AMED: Academy of Microscope Enhanced Dentistry

Lotus Land Garden Tour with Lunch
You are invited to visit Lotusland , a unique 37-acre estate and botanic garden situated in the foothills of Montecito to the east of the city of Santa Barbara. Visit www.lotusland.org for more information.

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My Endodontic Practice
There is an old expression that to see the future you only have to look at the past. A 35-year retrospective analysis of my clinical practice will provide a glimpse of those early years, the enormous technical changes that followed, and how these changes created both chaos yet enormous opportunities. This presentation will focus on the unforeseen and unanticipated benefits of utilizing the dental operating microscope in every day practice. Through this monologue, Dr. Ruddle will share his experiences and provide a brief look into the past, present, and future of Endodontics.

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The Endodontic-Periodontal Differential Diagnosis
Endodontic diagnosis requires astute observation of signs, symptoms, tests, and radiographs. Distinguishing between artifacts and significant clinical entities can be very challenging. In this presentation Dr. Pannkuk will describe a logical approach to interpretation that can predictably and accurately distinguish between confusing presentations of periodontal and endodontic disease. He will show interesting and unique cases that highlight the clinical strategy.

At the end of the presentation the audience will be able to:

• recognize important subtle radiographic signs
• determine prognosis
• recognize the treatment implications of an endodontic or periodontal disease etiology

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The Power of 3D Imaging in Endodontics and Beyond...
We have been relying on radiographs to analyze dental disease and diagnose dental pathosis since the early 1900's. This age-old 2D technology has obvious limitations. As a result, much of the true data has been hidden from us for decades leading to shortfalls in diagnosis, treatment planning and ultimately patient care.

The time has finally arrived and we are now able to utilize 3D imaging to improve patient care dramatically. These are exciting times with the technologic breakthrough of High Resolution Cone Beam Computer Tomography (CBCT).

The goal of this presentation is to highlight the newfound capabilities of this amazing "new and improved" CT technology. The multiple uses of CBCT in dental diagnosis and treatment planning will be demonstrated with correlation of the CT images to the areas explored and photographed through the Operating Microscope.

After this presentation the audience will have a better understanding of:

• How and why CBCT is truly a diagnostic breakthrough

• What we have been missing all of these years

• When and how to decide if we need a CBCT scan

• How to read the scans and understand their value in everyday practice

• How to detect classic artifacts and thereby prevent misdiagnosis associated with CBCT

• What the challenges are with this new technology

• What we can look forward to with the CBCT of the future

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What I Learned During 8 yrs Research Study in iMage Enhanced Dentistry
In this presentation Dr. Hirata will share his research study results in these 8 yrs and a research project's result with Universities in Japan, in Europe, in Brazil and in the States in iMage Enhanced Dentistry. This iMage Enhanced Dentistry, like Image Enhanced Medicine in medical field, includes Microscopes, CT, MRI, MRA, Endoscopes, SEM, video systems and all other magnification systems. Topics will cover rapid healing, atraumatic soft tissue reaction, effect of hydration, effect of chemical substance, Implant rescue, treatment planning in Implantology, relationship between crack and soft tissue, precise tooth preparation, atraumatic tooth preparation, relationship between marginal fitness and leakage, retrospective research on old prosthesis, and more.

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Quantitative Percussion Diagnostics and Magnification – A Synergistic Combination
The introduction of magnification into dentistry revolutionized the ability of dentists to diagnose and treat abnormalities due to the increased size of objects and the flawless illumination provided. The microscope provided, regardless of specialty, more detailed visual information to the clinician in all phases of treatment.

During the last decade, a new technology has been explored that will give additional diagnostic information to the clinician. Quantitative percussion testing allows a clinician to evaluate the structural stability of natural teeth or dental implants by measuring the way it responds to a light impact on the buccal surface. The energy that is returned to the handpiece is analyzed in a manner that provides two pieces of information—the loss coefficient (LC) and energy-time response (ETR) of the structure tested . These two pieces of information can give the clinician indications of how sound the tested structure is and whether there are problems such as dentinal cracks and fractures, microleakage, recurrent decay, loose post and cores and other structural defects. By having an indication as to how a tooth or implant responds to mechanical stress prior to starting restorative care, the microscopic enhanced clinician will be prepared to look for potential problems where abnormal ETR’s are observed. ETRs also help patients understand the bioengineering challenges that some teeth present due to crack propagation and other serious biomechanical problems. Combined with video documentation of the defect, it creates a powerful documentation and patient educational tool simultaneously.

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Small FOV CBCT for   Endodontics: Another Gadget or a Paradigm Shift?
Just very recently small FOV (field of view) CBCT (cone beam computer tomography) unities became available for endodontics. These machines have lower radiation dosages, more resolution, are smaller and less expensive than the large FOV ones.

There are several machines available on the market and it is very difficult to select one that is more suitable for our clinical needs. Also it is crucial to know what is this technology about it, when and why to use it, how to interpret its results and how to implement it into a busy practice.

At the end of this presentation the participants will have a solid understanding about the small FOV CBCT unities and will be able to know why this technology represents a major paradigm shift in modern endodontics.

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Outcome Study Science and Art: Can the Value of an Endodontic Technique or Technology Be Adequately Assessed?
The endodontic literature spans a wide spectrum of accepted levels of evidence. In this presentation Dr. Pannkuk will discuss the lowest forms of scientific evidence like opinion and single anecdotal case histories comparing them to less obtainable rigid CONSORT guidelines and Systematic Reviews as it relates to our understanding of clinical success and the value of clinical tools like the surgical operating microscope. Mounds of low level evidence are readily available yet high level evidence is not. Is this a double-edged sword of scientific knowledge? Is all available evidence valuable when looked at critically as a whole? Is a foggy picture better than no picture of reality? The philosophy of what we can and cannot test when it comes to a nuanced clinical art will be discussed. There will be a specific focus on the value of the microscope, single versus multivisit endodontic procedures, and implant versus root canal treatment success rates. Dr. Pannkuk will pose the questions:

1. How does one achieve evidence-based clinical predictability?
2. What is a definitive clinical outcome versus clinical success?
3. What do we really understand about our clinical technique and choices?

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Microscope Assisted Precision Dentistry II
Recently attention has been focused on using Dental Microscopes. Many authorized medical doctors so called God-Hand in that field are definitely needed Microscopes and other up-to -date devices. In Dental field, more dentists require better and more excellent results in managing Minimal Intervention concepts, Esthetics, long term Prognosis and Occlusion, more precise procedure that surpass the limit in working under the naked eyes is required for those dentists. It has not been needed to state that high magnification and high resolution is essential to achieve fine dental treatment.

High magnification and resolution is giving dentists more clear images of not only root canals but also apical foramen. This grows the possibility in removing infected structures around apical area and in other difficult area for naked eyes. As the result, increasing the possibility higher and higher in saving treated root canals and miserable tooth.

Dental Microscopes may potentially guide all dentists to higher and higher level and finally may lead to be called God-Hand. In this presentation Dr. Okaguchi will share his concepts in Endodontically treated tooth through his clinical cases.

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Beyond the Microscope: What Else Can Make the Difference?
A range of clinical techniques and applications will be reviewed and illustrated in an attempt to help clinicians ensure and rationalize necessary treatment objectives for success. Anatomic exploration, systematic disinfection using new irrigation techniques will be discussed. Currently, effective irrigant delivery is a prerequisite for successful endodontics and this lectures will present an overview recommendations for safe and effective irrigation.

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Minimally Invasive Implant Surgery Supported by Microsurgical Techniques
The refinement of the surgical technique by means of a microsurgical approach is one of the most importaant determinants of successful esthetic results. A series of case reports in reconstructive implant dentistry and a controlled clinical study on periodontal regeneration and plastic reconstrcutive surgery demonstrated that a microsurgical approach is able to accelerate healing and improve the rate of primary soft tissue closure.

In this presentation the microsurgical concept will be demonstrated which will allow the participants to fullfil the high esthetic demands from the patients in the daily practice on a more predictable base. The microsurgical concept includes magnification aids, new instruments, new suture material and new flap designs. Case presentations using the microsurgical concept will help the attendees to understand the idea behind the novel idea better.

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The Hidden Secrets of Outstanding Results in Soft Tissue Management Around Implants: From Planning to Placement to Restoration
Pre-surgical, tran-surgical and post-surgical soft tissue management are critical factors in determining the overall implant outcome.

Implant success is currently measured not only by implant location, stability and lack of surrounding infection, but additionally by the adjacent soft tissue form, level, color, tone, health and support, with the aim of replicating or even improving upon the original tooth esthetics.

This course will focus in specific microsurgical techniques to achieve unsurpassed soft tissue outcomes around implants.

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Micro-Invasive Treatment of Periodontal Pockets
During the past several years, tremendous changes have occurred in the practice of periodontics and implantology. As our patients are now getting more conscious about their physical as well as psychological well-being, a shift of paradigm in the therapeutic modality has thus undertaken. Pain-free procedures and minimized post-operative trauma have become patients' primary concerns, and emphasis is now being placed on the aspect of non-surgical approach for treating periodontal disease as well as placing dental implants. In order to achieve these, microscopically enhanced therapies provide a new way for insight into the solutions. Under the microscope, "flapless approach" is no more equated with "blind treatment". The utilization of this perfect visual tool offers an aid as an eye opener for the dental clinicians. With the high power magnification, dentist's vision can actually pass through tiny openings such as pocket entrances and crestal gingival punched accesses. As a result, there would be no more need for traditional open flap surgery to create visibly large wounds. The advantage of doing so obviates the possibilities of relevant potential risks carried by surgeries, such as uncontrolled bleeding, post-operative swelling, pain and even neurosensory damage. Treatment is simplified with patient undergoing one single procedure. Without incision and tearing of periosteum, healing can be faster and more uneventful. So the whole therapeutic course can be a more cost effective one. Nevertheless in the meanwhile different solutions are offered to meet our patients' demands, questions have also arisen as to whether or not these "newly invented non-surgical methods" would violate against our basic biological principles that we have long followed and believed in. Five to ten years' follow-up results from presenter's private practice will be presented for open discussion and hopefully will unveil this myth.

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Papilla Reconstruction Using the Patch Technique
Papilla reconstruction is a difficult procedure to perform with your naked eye. However, the combination of a Dental Operating Microscope and the Patch Technique makes it much easier. In this presentation Dr. Akiyama will share his technique.

The Patch Technique is composed of the following operations under the Microscope: (1) Debridement, Desquamation, and Tension free incisions through the sulcus; (2) Harvesting connective tissue from the palate; (3) Supporting the epithelial flap with the harvested connective tissue patch; and (4) Lifting/Maintaining this combined flap to the coronal direction using a composite resin anchor on the tooth surface.

This technique gives more effective result in papilla reconstruction of both natural teeth and Implants in conjunction with using dental operating microscopes.

Dr. Akiyama will introduce several special instruments that provide more efficient performance with the Patch Technique under the Microscope.

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Pre-Treatment in Esthetic Restoration
Prosthetic treatment in esthetic zone requires not only acquiring tooth morphology harmonizing with patients' features but also gaining optimal continuous soft tissue lines. Dr. Matsumoto will share his clinical cases utilizing both Periodontal Microsurgery and Orthodontic treatment as a Restorative Pre -Treatment and discuss about its effectiveness and efficaciousness.

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Minimally Invasive Interventions & Interdisciplinary Approach for Esthetic Dentistry
Lately, favorable results are seen in many esthetic cases with minimally invasive techniques. This became possible due to the development of biomimetics, advancement in bonding technique, and treatment using the problem-based approach. In addition, the use of microscope has allowed us to obtain precise and predictable outcomes. Many treatments require the expertise of specialists to get the best esthetic results, therefore, team approach is integral and necessary in esthetic dentistry.

To achieve optimal esthetics, it is imperative to use the team approach. This team should include the restorative dentist, periodontist, orthodontist and oral surgeon. As the demands for esthetic outcomes increases, communication and mutual understanding of treatment goals between different treatment providers become more and more important.

Using my clinical cases, the use and effectiveness of the microscope in porcelain bonded restorations and management of interdisciplinary approach in esthetic dentistry will be discussed.

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Art and Precision with Direct Composites
Direct composites are one of the best solutions to restore anterior and posterior teeth regarding preservation of sound dental structure, natural appearance, reasonable cost and longevity. However, techniques are critical and careful attention to every step is essential to achieve best results.

We'll go through every step of the restorative techniques, showing how high magnification can make a huge difference.

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Obtaining Clinical Success with Micro Laminate Porcelain Veneers
Ceramic Micro Laminate porcelain veneers are a sub category of conventional veneers. They are extremely thin and much smaller in size and can be placed with little or no tooth preparation.Their use in diastema closure, augmentation of tooth form and color conserves tooth structure and creates a natural esthetic result. Marginal fit, adaptation, and finishing are absolutely critical to the long term success of the laminate and will be the emphasis of this presentation.

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Lasers and the Operating Microscope: Seeing the Light!
In this lecture and live demonstration, attendees will witness how hard and soft tissue lasers can impact daily dental practice to make clinical procedures simpler and more enjoyable. The operating microscope can help improve treatment outcomes in laser dentistry and this will be demonstrated in digitally photographed and videotaped clinical cases.

Clinical objectives that attendees will learn:

1. The four different wavelengths available at present for dental practice.
2. How soft tissue lasers can be used to help improve treatment outcomes.
3. The value of hard tissue lasers in clinical practice.
4. Live demonstration of at least one wavelength of laser at the end of the lecture.

Treatment Planning for Esthetics, Function and Longevity
Esthetic reconstruction has become more popular, with adult patients asking for this treatment. Very often the restorative dentist is challenged by tooth malpositions and tooth size discrepancies. Diagnostic and planning criteria will be outlined, to help the restorative dentist achieve the patients' satisfaction and the operators' goals.

The Perfect CAD/CAM Restoration
If you are considering purchasing a Cerec to integrate into your practice, attendees will learn the pros and cons of CAD/CAM dentistry and if it is a good fit for your practice. Altered preparation techniques, esthetic consideration and improved Cerec techniques will be presented for the microscope user based office.

Santa Barbara's Land Shark Tour
Climb aboard Santa Barbara's original amphibious tour vehicle for a personally narrated 90 minute land and sea adventure. Enjoy exquisite views of the Santa Barbara coastline, the Riviera, and the Santa Ynez mountains as seen only from our boat at sea. Don't miss this exciting and entertaining Land and Sea adventure to experience Santa Barbara.

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Periodontal Microsurgery: Achieving Gingival Level Alignment with Connective Tissue Graft
A harmonically aligned gingival level is a major factor in creating a beautiful smile. In esthetic dentistry, creating an aligned gingival level is of the utmost importance. At the same time, it is necessary to understand and consider each patient's request during treatment planning and to perform surgery with absolute accuracy.

This presentation will introduce the benefits of using a dental microscope in periodontal surgery with connective tissue graft for patients who desire esthetic dental treatment.

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Heroic Endodontics in an Age of Implants
Dr. Cami Ferris will present the clinical rationale for treating some cases that may otherwise be deemed "heroic" in today's implant-driven practices. She will discuss evaluation and consultation with the patient, as well as the referring dentist. Decision points and treatment modalities of two cases will be reviewed, including non-surgical retrieval of amalgam retrofilling material and use of Mineral Trioxide Aggregate cement.

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Utility of All-on-4 with Socket Preservation
All-on-4 with a concept of immediate function, developed by Dr. Paulo Malo, is a medical treatment for patients with edentulous jaw. At Malo's office, 80% of the cases who received All-on-4 were dentulous patients with severe gum disease. When All-on-4 treatment is given to dentulous patients, it is classified into two groups, immediate implant placement, and delayed implant placement.

Malo recommends immediate implant placement; however, the teeth to be extracted have the primary diseases and there is an indication that the surrounding alveolar bone is damaged. In addition, the volume of the alveolar bone in Asians is sometimes more restricted than that of Westerners.

When immediate implant placement is performed, the volume of the residual alveolar bone is restricted, due to flattening of the alveolar bone (the operative procedure of All-on-4), which is a series of procedures performed after tooth extraction. As a result, it is a concern that the size of the implant appropriate for immediate loading with All-on-4 treatment can not be determined.

The case presented is based on the results of the CT scan taken prior to the procedure, proving that application of immediate loading is difficult when the implant is performed in immediate implant placement. In this case, we conducted tooth extractions and socket preservation using a microscope and therefore could preserve the alveolar bone and obtain sufficient amounts of keratinized gingival.

Thereafter by using guided surgery, we succeeded in performing All-on-6 treatment after only 2 months from the extraction of the tooth.

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Tissue Management Around Implants in Esthetic Zone
It is well known that Implant procedure in Esthetic zone is effective, but is requiring complicated steps. Furthermore, it is also well known that both hard tissue and soft tissue management in that area is playing an important roll as a needed technique. Hard tissue management is usually performed before or at the same time placing Implants. On the other hand, Soft tissue management is able to perform after Implantation. That is the reason why Soft tissue management has been easy to prognoses the final result and been able to give long term stability with its appropriate technique and methods. In this presentation Dr. Kurihara will share his concept by showing his clinical cases grafting soft tissue around Implants after Implantation under the Microscope.

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The Matrix Revisited
This presentation focuses on problem solving with the use of different matrix systems for direct restorations, in both anterior and posterior teeth. Numerous clinical cases will help to illustrate the strategy to address difficult situations.

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Better, Faster, Prettier Composites; Hands on Course with Dr David Clark and Bioclear Matrix Systems

Direct Composites - Simplified, Beautified, Clarified. Participants will have the opportunity to perform modern composite dentistry utilizing the Bioclear Matrix Systems, Operating Microscopes, and flowable and paste composites.

Participants will perform the following on simulation models: Prepare and restore Clark Class II preparations, peg lateral treatment, Restoratively driven papilla regeneration ("black triangle" elimination), and advanced composite preparations and matrixing for deep caries and diastema closure.

Cracked Tooth diagnosis will be addressed and various techniques to prevent and treat cracked teeth with both the Cala Lilly and composite onlay will be performed. You will re-think the role of resins in their practice after seeing the possibilities in this renaissance of direct composites!

At the end of this course participants will:

• Achieve clinical proficiency in both diastema closure techniques and restoratively-driven papilla regeneration utilizing direct composites.

• Understand and achieve confidence with minimally traumatic class I and class II composite preparations, including the Clark Class II.

• Understand C-Factor, composite chemistry, and receive an update in dentin and composite bonding options.

• Understand the strengths and weaknesses of flowable and past composites.

• Receive a blueprint for the incorporation of flowable composites in all different types of composite preparations.

• Have confidence in diagnosis, treatment and prevention of cracked teeth

• Gain confidence in the use of the dental microscope for direct composites

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A Retrospective of Clinical Periodontal Microsurgery
Twenty years ago, microscopy was introduced to clinical dentistry. In the ensuing years it has become an important modality for periodontal and dental implant treatment.

What has been learned about microscopy and its importance in clinical practice and education? Dr. Shanelec will review his experience applying microsurgical principles to surgical practice as well as his progress in educating a new generation of microsurgical clinicians.

This presentation will highlight a case series of 300 immediate dental implants in extraction sockets with provisionals to demonstrate the value of a microsurgical approach for most challenging clinical and esthetic situations.

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Oral Medicine and the Clinical Operating Microscope: Experience at the University of Washington
The use of the clinical microscope in dentistry has proven to be an important adjunct to treatment in many fields including: restorative, endodontics, periodontics, and diagnosis. The diagnostic benefit of the clinical microscope in Oral Medicine, however, has not been as well developed as in the above dental disciplines.

Although oral cavity (& pharynx) account for only 2.5 - 3% of new cases of all cancer projected in 2008 (SEER program, National Cancer Institute) and only 1.3% of total cancer deaths of the same period, early diagnosis still rests on the dental profession to lead the way in detecting these lesions. Detection of persistent "white" or "red" lesions may also lead to a broad diagnosis of lesions due to autoimmune, infectious, or drug related etiologies. The introduction to dentistry of narrow band imaging, notably the VelScope, increases the visibility of suspected lesions but has limited capabilities of definitive differential diagnosis.

The use of magnification and light contrast techniques in oral medicine to narrow diagnosis, document lesion progression (assumed pre-malignant risk), and improve early detection as investigated at the University of Washington Department of Oral Medicine over the past year will be summarized.

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Latest in Photographic Documentation
Digital still and video camera technology is rapidly changing and their capabilities are converging. Current HD video cameras can take good quality still images and high end SLR still cameras now do good quality HD video. Both types of cameras can be used on a microscope. It is time to review how these changes impact documentation through the surgical operating microscope. This lecture will review and compare the technologies and how they impact equipment decision-making in the microscope driven practice. For completeness, they will also be compared to intra-oral wand type cameras. We will also review the storage and processing software necessary for the cameras. The second part will review the basic fundamental skills necessary for good clinical imaging and briefly review photo editing.

At the conclusion the participants should be able to:

• describe the functional and performance difference between digital video and digital still camera when applied to microscope photography, as well as how they compare to wand type intra-oral cameras.
• make informed purchase decision based on their particular clinical imaging needs.
• describe the basic skills necessary to produce good clinical images.

Thinking the Unthinkable: Regenerating the Whole Tooth
President Kennedy captured the American imagination in a speech made decades ago where he stated the unthinkable: “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard”. Our research team has been guided and inspired by the challenge of “doing what is hard” by embarking on a grand project to improve the oral health of the American people. We adopted the goal to regenerate a complete single rooted tooth. We sought to include the bioceramic portions and the tissues integrating the tooth to the bone using either a biological regeneration approach or a biomimetic recreation approach. A team of scientists was drawn from multiple universities and from multiple disciplines to be amalgamated as a trans-disciplinary, high-performance team dedicated to accomplishing this goal. We translated our broad goals into actionable organizational units, we identify three parallel interdisciplinary research groups that worked hand in hand with the others. One group involved the development of a "Blueprint" with structural and functional design specifications drawn from a human tooth, spanning gene expression to functional organization of the matrix. Members of our scientific team will mine, evaluate, and develop essential information needed for the Blueprint, while other members will create high-fidelity models intended to be so perfect that they might bypass wet laboratory tests in favor of computer generated outcomes. Knowledge from the Blueprint will be translated to stem cells or genetically engineered cells that, in conjunction with molecularly designed informational-rich extracellular matrices, will direct tissue regeneration. The Blueprint information is also used to guide the fabrication of nature-inspired biomimetic equivalents of tooth components using synthetic molecular systems and genetically engineered peptides.

Our vision is defined by five prioritized goals:

1) Regenerate functional tooth structures and supporting tissues;
2) Develop intermediary devices that are used for repair of diseased oral tissues;
3) Develop stem cell lines from single teeth applicable to all regenerative medicine strategies;
4) Build a polydisciplinary team with renewable knowledge and techniques to achieve these goals;
5) Translate this knowledge and technical capability into devices that improve health while creating: educational opportunities, new research pathways, new clinical applications and new jobs in technology-rich environments.