Monthly Archives: January 2011

Rethinking Bicuspid Extraction Patterns

 From: Morton Speck []
Sent: Monday, January 31, 2011 10:04 AM
Subject: Rethinking Bicuspid Extraction Patterns

Before I launch into one of my favorite topics, it’s great to see a refurbished ESCO as well as many of the usual suspects.  Thanks Huibi!

Now to cut to the chase!

Most of us consider extracting the four 1st bicuspids in a Cl. 1 crowded case a no-brainer because that tooth is closest to the crowding.  However, that is not always the best strategy in the maxillary arch for the following reasons: since the 1st bicuspid is generally larger than the 2nd, the presence of the 1st bicuspid makes the reopening of the extraction site less likely; furthermore, should the space reopen, it is less obvious because of its more distal position; equally important, the difference in the gingival heights of the cuspid and 2nd bicuspid can compromise smile esthetics.  The natural juxtaposition of the cuspid and 1st bicuspid results in a much more pleasing appearance.

Maxillary 1st bicuspids are also traditionally removed in single arch extraction cases, most notably in Cl. ll div. 1 cases.  For the reasons stated above, I would argue again that the maxillary 2nd bicuspid should be the tooth of choice in most cases.  The extraction of the maxillary first molar in single arch extraction cases is also a valid option, but that is the topic for another discussion.
With these considerations, I would ask ESCO readers why they would argue against the removal of maxillary 2nd bicuspids in the majority of cases, and in all cases where this size disparity exists, barring any periodontal considerations.
My guess is that most practitioners avoid removing maxillary 2nd bicuspids, either because they never gave it serious thought, or they were wary of the additional mechanics required and/or the anchorage-taxing problems this protocol entails.  But to trade a superior result for treatment expedience, in my view, does a disservice to your patient.  I respectfully suggest that if you have consistently favored 1st bicuspid extractions in the situations I have described, that you reconsider your options.

Attached are a couple of slides (click here ESCO) that illustrate the size and gingival height difference in a particular case.

Mort Speck
Lexington, MA

Planmeca Xray machine

From: Dr. ThuyDuong Truong <>
Subject: Planmeca Xray machine
Date: Tuesday, January 25, 2011, 11:21 AM

I have a Digital Pan/Ceph Planmeca CC 2002 purchased in the year of 2002 with the Dimaxis 2.4.5 version.  Does anyone have problem with it lately regarding the PCI board connection to the Dimaxis software.  Any information is appreciated. 
ThuyDuong Truong
San Diego, CA

Hand sanitizers

From: <>
Subject: Hand sanitizers
Date: Monday, January 24, 2011, 10:49 AM

I started using handsanitizing gel instead of handwashing a few months ago.  I find that it allows me to glove up much more quickly and move through my day.  I still wash if there is visible soil on my hands (usually after soldering something in the lab).  Anyone aware of any studies that compare the use of hand sanitizers instead of hand washing?  How many of you are using hand sanitizers?

Kevin C. Utley
Cordova, TN

Receivables / Payables

From: Leon Klempner <>
Subject: Receivables/Payables
Date: Friday, January 14, 2011, 7:55 AM

Does anyone have a simple system of tracking supplies received so that all monthly statements can be easily verifiable before payment?

Leon Klempner
Port Jefferson, NY

Online Collaboration

From: Leon Klempner <>
Subject: Online Collaboration
Date: Friday, January 14, 2011, 7:44 AM

In these economic times, enhancing relationships with our referring dentist and patients has become more important than ever.

Has anyone successfully use online collaboration tools like Fuze, Webex, GoToMeeting, etc successfully?  If so, please share.
Leon Klempner
Port Jefferson, NY

ESCO Listserv Not Functioning

Dear ESCOers,

Since the last ESCO Digest (ESCO Digest – 6 Jan 2011 to 9 Jan 2011 #2011-3) was delivered on Monday, Jan 10, 2011, we have not received any new postings or replies via the ESCO Listserv. All messages came to the editor’s mailbox are junk emails and spam.  The same problem happened in the past year.

The good news is that hundreds of ESCO subscribers subscribed the ESCO Forum ( in the past few days. More and more subscribers have mastered the way to post messages and/or leave comments using the WordPress. Thank you for your contribution to make ESCO alive! We will appreciate if you can spread the words out to your colleagues and friends about the ESCO upgrades to ESCO Forum. More information regarding how to get started is available on our “Helpdesk” web page: If you have any questions, feel free to email

Have a nice day!

Huibi Liu
Chicago, IL

A DIY 3-d desktop STL machine you can play with

From: Stanley Sokolow <>
Subject: A DIY 3-d desktop STL machine you can play with
Date: Tuesday, January 11, 2011, 12:39 PM

If you’ve seen the video presentations from Align Technology about their process for turning 3-d computer virtual models into aligners, you probably saw their elaborate 3-d stereolithography (STL) machines.   These devices have a platform which sits at the surface of a vat of light-cure plastic liquid and a laser which the computer controller scans across the liquid surface, drawing a horizontal cross-section of the object (patient’s teeth).   Then the controller lowers the platform a smidgen and draws (light-cures) the next thin layer, and so on until the plastic cast is built.   These machines cost hundreds of thousands of dollars each.  They are about the size of a very large refrigerator, or two.  Not practical for an orthodontic office’s lab.

I’ve seen a different approach for turning 3-d data into physical models.  This line of products uses something resembling an ink-jet printer, but instead of squirting ink, it squirts melted wax.   The jet is moved around on a flat area by the machine and builds up a model, layer by layer, like the light-cure STL machine.   The market is for engineering firms who want a quick physical prototype of mechanical parts, but it’s wax.  These devices cost about $3000 to $4000 each.

Today I discovered that a small company is showing, at the 2011 Consumer Electronics Show, a desktop 3-d STL machine that uses thermoplastic ABS filament (resembles the “string” for a string-trimmer weed-eater tool), heated by the drawing head, and extruded onto the platform.   This builds up the model the same way as the other machines, but what you get is a plastic model.  It can also make objects with PLA, which is a biodegradable plastic.  The box is small enough to sit easily on a desk or counter top.  You supply the computer.  It’s sold as a partially assembled kit, for $1,225 (US dollars).  I don’t know anything about the software that comes with it, but the ads say it is an “open source” product, so I assume it’s something a Do-It-Yourself (DIY) geek can deal with.   Here’s an article describing it, with a video:–the-diy-3d-printer/17516/.  They call it the “Thing-O-Matic”.

If you’ve ever wanted to experiment with turning 3-d orthodontic models into physical casts in your office, this may be a way to get started.  It’s not a turnkey product for orthodontic use, but a component of one if you are technically competent enough to take the idea and turn it into something practical.  Why would you want one?   Maybe, if you have eliminated plaster casts from your office records and you want the ability to turn quickly a 3-d virtual model into a physical model upon which you can make an appliance in-house, this might do it for you.  The companies that digitize impressions can produce the output in various data formats, often including the standard STL format.   Or maybe you are an orthodontic inventor and want to make prototypes of your designs for a new bracket or new instrument.  Or maybe you want to make jewelry or toys from designs you create on 3-d modeling software.  If you like to tinker with such things, check it out at: MakerBot Industries.

Have fun.