteered to be the first test patient last year. Dr. Mark Mizner at Commonwealth Dental Group in Boston used the laser in place of a drill to fill a cavity in one of Cataldo’s teeth and has made the device a staple of his practice since then.

“Here’s the typical reaction of patients: They get up out of the chair, and they go, ‘Oh my God. That was amazing,’ ” Mizner said. “They can’t believe that I just drilled their tooth with no shot and it didn’t hurt.”

The Solea is not a total replacement for the drill — at least not yet. It cannot be used to perform root canals or implants, and in one in 10 cases dentists say they finish laser procedures with a drill, often to smooth rough edges. Even then, however, anesthesia is usually unnecessary because the laser’s numbing effect lingers, much like Novocain itself.

Few dental practices have the new laser, but Cataldo said the new venture funds should help Convergent market the Solea and gain wider adoption. To all the dentalphobics out there, he added that a directory of offices using the laser will be posted on the Convergent website soon.

“What we’re trying to do,” he said, “is take the dread out of dentistry.”

Dr. Domenick Coletti is keen on adopting new dental technologies and techniques that can further enhance his practice at Central Maryland Oral and Maxillofacial Surgery. To learn more about the clinic’s dental procedures and services, visit this website.

REPOST: Examining embryonic teeth prevents problems in later life

A new study being discussed in The Digital Journal shows how a groundbreaking imaging technique could help prevent future teeth and jaw problems using embryo samples.

Image Source: digitaljournal.com

A new 3D imaging technique shows how to prevent teeth and jaw problems through early intervention. This is by identifying incoming wisdom teeth, crowded teeth, and malocclusion in the embryo. 

 

Working with scientists on the Biomedical Imaging and Therapy (BMIT) beamline at the Canadian Light Source synchrotron, a research group from the University of Saskatchewan observed, in microscopic detail, the 3D organization of young teeth within the jaw. The findings lay the groundwork and could have future impact on oral health-related quality of life. 

 

To test out the method scientists used a synchrotron-based micro-computed tomography (micro-CT) imaging technique, according to the Oral Health Group. With the method, silver-stained mouse embryo samples showed even the very earliest stages of tooth development. This type of 3D imaging technique for teeth is rare because of the technical specifications required to maximize the scanner so that it can capture such tiny, translucent and jelly-like tissues. The success on animal models will lead to trials on humans next.

 

The research was recently published in The Anatomical Record. The paper is titled "Technique: imaging earliest tooth development in 3D using a silver-based tissue contrast agent."

The study was undertaken at the Canadian Light Source. This is Canada’s national centre for synchrotron research and a global centre of excellence in synchrotron science and its applications. Located on the University of Saskatchewan campus in Saskatoon, the CLS has hosted 1,700 researchers from academic institutions, government, and industry from 10 provinces and territories; delivered over 26,000 experimental shifts; received over 6,600 user visits; and provided a scientific service critical in over 1,000 scientific publications, since beginning operations in 2005.

 Support for this research was provided by the Natural Sciences and Engineering Research Council of Canada and the Canadian Institutes of Health Research - THRUST program.

Dr. Domenick Coletti is an expert oral and maxillofacial surgeon practicing in Maryland. Learn more about the latest procedures and treatments of oral health problems by following this Twitter account.

REPOST: Dry Mouth Relief

Alan Carr, D.M.D., of the Mayo Clinic describes how to effectively treat dry mouth in the article below.

The best way to treat dry mouth — known medically as xerostomia (zeer-o-STOE-me-uh) — depends on what's causing it. You can do some things to relieve dry mouth temporarily. But for the best long-term dry mouth remedy, you need to address its cause.

Image source: webmd.com

To relieve your dry mouth:

• Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva. For some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause diarrhea or cramps if consumed in large amounts.
• Limit your caffeine intake because caffeine can make your mouth drier.
• Don't use mouthwashes that contain alcohol because they can be drying.
• Stop all tobacco use if you smoke or chew tobacco.
• Sip water regularly.
• Try over-the-counter saliva substitutes — look for products containing xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or ones containing carboxymethylcellulose (kahr-bok-see-meth-ul-SEL-u-lohs) or hydroxyethyl cellulose (hi-drok-see-ETH-ul SEL-u-lohs), such as Biotene Oral Balance.
• Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Rinse, which also offer protection against tooth decay.
• Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.
• Breathe through your nose, not your mouth.
• Add moisture to the air at night with a room humidifier.

Image source: healthcentral.com

 
Saliva is important to maintain the health of your teeth and mouth. If you frequently have a dry mouth, taking these steps to protect your oral health may also help your condition:

• Avoid sugary or acidic foods and candies because they increase the risk of tooth decay.
• Brush with a fluoride toothpaste. Ask your dentist if you might benefit from prescription fluoride toothpaste.
• Use a fluoride rinse or brush-on fluoride gel before bedtime.
• Visit your dentist at least twice yearly to detect and treat tooth decay or other dental problems.

Image source: webmd.com

If these steps don't improve your dry mouth, talk to your doctor or dentist. The cause could be a medication or another condition. Medications are one of the most common causes of dry mouth. Long-term relief from your dry mouth may mean stopping or changing your medication or its dosage, or addressing underlying health issues.

Dr. Domenick Coletti is an oral and maxillofacial surgeon based in Maryland. Visit this website for more on him and his practice.

REPOST: Charity welcomes Action on Sugar group

Obesity and its related diseases---chronic heart diseases and diabetes---may be the main issues of excessive sugar consumption in Britain.  The country's dental experts, however, are welcoming the crackdown on sugar for oral health reasons.  Medical News Today reveals the formation of Action on Sugar, a group that educates the global public on unnecessary sugar intake, and how it is receiving support from the British Dental Health Foundation:

Image source: http://blog.naturalgumption.com

A new group formed to tackle and reverse the growing obesity epidemic has been welcomed by the British Dental Health Foundation.

Action on Sugar, formed of a number of leading worldwide experts, hopes to educate the public on the dangers of hidden sugars and raise awareness of the 'un-necessary' amounts of sugar added to our foods and drinks, a large reason behind the growing obesity crisis.

England has some of the highest obesity rates in the developed world, with 60 per cent of adults and one third of 10 and 11 year olds being overweight or obese. Diet-related illnesses cost the NHS billions each year, and conditions such as type II diabetes and heart disease have also increased.

Latest figures show more than three in every 10 children starting primary school do so with tooth decay, while a third of children aged 12 have visible dental decay.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, welcomed the formation of the group, given the adverse effect large amounts of sugar has on oral health.

Dr Carter said: "Health professionals have long held the opinion that sugar is addictive, and it is pleasing to see so many leading health experts come together to tackle the problem.

"Consuming too many sugary foods and drinks can potentially increase the risk of dental erosion and tooth decay. The increase in consumption of sugary drinks is one of the key reasons for tooth decay.

"The idea that too much sugar is bad for health is not a new concept, yet it is surprising how many people seem to ignore the message. The additional cost of dental treatment from untreated tooth decay is also a growing problem. Cutting back on regular visits may seem like a good idea on the wallet, but the potential cost of emergency treatment is even higher.

"Visiting the dentist regularly and cutting down on how often you have sugary foods and drinks are two of the Foundation's key messages. Following them - and brushing your teeth for two minutes twice a day using a fluoride toothpaste - may help to reduce rising levels of decay in children and adults in the UK."

Emeritus Professor Aubrey Sheiham from the Department of Epidemiology & Public Health, University College London, a global expert advisor of Action on Sugar said: "Free sugars are the main cause of the most common disease in the world; dental caries. If any dietary product were to cause decay of any other part of the body, it would have been severely controlled. Yet sugars decay the hardest human tissue - teeth - and very little is done about controlling sugars. Therefore, policies should be formulated to develop products, such as baby foods and other food products and drinks that have no added sugars."

Dr. Domenick Coletti is a partner at Central Maryland Oral and Maxillofacial Surgery, P.A.  He is an expert in dental surgical procedures.  Visit this blog for updates and findings about oral health.

Repost: CDC includes periodontal disease in annual health report

This article from the Dental Tribune International notes that The Centers for Disease Control and Prevention has included for the first time in its annual report statistics on the prevalence of periodontitis among U.S. adults.

According to the report, more than 47 percent of adults aged 30 and over (approximately 65 million adults) had periodontitis during 2009–2010. While an estimated 8.7 percent had mild periodontitis, the prevalence of moderate periodontitis was 30 percent. Severe periodontitis was estimated to occur in 8.5 percent.

A new report has shown that periodontal disease is a
significant public health concern. (Photo: botazsolti/Shutterstock)
Image Source: dental-tribune.com

Among other aspects, the survey found that periodontitis was directly associated with lower levels of education and higher levels of poverty, both of which influence the use of dental services by adults. Rates of periodontitis were highest among adults with less than a high school education (66.9 percent). More than 16 percent of adults in poor families had severe periodontitis.

The prevalence of periodontitis was significantly higher in non-Hispanic blacks (58.6 percent) and Mexican-Americans (59.7 percent) compared with non-Hispanic whites (42.6 percent). Among all ethnic groups, the prevalence of periodontitis increased with age (24.4–70.1 percent). The prevalence of periodontitis was significantly higher among men (56.4 percent) than among women (38.4 percent).

The purpose of the report was to discuss and raise awareness of the differences in the characteristics of people with periodontal disease and to prompt action to reduce these disparities, the CDC stated.

Data for the report was obtained from the 2009–2010 National Health and Nutrition Examination Survey, a program of studies designed to assess the health and nutritional status of adults and children in the U.S. The survey examines a nationally representative sample of about 5,000 people each year.

The report, titled "CDC Health Disparities and Inequalities Report — United States, 2013," was published as a supplement to the November issue of CDC's Morbidity and Mortality Weekly Report and can be accessed on the organization's website.

Oral health practitioners like Dr. Domenick Coletti would agree with CDC that periodontal disease is an important public health issue. Subscribe to this Twitter account to receive regular updates on oral health.

REPOST: Olympic Athletes Bomb on Oral Hygiene

Olympians undergo a constant series of stringent physical exams to ensure their readiness for competition. An article on TIME suggests that the focus on their bodies may actually be leaving their teeth neglected.

Japan's Fumiyuki Beppu leads the breakaway during the Men's Road Race Road Cycling on day 1 of the London 2012 Olympic Games on July 28, 2012 in London, England. | Image source: TIME

Olympic athletes are at the top of their game when it comes to their physique, but not so much for oral hygiene. New research from the British Journal of Sports Medicine reveals that elite athletes tend to have more cavities, tooth erosion and gum disease than others of a similar age.

Surveying athletes who attended the dental clinic at the 2012 Olympic Games in London for free check-ups and mouth guards, researchers at the University College London (UCL) found a fifth of visitors said that oral health affected training and performance and more than 40 percent were “bothered” by their oral health. Of the 302 athletes surveyed (with data available for 278) from Africa, the Americas and Europe, more than half of respondents had cavities, including 45 percent with dental erosion and 76 percent showed signs of gingivitis.

Though the data is confined to only those visiting the Olympic Village clinic, the researchers assert that the findings are consistent with previous studies. Olympic athlete’s high intensity performance includes consuming large amounts of carbohydrates as well as sugary drinks. Ian Needleman, a professor at UCL who spearheaded the study, said that extreme training places stress on the immune system leaving athletes at high risk of oral disease, the BBC reports. The study also notes that half of the athletes examined had not had a dental examination the year before.

Previous research found that inflammation elsewhere in the body can affect the likelihood of injury as well as recovery time. Researchers have even linked a higher risk of heart attacks among people who do not brush their teeth twice a day (which results in inflamed gums).

As an experienced dental surgeon, Dr. Domenick Coletti would recognize the signs of gum and tooth decay early on and educate patients on better oral hygiene. Click 'Like' on this Facebook page for more updates about dental care.

REPOST: Chin advancements: The oral surgery perspective

Is it possible that some of today’s gadgets can cause diseases that can compromise “our work, activities of daily living, and perhaps even our appearance?” Dr. Tim Sands, Dr. Claudio Tocchio, and Dr. Robert Givelas take a look at some of these new ailments like “smartphone face” which can lead to more people seeking treatment for the affected body part. Read their Oral Health Group report below.

Mucosal incision (Image source: oralhealthgoup.com)

There is no argument that recent innovations in the diagnosis and management of disease involve the application of technology. However, can some of the complementary technological advancements and gadgets that have become lifestyle necessities actually cause disease themselves? Blackberry thumb, iPad finger, and tech neck are becoming the common new ailments compromising our work, activities of daily living, and perhaps even our appearance.

Smartphone face1 is the phenomenon that describes how sitting for hours with your head tipped forward staring at a smartphone, laptop or computer screen, will shorten the neck muscles and increase gravitational pull on the lower face and chin. This leads to submental fullness, double chin (buccula), facial sagging (jowls) and a recessive chin profile (microgenia). The development of the symptoms characterizing smartphone face can be attributed to genetics, the natural aging process and weight fluctuation; nevertheless, the explosion in the use of electronic gadgets has mirrored the rise in individuals seeking treatment of the chin.

According to the American Society of Plastic Surgeons the number of chin augmentation surgeries performed in the United States increased over 70 percent in 2011.2 This increase is more than breast augmentation, botox and liposuction. With equal numbers of both men and women opting for the procedure, it makes chin augmentation the fastest growing plastic surgery trend.3 A trend that is expected to continue as facial aging may first appear in the chin and jaw line. The posting of pictures on Facebook and Instagram and the increasing prevalence of video chat technology, like Skype and FaceTime where perceived flaws are instantly captured for all to see, may be driving force behind the escalating numbers.4 Many people are seeking ways to improve their appearance, boost self-confidence and provide themselves any competitive advantage in the workplace.

THE COSMETIC SURGERY PERSPECTIVE - AUGMENTATION
The chin forms an integral part of the total facial esthetic and profile. A visual treatment objective is developed from a lateral cephalometric tracing and a systematic clinical patient evaluation.5 Esthetic considerations of the lower facial third requires attention to vertical dimension, symmetry and profile to achieve facial balance with the forehead, cheeks, paranasal area, lips and neck.6 Many patients that present for nasal surgery, only after consultation, realize that adding a chin augmentation can improve their overall facial balance and appearance in profile.2

Cosmetic chin augmentations, whether performed by an otolaryngologist or a plastic surgeon, most frequently incorporate the use of an alloplastic implant. Chin implants can be silicone, polymethacrylate, polyethylene or expanded polytetraflourethylene.7 The procedure is performed by an extraoral submental approach as the chin implant is often combined with cervicofacial liposuction, platysma plication (necklift) or rhytidectomy (facelift) through the same skin access incision.6 The implants can be biocompatible, easy to contour, place and remove if necessary.

Injectable facial volumizing fillers including hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse) are being used to temporarily augment the chin. The effects can last up to a year and allow an idea of what a chin implant may more permanently provide.2
The use of chin implants is low risk but is not without complication. Alloplastic materials may result in unpredictable soft tissue contours, resorption of bone and sometimes underlying tooth roots, palpable mobility, infection and inflammatory foreign body reactions.5

Preoperative radiograph (Image source: oralhealthgroup.com)

THE ORAL SURGERY PERSPECTIVE - ADVANCEMENT
Chin augmentations performed by an oral and maxillofacial surgeon most frequently involve a sliding bony advancement by genioplasty. The genioplasty is a horizontal osteotomy of the mandibular symphysis. Originally described from an extraoral approach,8 it is almost exclusively performed today by intraoral access.9 Although a genioplasty can be an isolated procedure, an oral surgeons participation is usually to complement other orthognathic surgical procedures required to correct a malocclusion. Unlike cosmetic implant augmentation, the bony chin advancement not only affords an esthetic change but can provide functional objectives. Genioplasty advancement of the genial tubercle and genioglossus muscle is used to treat sleep apnea.6 Lip competency can be improved by incorporating a vertical chin reduction with the horizontal advancement. In variation, the genioplasty can be used to improve almost every skeletal abnormality of the chin. An excellent review on the preoperative radiographic assessment and clinical patient evaluation was previously published in Oral Health.5 Since this article is on chin augmentation; we are limiting the discussion to our genioplasty advancement technique. Potential complications are addressed at each step to minimize their development.

GENIOPLASTY ADVANCEMENT TECHNIQUE
In the oral surgery environment, since chin advancement is often combined with a LeFort I or a mandibular bilateral sagittal split osteotomy, a general anesthetic is used. However, it can be performed independently on an outpatient basis under sedation and local anesthesia.10 A local anesthetic with vasoconstrictor is injected submucosally along the symphysis to the gonial notch bilaterally. The lower lip is retracted and a superficial mucosal incision is made 1 cm anterior to the depth of the labial vestibule from cuspid to cuspid (Fig. 1). This incision may allow identification of the mental nerve branches.6 An incision placed too close to the vestibule can result in scar bands and unaesthetic mucosal webbing. The incision is then angled directly to the labial cortical bone through the mentalis muscle and periosteum. The soft tissue is reflected superiorly and inferiorly to expose the intended level of the osteotomy. Lateral dissection identifies the mental foramina bilaterally and then extends posteriorly to the inferior aspect of the mandibular body.

A midline vertical line is marked into the labial cortex perpendicular to the planned horizontal osteotomy (Fig. 2). A failure to preoperatively assess and mark the facial and dental midline can lead to transverse malposition and asymmetry. The horizontal osteotomy is made approximately 5 mm inferior to the mental foramen with a reciprocating saw cutting cross-table from the posterior to the midline, through both labial and medial cortices (Fig. 3). The mental nerves are carefully protected as the osteotomy is performed. Poor exposure, excessive retraction or inadequate protection are the most common causes of nerve injury.11 In one study,12 although postoperative sensory loss was found temporarily in all patients, normal sensation returned within 12 months. The posteromedial aspect is the most problematic area to cut. A retractor is placed under the inferior border of the mandible to protect the facial artery and vein. If the posterior osteotomy is not confirmed, an unfavorable fracture of the inferior border of the mandible distally may occur.11 Mobilization of the inferior free chin segment is accomplished (Fig. 4) and is anteriorly repositioned to the predetermined advancement.

Posoperative radiograph (Image source: oralhealthgroup.com)

Stabilization can be made with cortical or circumferential stainless steel wires, titanium miniplates or screws. Our preferred stabilization method involves rigid fixation using two interosseous titanium screws and a lag screw technique. A 1.5 mm hole is drilled in a superior and posterior direction, engaging both the labial cortex of the inferior free chin fragment and the medial cortex of the superior tooth-bearing segment. The labial cortex is countersunk to reduce postsurgical screw palpation and enlarged to the same 2.0 mm diameter of the fixation screw itself. The screw threads do not engage the chin fragment as the screw is placed and tightened (Fig. 5). This technique provides rigid fixation with mild compression (Fig. 6). Titanium screws osseointegrate and rarely need removal. Inadequate stabilization of the mobilized chin fragment may lead to malposition, asymmetry or bony nonunion. Rigid internal fixation promotes maintenance of the advancement and minimal relapse is reported.10 The ratio of soft tissue change to amount of bony movement associated with a surgical genioplasty advancement is predictable and close to 1:1. There is a bony remodeling or rounding of the posterior wings and osteotomy step of the advanced segment that occurs with time.

Initial soft tissue closure involves the mentalis muscles bilaterally and the mucosal midline is identified and a resorbable suture is placed to coordinate symmetry. The mucosal layer is then closed in a running fashion (Fig. 7). A layered closure, midline identification and muscle reapproximation helps to obtain optimal chin and lip position.11 An Elastoplast chin pressure dressing is applied for 48 hours to minimize hematoma formation and to help support the suture line. A comparison of the preoperative and postoperative radiographs confirms the bony and soft tissue advancement and improved lip competency provided by genioplasty (Figs. 8, 9).

Chin augmentation can be performed competently by a number of specialties, each of which employs their preferred technique. It appears the patterns for referral may be based on whether a patient’s evaluation determines the need for primarily an esthetic change or there are also functional objectives. The desired treatment goals can be achieved and complications minimized with systematic clinical and radiographic evaluation, careful surgical technique and consideration of the anatomy of the area.

Dr. Domenick Coletti, a Maryland-based surgeon, performs a number of maxillofacial and oral surgical procedures, including chin surgery. Visit this website for more information.