Volume 11, Number 3

March 2000

EDITOR
Arun K. Garg, DMD Associate Professor of Surgery Director, Center for Dental Implants Division of Oral/Maxillofacial Surgery University of Miami School of Medicine

The Use of Platelet-Rich Plasma to Enhance the Success of Bone Grafts Around Dental Implants
Although bone augmentation for supporting osseointegrated dental implants has been a routine technique in dentistry for more than 10 years, there is ongoing research aimed at improving clinicians ability to manage bone grafts. More recently, researchers have focused on the possibility of applying polypeptide growth and differentiation factors to enhance bone regeneration, says Arun K. Garg, DMD, associate professor of surgery in the division of oral/ maxillofacial surgery at the University of Miami School of Medicine. factors initiate the process of bone regeneration. During the first three to four weeks after graft placement, the biochemical and cellular phase of bone regeneration occurs, clinically consolidating the graft by coalescing individual osteoid islands, surface osteoid on cancellous trabeculae, and host bone. Osteogenesis and osteoconduction also are occurring. This cellular phase is often referred to as phase one bone regeneration or the woven bone phase, Garg comments. During phase one, the cellular regeneration that has occurred produces disorganized woven bone that is structurally sound, but not to the degree of mature bone. The bone will undergo an obligatory resorption and replacement type of remodeling, explains Garg. Eventually, phase one bone is replaced by phase two bone, which is less cellular, more mineralized,

EDITORIAL ADVISORS
Editor Emeritus: Morton L. Perel, DDS, MScD Charles A. Babbush, DDS, MScD Head, Section of Dental Implant Reconstructive Surgery Mt. Sinai Medical Center Cleveland Thomas J. Balshi, DDS, FACP Private Practice, Implant Prosthodontics Prosthodontics Intermedica Institute for Facial Esthetics Fort Washington, PA Anita Daniels, RDH Clinical Instructor Center for Dental Implants University of Miami School of Medicine Miami Charles E. English, DDS Staff Prosthodontist Veterans Affairs Medical Center Augusta, GA Jack A. Hahn, DDS Private Practice Cincinnati Kenneth W.M. Judy, DDS Clinical Professor Department of Prosthodontics University of Pittsburgh School of Dental Medicine Jack T. Krauser, DMD Private Practice, Periodontics and Implantology Boca Raton, FL Department of Periodontics Nova Southeastern College of Dental Medicine Davie, FL Richard J. Lazzarra, DMD, MScD Associate Clinical Professor Periodontal and Implant Regenerative Center University of Maryland Private Practice West Palm Beach, FL Robert E. Marx, DDS Professor and Chief Division of Oral/Maxillofacial Surgery University of Miami School of Medicine Carl E. Misch, DDS, MDS Co-Director, Oral Implantology University of Pittsburgh School of Dental Medicine Daniel Y. Sullivan, DDS Private Practice, Implant Prosthodontics McLean, VA; Washington, DC

Process of Bone Regeneration

Bone obtained from donor sites, such as the ilium and tibial plateau, contains osteocompetent cells and islands of mineralized cancellous bone, fibrin from blood clotting, and platelets from within the clot. Within hours of graft placement, the platelets within the clot degranulate, releasing platelet-derived growth factor (PDGF) and transforming growth factors beta-1 and beta-2 (TGF-B1 and TGF-B2), Garg explains. These

This Month Inside

Clinically significant abstracts ....21

NOW AVAILABLE ON-LINE! Go to www.ahcpub.com/online.html for access.

18
and structurally more organized into lamellar bone, he continues. Osteoclasts initiate the replacement of phase one bone with phase two bone. Theories have suggested that phase one bone is resorbed by osteoclasts in a normal remodelingreplacement cycle. Histologically, these grafts enter a phase of longterm remodeling that is consistent with normal skeletal turnover. As part of this cycle, a periosteum and endosteum develop, and the graft retains a dense, cancellous trabecular pattern. Growth and differentiation factors are a class of biologic mediators that play a crucial role in stimulating and regulating the wound healing process in the body. Specific growth and differentiation factors appear to regulate key cellular processes, including mitogenesis, chemotaxis, differentiation, and metabolism. All of these factors are critical in the process of osseointegration, Garg notes. The theory is that applying these growth factors to bone graft material can enhance and even accelerate the normal regenerative process of bone, he explains. One strategy for trying to harness the benefits of growth and differentiation factors is to apply platelet-rich plasma (PRP) to bone graft sites, comments Garg. Platelets are a rich source of PDGF, TGF-B1, and TGF-B2. Studies have shown that the cancellous marrow cells present in graft material harbor receptors for these growth factors. It also has been shown radiographically that adding PRP to graft material significantly reduced the time to graft consolidation and maturation, as well as

Figure 1. Drawing off 90 cc of venous blood from patient.

Figure 2. Placing the drawn blood into the disposable bucket.

Dental Implantology Update (ISSN 1062-0346) is published monthly by American Health Consultants, a unit of Medical Economics, 3525 Piedmont Road NE, Building Six, Suite 400, Atlanta, GA 30305. Telephone: (404) 262-7436. Periodical postage paid at Atlanta, GA 30374. POSTMASTER: Send address changes to Dental Implantology Update, P.O. Box 740059, Atlanta, GA 30374. American Health Consultants, in affiliation with Boston University Goldman School of Graduate Dentistry, offers continuing dental education to subscribers. Each issue of Dental Implantology Update qualifies for 1.5 continuing education units. Customer Service: (800) 688-2421. Fax: (800) 284-3291. Hours of operation: 8:30 a.m. - 6:00 p.m. Monday - Thursday; 8:30 a.m. - 4:30 p.m. Friday EST. E-mail: customerservice@ahcpub.com. World Wide Web: www.ahcpub.com. Subscription rates: U.S.A., $449 per year. Students, $200 per year. To receive student/resident rate, order must be accompanied by name of affiliated institution, date of term, and the signature of program/residency coordinator on institution letterhead. Orders will be billed at the regular rate until proof of student status is received. Outside U.S., add $30 per year, total prepaid in U.S. funds. One to nine additional copies, $269 per year; 10 to 20 additional copies, $180. Missing issues will be fulfilled by customer service free of charge when contacted within 1 month of the missing issue date. Back issues, when available, are $75 each. For 18 continuing education units, add $96 per year. Opinions expressed are not necessarily those of this publication. Mention of products or services does not constitute endorsement. Clinical, legal, tax and other comments are offered for general guidance only; professional counsel should be sought for specific situations. Copyright 2000 by American Health Consultants. Dental Implantology Update is a trademark of American Health Consultants. The trademark Dental Implantology Update is used herein under license. All rights reserved. Reproduction, distribution, or translation of this newsletter in any form or incorporation into any information retrieval system is strictly prohibited without express written permission. For reprint permission, please contact American Health Consultants. Address: P.O. Box 740056, Atlanta, GA 30374. Telephone: (800) 688-2421. Group Publisher: Brenda Mooney, (404) 262-5403, (brenda.mooney@medec.com). Executive Editor: Susan Hasty, (404) 262-5456, (susan.hasty@medec.com). Managing Editor: Kevin New, (404) 262-5467, (kevin.new@medec.com). Senior Production Editor: Brent Winter, (404) 262-5401.

Dental Implantology Update

March 2000

19
improving the density of trabecular bone. Applying PRP to graft material amplifies the influence of PDGF and TGF-B, at least during the initial stages of the bone regeneration process. As the platelets degranulate, PDGF and TGF-B are released. It is generally agreed that all platelets degranulate within three to five days and that their initial growth factor activity may expire within seven to 10 days, Garg says. The initial boost that PRP appears to give to the process of bone regeneration can be useful because it jump-starts the beginning of a cascade of regenerative events that continue to form a mature graft, adds Garg. cells, while angiogens generate new capillaries. Upregulation of other growth factors promotes fibroblastic and osteoblastic functions, cellular differentiation, and accelerated effects on other cells, such as macrophages. There also is evidence that PDGF increases the rate of stem cell proliferation, Garg comments. TGF-B1 and TGF-B2 are involved with general tissue repair and bone regeneration. Their most important role appears to be chemotaxis and mitogenesis of osteoblast precursors and the ability to stimulate deposition of collagen matrix for wound healing and bone, says Garg. These growth factors also enhance bone formation by increasing the rate of stem cell proliferation, and they inhibit some degree of osteoclast formation and thus bone resorption. The fibrin component of PRP helps to bind the graft material and assists in osteoconduction throughout the graft by acting as a scaffold to support the growth of new bone. In addition, PRP modulates and upregulates the function of one growth factor in the presence of the other growth factors. This feature differentiates PRP growth factors from other growth factors, which are single growth factors that only function within a single regeneration pathway, Garg explains.

Studies on PRP Use

Research that focuses specifically on the usefulness of PRP for bone grafts related to implants is in its infancy. The results of the first clinical study in humans, however, appear promising and are in agreement with preclinical studies in animals. Results showed enhanced bone regeneration when PDGF, TGF-B, or other growth factors were applied. Several orthopedic studies also have shown evidence of the beneficial effects of autologous fibrin that was obtained containing PDGF and TGF-B. In a controlled trial by Marx et al. that included 88 patients undergoing bone augmentation for resected mandibles, two different investigators radiographically assessed the sites that were treated with graft material plus PRP and the control sites that were treated with graft material only.

Growth Factors Perform a Wide Range of Functions

PDGF is considered to be one of the principal healing hormones present in any wound. It initiates healing of connective tissue, including bone regeneration and repair. PDGF is a potent mitogen and angiogen and also is an upregulator of other growth factors, Garg explains. Mitogens trigger an increased number of healing

Figure 3. Placing the filled bucket into the automated hardware system for preparation of platelet-rich plasma (PRP).

Figure 4. After the spin, the PRP can be seen in the left side of the bucket (bottom layer with the small red button) as well as the platelet-poor plasma (the top serum layer). The red blood cells and anticoagulant can be seen in the right side of the bucket.

March 2000

Dental Implantology Update

20
At two, four, and six months, the grafts containing the PRP were consistently rated as having reached maturity levels nearly twice their actual levels, Garg comments. Histomorphometric assessment also revealed bone graft densities in the PRP-treated group that were 15% to 30% higher than the control group at six months. In another controlled study of 20 patients who underwent extractions before dental implant placement, patients treated with PRP and grafts demonstrated a significantly greater buccolingual/palatal width of bone and epithelialization than controls at 16 weeks. Connective tissue was found filling the main portion of the defect in many of the control sites. sequester and concentrate the platelets. Application of PRP requires initiation of the coagulation process. This process is produced by mixing 5 mL of 10% calcium chloride with 5,000 units of topical bovine thrombin. The protocol for PRP application requires the use of a 10 mL syringe for each mix, Garg says. Each mix draws, in order: 6 mL of PRP, 1 mL of the calcium chloride/ thrombin mix, and 1 mL of air to act as a mixing bubble. The syringe is

Clinical Technique for the Use of PRP

The PRP is prepared by extracting a small amount of blood from the patient and using a cell separator to

Figure 5. Window created for augmentation of the maxillary sinus with bone graft and PRP.

Figure 6. Placement of autogenous bone into graft site and packing with sterilized amalgam condenser.

Figure 7. PRP in syringe with small mixing bubble (1 cc air bubble) and activator (the calcium chloride and thrombin mix).

Figure 8. Injecting the activated PRP into and over graft. The activated PRP has the consistency of a thin gel.

Dental Implantology Update

March 2000

21
gently agitated for six to 10 seconds to initiate clotting (gelling), Garg explains. The PRP is now in the consistency of a gel and is added to the graft material. After the PRP is added to the graft material, the fibrin formation binds the otherwise loose graft material together to assist the surgeon in sculpting the graft material. There is an in-office machine available that makes this technique practical for everyday clinical use (SmartPREP, Harvest Technologies Corp., Norwell, MA). Using this system, a 90 mL sample of blood is obtained from the patient using standard venipuncture technique. The blood is placed in the automated dual-spin centrifuge, which separates whole blood into red blood cells, platelet-poor plasma, and a growth-factor-enriched platelet concentrate (PRP). The machine works as follows: The centrifuge swing bucket is loaded with a disposable cup filled with the patients blood. The bucket is initially in the vertical position. After the start button is pressed, the rotor begins to turn and the rotor buckets are repositioned to a horizontal position. Red blood cells sediment below the shelf, with PRP above the shelf. After PRP separation, the rotor is slowed with the buckets remaining in the horizontal position, which allows the PRP to decant from the red blood cell chamber to the plasma chamber. When the decant is complete, the rotor begins to turn and the buckets remain in the horizontal position. The platelets in the PRP begin to sediment to the bottom of the plasma chamber. After this hard spin, the platelets have been concentrated at the bottom of the plasma chamber and the buckets are returned to a vertical position. The disposable cup is removed, and the platelet-poor plasma is withdrawn from above the concentrated platelets. The PRP is then drawn and used. March 2000 The use of PRP appears to provide benefits that lead to more rapid and effective bone regeneration, Garg says. This may be attributed to the concentrated levels of PDGF and TGF-B, as well as other growth factors or proteins that have not yet been identified. This technique does not carry any risk for patients whose blood is used relatively quickly. It also eliminates concerns of disease transmission or immunogenic reaction that exist with allografts or xenografts. Because PRP is prepared at the time of surgery, the possibility of mislabeling a sample is avoided. The use of growth factors is particularly attractive for cases with features that typically reduce the success of bone grafts and osseointegration, such as patients with an edentulous, severely atrophic maxilla, patients with osteoporosis, and those with previous dental disease and subsequently scarred and altered tissues, Garg comments. Future studies are needed to determine the optimal concentration of different growth factors and to identify other factors that may exist in PRP that could further explain the benefits of this treatment in wound healing and bone formation, he concludes. Contact: Arun K. Garg, DMD, 6633 Roxbury Lane, Miami Beach, FL 33141. Fax: (305) 865-1148. Marx RE, Carlson ER, Eichstaedt RM, et al. Platelet-rich plasma. Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85:638-646. Marx RE, Garg AK. Bone Graft Physiology with Use of Platelet-Rich Plasma and Hyperbaric Oxygen. In: The Sinus Bone Graft. Jensen O, ed. Chicago: Quintessence Publishing; 1998, pp. 183-189. M

Clinically Significant ABSTRACTS

Ulm C, Kneissel M, Schedle A, et al. Characteristic features of trabecular bone in edentulous maxillae. Clin Oral Res 1999; 10:459-467. In the maxillary alveolar ridge, extensive resorption occurs after tooth loss. In addition, cancellous bone undergoes intense remodeling processes. These facts have an important effect on surgery for the placement of endosseous implants, because the primary stability and thus the prognosis of the implants depends on the density of the cancellous bone and the structure of the alveolar ridge. Histomorphic measurements are the only means to produce an exact assessment of the structural qualities of cancellous bone. None of the radiographic, microradiographic, or computed tomographic methods has enough precision for structural analysis. The authors conducted a study to evaluate the cancellous bone structure in the maxillae of edentulous men and women in terms of quality and quantity by measuring the international histomorphometric standard parameters in the different regions of the maxillary alveolar process. Edentulous maxillae were obtained from cadavers (29 women Dental Implantology Update

Related Readings
Committee on Research, Science, and Therapy of the American Academy of Periodontology. The potential role of growth and differentiation factors in periodontal regeneration. J Periodontol 1996; 67:545-553. Dennison DK, Vallone DR, Pinero GJ, et al. Differential effect of TGFB1 and PDGF on proliferation of periodontal ligament cells and gingival fibroblasts. J Periodontol 1994; 65:641-648.

22
and 23 men). It was not possible to obtain information on the exact time of tooth loss for each cadaver or on which of the individuals had worn dentures. All of the maxillae were from individuals older than 61, except for three. At three different sites, 156 bone sections (each 5 mm thick) were removed from the maxillary alveolar process. They were obtained from the regions of the lateral incisor, first premolar, and first molar. Because each histomorphometric analysis should cover a measuring field of at least 25 mm2, 22 of the sections were excluded from the examination. The sections were embedded in resin, and a 20 m-thick ground section was prepared for each region. The sections were impregnated with von Kossa silver staining, which marks mineralized structures, and photographs were taken of the silverstained surfaces. The images were scanned into an automatic image analyzing system and transformed into binary images. The following parameters were measured: trabecular bone volume, trabecular number, trabecular thickness, trabecular plate separation, and trabecular interconnection. Results showed an extreme range of variation for each of these parameters. Between the highest and lowest trabecular bone volumes, a difference of more than 45% was observed. In addition, it was found that the trabecular bone volume, thickness, and number were distinctly lower in the molar region compared with the incisal and premolar regions. In all investigated regions, significant sex-specific differences were observed, with the maxillae of women showing a smaller amount and a lower connectivity of cancellous bone compared with the maxillae of men. The authors say they believe this difference between men and women was probably the result of increased postmenopausal bone loss in women. M Dental Implantology Update Parodi R, Carusi G, Santarelli G, Nanni F. Implant placement in large edentulous ridges expanded by GBR using a bioresorbable collagen membrane. Int J Periodont Rest Dent 1998; 18:267-275. Placement of osseointegrated implants may sometimes be difficult or even impossible due to the shape of the edentulous alveolar crest. There may be anatomic defects in the width of the bone, height of the bone, or both. Many techniques have been used to try to overcome these problems and make implant placement possible. A good success rate has been reported in the literature with the use of a two-step guided bone regeneration (GBR) technique with nonresorbable membranes on small edentulous ridges (a single tooth). However, with this technique, a second surgical procedure is necessary to remove the membrane. The authors report that they have had a high success rate with the use of resorbable collagen membranes in single-tooth replacement cases. The success rate is reduced when the edentulous area is large because the size of the nonresorbable membrane is directly proportional to the probability of early exposure, and because the size of the defect appears to directly influence the amount of bone regeneration that is achieved. The authors conducted a study to evaluate the placement of implants in narrow edentulous ridges spanning two teeth or more after using the GBR technique with a bioresorbable membrane to expand the ridge. With this technique, resorbable collagen sponges were placed under the membrane to maintain a tent effect. The study population consisted of 16 patients (11 women and five men) who had alveolar ridges of insufficient width for placement of screw-type implants. Four cases were located in the mandible, and 12 were located in the maxilla. Only one ridge augmentation was performed in each patient. Local anesthesia was administered. A crestal incision was made on the linguopalatal aspect of the ridge that extended intrasulcularly one tooth distal and mesial of the edentulous ridge. On the buccal aspect, two vertical releasing incisions were made. The alveolar ridge was visualized following elevation of full-thickness buccal and lingual flaps. To identify the area of ideal implant placement, a previously made surgical stent was positioned on the ridge, and the width in that area was measured. A GBR procedure was performed if the width of the ridge was less than 5 mm. During the GBR procedure, the alveolar bone was decorticated and the bony surface was smoothed. In the deficient areas of the ridge, at least two native collagen sponges were placed buccally and lingually. The bioresorbable membrane was trimmed and shaped so it completely covered the alveolar ridge and the sponges. Sutures were used to hold the membrane in place, and pins were used to fix the membrane in a few cases. After soaking the collagen sponges with blood, the flaps were sutured to achieve primary closure over the membrane. The patients were evaluated every two weeks for the first two months and then on a monthly basis. During this time, patients were not allowed to wear a removable prosthesis in the treated area. At seven to 12 months after the initial surgery, placement of the implants was performed. According to the authors, the most important outcome of the study was that implant placement was possible in 12 of the 16 cases after treatment. The mean increase in the size of the crest was 2.49 mm, and this was clinically and statistically significant. In addition, a successful outcome was seen with all of the implants placed. The authors concluded by saying an advantage of this technique March 2000

23
is that there were no important clinical complications or loss of hard or soft tissue, even in cases in which no appreciable results were obtained. M

Calendar
Academy of Osseointegration March 9-11, New Orleans. For more information, contact: AO, 401 N. Michigan Ave., Chicago, IL 60611-4267. Fax: (312) 245-1080. San Francisco Tenth Annual Implant Symposium March 911. For more information contact ICOI at (800) 442-0525 or (973) 783-6300. Fax: (973) 783-1175. Cutting Edge II: The Cruise April 2-9. For more information, contact: MECC. Telephone: (305) 663-1628. Fax: (305) 663-1644. Jubilee Congress of the German Society for Oral and Maxillofacial Surgery May 3-6, Berlin, Germany. For more information, contact: Prof. Dr. Jurgen Bier. Telephone: 030/45055055. Fax: 030/450-55901.

American Academy of Periodontology May 5-6, Washington, DC. For more information, contact: AAP, 737 N. Michigan Ave., Suite 800, Chicago, IL 60611. Fax: (312) 573-3225. American Academy of Periodontology Sept. 17-20, Honolulu. For more information, contact: AAP, 737 N. Michigan Ave., Suite 800, Chicago, IL 60611 Fax: (312) 573-3225. AAOMS 82nd Annual Meeting, Scientific Sessions and Exhibition Sept. 20-24, San Francisco. For more information, contact: AAOMS, 9700 W. Bryn Mawr Ave., Rosemont, IL 60018. Telephone: (800) 822-6637. Fax: (847) 678-6286. American College of Prosthodontists Nov. 15-18, Honolulu. For more information, contact: ACP, 211 E. Chicago Ave., Suite 1000, Chicago, IL 60611. M

New and Noteworthy

For 2000 and Beyond: Trends That Will Shape Oral Health
The trends that will shape oral health in the coming decade will begin with a biological and information revolution, says Harold Slavkin, DDS, director of the National Institute of Dental and Craniofacial Research (NIDCR), a division of the National Institutes of Health in Bethesda, MD. Slavkin is quoted in an article in the November-December 1999 issue of KDA Today, a publication of the Kentucky Dental Association. In this new era of rapid information exchange, clinicians will skip the long wait for scientific research to trickle down to the dental office. Instead, technology allows the practicing clinician to virtually peer over the shoulders of researchers and watch their efforts unfold, writes Timothy Donley, DDS, author of the article. In an effort to help clinicians target specific populations at risk for certain types of diseases, the NIDCR is attempting to selectively control the pathogenic microbes that infect and reinfect the oral tissues of healthy and immunocompromised individuals. Donley writes that researchers also are focused on identifying susceptibility genes that predispose people to infectious dental disease. Yet another area of interest is development of biomaterials used in repair and reconstruction of oral tissues. Some of these approaches March 2000

already are being tested, Donley notes. For instance, current studies suggest the viability of a caries vaccine. One approach would be to block primary colonization by cariogenic bacteria with an immunization regime beginning at about age 1. This could be achieved by immunization of the mucosal immune system or by passive application of protective antibodies in a directly applied vehicle or via food products. NIDCR is currently developing plants genetically engineered to produce antibodies against streptococcal bacteria, and clinical trials are planned. The NIDCR also has identified a new human suppressor gene, DOC1. The tumor suppressor gene and the protein it encodes are expressed in all normal human tissues and not detectable in human oral cancers,

suggesting a faulty DOC-1 gene might be a factor in developing oral cancer. This knowledge could lead to new treatment and prevention strategies. Other developments noted in Donleys article: An animal model of osteoporosis has been developed: a biglycandeficient mouse. Without biglycan, bone-forming cells are less active than normal. Such a model will be used to test new therapies to prevent osteoporosis. Researchers who are searching for inexpensive, noninvasive, and easy-to-use diagnostic aids for oral and systemic diseases and risk assessments are interested in the diagnostic uses of saliva. Molecularly based assays for constituents found in saliva may permit salivary assays to become important monitors of oral Dental Implantology Update

24
and overall health, suggesting such testing could become a routine part of the dental and medical office visit. A form of gene therapy that reduces chronic pain by targeting the spinal cord is being investigated in animals. Animal studies are under way in which a pain-relieving gene is introduced into the sheath surrounding the spinal cord, where the gene pumps out the pain-numbing product it is coded to produce. M

Fast-Setting Restorative
Encapsulated Fuji IX GP Fast glass ionomer, a faster-setting version of the original Fuji IX GP restorative, is formulated to set approximately 3 minutes and 35 seconds after mixing. Final finishing reportedly can begin 3 minutes after placement. Offered in Vita shades A2, A3, A3.5, B2, and B3, the viscous material exhibits wear resistance, provides chemical adhesion to tooth structure and long-term marginal sealing ability, and releases fluoride to promote remineralization of dentin and enamel. The restorative is suitable for minimal intervention restorations, including Class I and II restorations in deciduous teeth, emergency or interim restorations, long-term temporaries, and core build-ups and block-outs. For more information, contact GC America. Telephone: (800) 323-7063. World Wide Web: www.gcamerica. com.

Windows, Unix, or Macintosh operating systems. For more information, contact Cygnus Technologies. Telephone: (800) 626-2664. World Wide Web: www.cygnus-technologies.com.

Delivery Unit
Marus Dentals euro-style control head includes space for adding accessories. Features include an aseptic design for simple cleaning, a whip mechanism said to provide lateral whip movement in unison with the doctors handpiece positioning, and fully adjustable counterbalance to minimize tubing pull-back. For more information, contact Marus Dental. Telephone: (800) 304-5332. World Wide Web: www. marus.com.

New Product News

Practice Management Software
Version 7.5 of Dentrix dental practice management software includes a new patient archiving feature, the ability to add and customize patient alerts that pop up to notify the dental office staff of special situations directly involving a patient, and other enhancements designed to streamline the operations of a practice. The Patient Archiver feature allows users to archive patient information from the database. Key patient information is archived and stored safely and is accessible with just a few clicks. The Patient Alerts function is another method of alerting staff and doctors in the office about special conditions or circumstances surrounding a patient. Each patient can have up to five alerts. The software also provides the ability to allocate payments and adjustments to individual patients, an Auto Tax/Discount function, increased Continuing Care system options, enhancements to the Treatment Plan Presenter and Practice Analysis, and several new reports. For more information, contact Dentrix Dental Systems. Telephone: (801) 763-9300. World Wide Web: www.dentrix.com. Dental Implantology Update

Cordless Micromotor
The cordless Viva-Mate 3 electronic micromotor is designed for general dental procedures performed outside the fixed operatory setting. The quiet, low-vibration motor delivers high torque and a speed range of 2,000 to 30,000 rpm in forward and reverse directions. Compatible with any ISOE-type attachment, it can be used for a variety of procedures, including general cutting, tooth polishing, endodontic treatment, and denture adjustment. The lightweight micromotor also can serve as a backup for the air system. The standard set (no. Y103-611) includes the NCL25SS micromotor, an EX-6 straight handpiece, a control unit, and a charger. A foot control is offered as an option. The micromotor carries a one-year warranty. For more information, contact NSK America Corporation. Telephone: (888) 675-4675. M

Digital Intraoral Cameras

Requiring no image capture card, the CygnaScope FireWire Series of digital intraoral cameras incorporates Hot Swap technology to permit instantaneous plug-andplay operation. The system can be shut down while running, without shutting down or rebooting the computer. The lightweight, portable cameras permit one-finger focusing, freezing, and capturing of any intraoral or full-face view with a single-lens system. Suitable for multi-operatory environments, the cameras do not require docking stations or through-the-wall wire routing; movement from patient to patient reportedly is accomplished with one plug. Their optics are described as state-of-the-art to provide exceptional image quality. The cameras are compatible with

March 2000