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Spring/Summer 2011

Organized for the Study of Temporomandibular Disorders and Dental Occlusion

In This Issue: President’s Message Resisting the Sway

Letter from the Editor The Good Life

2012 Meeting Program Deformations in the Oral Environment Due to Dental Compression Syndrome

By Gene McCoy, DDS

Levels of Evidence in Our Professional Readings

By David S. Hancock, DDS

Board to Survey Membership on Options for Rising Costs

By Guy Deyton, DDS

2011 Annual Meeting Abstracts

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President

Dr. J. Terry Green 800 Shroyer Road, Dayton, OH 45419 937 293 3402, email jtgreen@erinet.com

President elect

Dr. David Hancock 7125 E. Lincoln Dr. #A204, Scottsdale, AZ 85253 480 941 4021, email dshddsnu1976@aol.com

Vice president

Dr. James Buckman 25 E. Washington, #2025, Chicago, IL 60602 312 236 2968, email jbuckman@uic.edu

Past president

Dr. DeWitt Wilkerson 111 Second Ave. NE#1104, St. Petersburg, FL 33701 727 821 4433, email dwilkerson@icfcd.com

Secretary

Dr. Ken Peters 200 West County Line Road #270, Highlands Ranch, CO 80129 2342, 303 791 2570, email ksp014@qwestoffice.net

Treasurer

Dr. Michael Varley 8925 S Ridgeline Blvd, Suite 110, Highlands Ranch, CO 80129, 303 470 0500, email ddsdr709@qwestoffice.net

Executive Director

Mr. Kenneth Cleveland 207 E. Ohio Street, #399, Chicago, IL 60611 847 965 2888, email exec@aes tmj.org

Directors:

Dr. Robert Flikeid, email rflikeid@aol.com Dr. Jim Gavrilos, email jgavrilos@barringtondentist.com Dr. Tara Griffin, email drtaragriffin@gmail.com Dr. Mark A Hargreaves, email mark@kendrickdental.co.uk Dr. Warren F Jesek, email wjesek@aol.com Dr. Keith Kinderknecht, email kinder@uab.edu Dr. Jacob Park, email parkj@uthscsa.edu Dr. Mike Racich, email mikeracich@shaw.ca

THE AMERICAN EQUILIBRATION SOCIETY

American Equilibration Society How to contact us AES Central Office 207 E. Ohio Street Ste. 399 Chicago IL 60611 Phone: 847 965 2888 Email: exec@aes tmj.org AES website: www.aes tmj.org

Planning to move?

Please contact AES Central Office so we can update your file and you will not miss important correspondence needed to update our annual AES Roster Book.

AES Contact is published by: Palmeri Publishing Inc. 35 145 Royal Crest Court, Markham, ON L3R 9Z4 Phone: (905) 489 1970 Fax: (905) 489 1971 Email: ettore@palmeripublishing.com Website: www.spectrumdialogue.com

2011 2012 AES Committees are as follows: PROGRAM PLANNING COMMITTEE (2012) Dr. Matthew Lark, Dr. Jeffrey Okeson PROGRAM PLANNING COMMITTEE (2013) Dr. Curt W. Ringhofer, Dr. James McKee PROGRAM PLANNING COMMITTEE (2014) Dr. Michael Racich, Dr. Aad Zonenberg GENERAL ARRANGEMENTS Dr. Myron Winer, Dr. Michael Vold MEMBER COMMUNICATIONS/ EDITOR, AES CONTACT Dr. Tara Griffin FINANCIAL ADVISORY Dr. Michael Varley PROFESSIONAL RELATIONS Dr. Peter Neff, Dr. Michael Barnett PUBLIC RELATIONS/INSURANCE Dr. Frank Gardner III MEMBERSHIP/CREDENTIALS Dr. Robert Flikeid

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INTERNATIONAL MEMBERSHIP Dr. Claus Avril – Italy Dr. Ransom Altman – Netherlands Dr. Asterios Doukoudakis – Greece Dr. Gary Ecker – Australia Dr. Mark Hargraves – UK Dr. Yasuo Hatano – Japan Dr. Heinz Mack – Germany Dr. Sandro Pallo – Switzerland Dr. David Tay – Singapore

INTERNET / WEBSITE Dr. Jim Gavrilos

SCIENTIFIC INVESTIGATION Dr. David Hancock

PROCEDURAL GUIDELINES AD HOC COMMITTEE Dr. Ronald Taylor

CONSTITUTION & BY LAWS Dr. Keith Kinderknecht

MARKETING COMMITTEE Dr. Tara Griffin

STRATEGIC PLANNING COMMITTEE Dr. Richard Schirmer EXHIBITS Dr. Warren Jesek PRESIDENTIAL ADVISORY/NOMINATING Dr. Ronald Taylor Dr. Michael Barnett

CLINICAL GUIDELINES Dr. Ronald Taylor POSTERS Dr. Jacob Park BUSINESS MODEL AD HOC COMMITTEE Dr. Guy Deyton

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President’s Message

Resisting the Sway Terry Green, DDS

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n these economic times, it is more important than ever that we be able to provide a wider range of services to our patients. In that effort we are focusing for the AES to be more important to practicing dentists. Please take the opportunity to unlock your information so that patients can access it from the AES website.

The book SWAY -The Irresistible Pull Of Irrational Behavior by Ori and Rom Brafman describes the phenomenon of “sway” as being when a person lets his past history determine his future actions. Think about a dentist who really cares about you and has done the root canal, the post & core, the crown and then recommends an apico surgery, not because it is the best treatment but because he is vested in that tooth. Similarly, we must resist the “sway” in diagnosing and treating our patients. In these difficult economic conditions we must resist looking at our patients as economic opportunities and remember they are people in need. A patient suffering from TMD who is in pain may just need a splint and time to heal, not a full mouth reconstruction.

While it has been said that ignorance is bliss, as a dentist it can also be expensive. Malcolm Gladwell, author of The Tipping Point and keynote speaker at the 2006 Dental Trade Alliance meeting mentions our dental industry is fragmented and could benefit from “a trusted voice” to sort through and make sense of the overwhelming deluge of available technology and dental services (LMT Comm, Oct 2006). Dental technology has reached a tipping point where you can buy more technology than you can make a profit with. It is the mission of AES to enrich the lives of our members, the dental community and the public we serve through education, mentorship and research.

It is still true today that you only see what you know. For the 2012 AES Scientific and Clinical Sessions, our Program Chairmen Dr. Matt Lark and Dr. Jeffrey Okeson have organized a group of outstanding speakers with significant clinical information to share, enlighten and challenge us to better treat the needs of our patients. I hope you plan on joining us!

Continuing Education Recognition Program

THE AMERICAN EQUILIBRATION SOCIETY

The American Equilibration Society is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. The American Equilibration Society designates this activity for 13 continuing education credits.

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Letter from the Editor

The Good Life Tara Griffin, DMD, FAGD

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his year’s AES Annual Meeting was one to remember. Program co-chairmen Bo Bruce and Dave Newkirk assembled an outstanding group of clinicians who provided invaluable information to those in attendance. This meeting was also memorable because it was dedicated to Dr. Pete Dawson. Past President Witt Wilkerson presented Dr. Dawson with a plaque from AES that had a picture of Pete with his wife Jodi who is wearing a hat that says Life is good. Almost every one of us has heard that slogan or seen a hat or T-shirt with a smiling face and the Life is good words printed on it. The message is so simple, yet powerful, and I was curious to find out how such a simple message had become so popular.

I found a recent story in the Experience Life magazine (March 2011) about the development of the Life is good brand that I would like to share. I believe it exemplifies what all of strive us to achieve in our life and what a perfect slogan and message that is for Dr. Dawson and his family to share with each other and with us.

The two youngest of six children from Massachusetts, Bert and John Jacobs learned about the power of positive thinking from their mother, who always looked on the bright side of things even when money was tight. The brothers’ ultimate dream was to share that hopeful message with the world through art. Neither brother knew anything about starting a business. They chose to sell Tshirts because it was a simple, cheap way to get an immediate reaction from people. After five years of selling their self-designed T-shirts at weekend street fairs and college dorms, the brothers were broke. So they each took jobs as substitute teachers and agreed to give T-shirts just one last shot.

They printed 48 shirts with a new design: a simple smiling face and the slogan, Life is good. Jake, the cartoon hero of the Life is good brand was created by John Jacobs. At a street fair in Cambridge, Mass., in 1994, they sold out in 45 minutes. Today, their company, Life is good, is a $100 million business. Jacobs believes the T-shirts are popular with consumers because of the optimistic message. He believes our culture is so overwhelmed with negativity and that the focus should be on what's right with the world, rather than on what's wrong. Hence their mission: to spread the power of hope and a healthy optimistic strategy for living.

The company also focuses on giving back, which is a core part of the company’s mission. The Life is good Kids Foundation helps children overcome life-threatening challenges, such as violence, illness and extreme poverty. The Jacobs receive countless letters and photos from a wide fan base. Dear to their hearts are the letters from people who say that they wore their Life is good shirts or hats to get through difficult times. The Jacobs brothers believe these are the people who have taught us the true meaning of their message. They say, “We all have a choice. We can focus on what's wrong with the world, or we can see the sunny side, even when it rains.” One of their favorite sayings is, 'Remember that the music is not in the guitar.’ According to the brothers, “We get to decide how to use what we have and that's the great thing about optimism. You don't start it or own it. You simply let it loose in the world and help it grow."

Thank you to Dr. Dawson and all of those who have contributed so much to our profession. Thank you for your optimism and allowing us to grow and follow in your footsteps. And, thank you to all who attended this year’s meeting. We have another phenomenal program organized by co-chairmen Matt Lark and Jeff Okeson for the 2012 Annual Meeting. I encourage you to look ahead and plan to attend! And, remember Life is good!

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AES 2011 Annual Meeting Chicago Marriott, February 23-24, 2011

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2012 Meeting Program

Day 1 Evidenced Based TMD: Paradigms for a New Decade

Wednesday, February 22, 2012 Panel 1: Orofacial Pain: Mechanisms and Treatment Considerations 7:00am – 8:00am

Continental Breakfast

8:00am – 8:20am

Opening Ceremony

8:20am – 8:30am

Introductions

8:30am – 9:15am

Evidence Based Treatment Philosophy — Peter Baragona, DDS

9:15am – 10:00am

Orofacial Pain - Looking at the Big Picture — Jeffrey Okeson, DMD

10:00am – 10:30am

Break with Exhibitors

10:30am – 11:15am

Glia as the “Bad Guys” in Dysregulating Pain & Opioid Actions: Clinical Implications — Linda Watkins, PhD

11:15am – 12:00pm

Red Flags in Treating the High Risk Pain Patient — Charley Carlson, PhD

12:00pm – 12:15pm

Morning Panel Discussion

12:15pm – 1:30pm

Lunch

Panel 2: Occlusion, TMJ Imaging, and Arthrocentesis 1:30pm – 2:15pm

Functional Occlusal Assessment: The 3 Ps — John Kois, DDS, MS

2:15pm – 3:00pm

Intracapsular Disorders: Imaging Considerations — Gerhard Undt, DMD, MD

3:00pm – 3:30pm

Break with Exhibitors

3:30pm – 4:15pm

Arthrocentesis — Steven Shall, DDS and Matthew Lark, DDS

4:30pm – 5:00pm

Afternoon Panel Discussion

6:30pm – 8:30pm

President’s Reception You may register online at www.aes-tmj.org

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2012 Meeting Program

Day 2 Evidenced Based TMD: Paradigms for a New Decade

Thursday, February 23, 2012 Panel 3: Sleep and Medical considerations of Orofacial Pain 7:00am – 8:15am

Continental Breakfast

7:15am – 8:15am

New Member Breakfast

8:15am – 8:30am

Introductions

8:30am – 9:15am

Efficacy of Hard Splint for Treating TMD — James Fricton, DDS

9:15am – 10:00am

Medical Conditions Posing as TMD — Donald R. Tannenbaum, DDS

10:00am – 10:30am

Break with Exhibitors

10:30am – 11:15am

Bruxing and the TMD/OFP Patient — Alan Glaros, PhD

11:15am – 12:00pm

Current Concepts in Sleep Dentistry — Dennis R. Bailey, DDS

12:00pm – 12:15pm

Morning Panel Discussion

12:15pm – 1:45pm

Lunch and AES Membership Meeting

Panel 4: The Restorative TMD Connection 1:45pm – 2:30pm

TMD Related Topics — Frank Spear, DDS, MS

2:30pm – 3:15pm

Advanced Implant Reconstruction for the Parafunctional Patient —Ricardo Mitriani, DDS, MSD

3:15pm – 3:45pm

Break with Exhibitors

3:45pm – 4:30pm

TBD — Jeff Rouse, DDS

4:30pm – 5:00pm

Afternoon Panel Discussion

5:00pm – 5:15pm

Closing Remarks

You may register online at www.aes-tmj.org AES Contact

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2011-2012 AES Executive Officers AES President Terry Green, DDS

AES President Elect David S. Hancock, DDS

Dr. Green has a Restorative/Implant practice in Dayton, OH. Since graduating from Ohio State University, College of Dentistry in 1973, Dr. Green has been serving Dayton families for the past 35 years and has accumulated more than 13,000 hours of continuing education. He is a Master of the Academy of General Dentistry, a Fellow of the International College of Dentists, the American College of Dentists, and the American Academy of Restorative Dentistry and is an active member of many dental organizations. Dr. Green serves as a faculty member for the Misch Implant Institute in Michigan and a clinical instructor at the Kois Center in Seattle. Dr. Robert Tootle of Columbus, Ohio was his mentor and he influenced Dr. Green to join the AES in 1974.

He has been a member even since. He is also a Diplomat of the International College of Oral Implantology (ICOI). He has been an AES member for 35 years and has served on the board since 2002.

Dr. Hancock has practiced in Scottsdale AZ for 35 years. He established his practice in 1976, immediately after completing dental school at Northwestern University. He has a general practice, however, most of his time is spent in the area of restorative care and treatment of TMD disorders. His patient population is older so he spends a lot of time dealing with worn dentition cases. He is fortunate to have been in the same town for so long, and has a wonderful patient base who appreciates what dentistry can do for them. He has been a member of AES for fourteen years. He has been a member of the Scientific Investigation Committee since 1999, and has served as chairman since 2004. He is also a member of the Clinical Practice Guidelines Committee. He was elected to the Board of Directors in 2006, and has served as AES Secretary, and Vice President.

Currently he is President-Elect of the society. In addition to his membership in AES, he holds membership in the American Dental Association, Academy of General Dentistry, American Academy of Orofacial Pain, and the Academy of Dentistry International.

AES Vice President

AES Secretary

James W. Buckman, DDS Dr. James W. Buckman received his DDS from the University of Illinois, College of Dentistry in 1964. After completing a Rotating Internship at the West Side Veterans Hospital in Chicago, he joined the faculty at the University of Illinois, College of Dentistry and carried on a part-time private practice. In 1975, he received his Certificate in Prosthodontics from the University of Illinois, College of Dentistry. He is currently Professor of Restorative Dentistry at the University of Illinois at Chicago serving as course director for the undergraduate and postgraduate occlusion courses. He recently retired from his restorative private practice of forty-five years. He has served as an officer in the Dental Anatomy and Occlusion Section of the American Association of Dental Schools when he co-authored Teaching Guidelines for Dental Anatomy and Occlusion. He is also a member of the American Dental Association and the American College of Prosthodontists.

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Ken Peters, DDS Ken Peters received his D.D.S. degree from the University of Colorado in 1984.

In private practice since 1985, he strongly believes in the value of high quality, fee-for-service dentistry and the influence the occlusion and the temporomandibular joints have on the outcomes of the care we provide our patients. He’s been a member of AES since 1994, and served as a member of AES’s Board of Directors from 2005 to 2009 and program co-chair in 2010. A supporter of organized dentistry, he is a past president of the Colorado Prosthodontic Society and the Metro Denver Dental Society, and he is the current Vice President of the Colorado Dental Association. He has had the privilege of serving as the general chairman for the 2006 and 2011 Rocky Mountain Dental Conventions. He has developed continuing education programming for both the RMDC and the Colorado Prosthodontic Society. Ken began his occlusion training back in 1994, and is a faculty member for

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AES Secretary cont...

IPSO, the International Partnership for the Study of Occlusion.

He volunteers one day a week as an associate professor at the University of Colorado School of Dentistry as a clinical instructor to the undergraduate students. Ken lives and practices in south Denver, and in his spare time enjoys spending it with his wife Teresa and his children, Scott and Andrea.

AES Treasurer Michael R. Varley, MS, DDS Dr. Michael Varley received his Bachelors degree from Eastern Michigan University and Master of Science Degree from Wayne State University. After graduating from the University of Detroit School of Dentistry, he served on the part time faculty until moving to Colorado in 1987 entering private practice.

His Highlands Ranch, CO general dental practice focuses upon a comprehensive approach to patient care emphasizing occlusion, cosmetic dentistry, and laser-assisted dentistry. After attaining additional certification in occlusion under Niles Guichet, D.D.S. and John Bassett, D.D.S., he became a member of the American Equilibration Society in 1994. In addition, Dr Varley is a past president, treasurer and board member of the Metropolitan Denver Dental Society and Foundation and Trustee to the Colorado Dental Association. He currently serves on the Budget and Finance Committees for the aforementioned society and association and is co-chairman for the 2011 Rocky Mountain Dental Convention. He enjoys downhill sports and scuba diving with his wife Suzanne and their two children.

RESERVE THE DATE 57th Annual Scientific Meeting

February 22-23, 2012 Chicago Marriott Hotel

•

Chicago, Illinois

Evidenced Based TMD: Paradigms for a New Decade Program Co chairmen: Dr. Matthew Lark and Dr. Jeffrey Okeson AES Contact

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Gene McCoy, DDS

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Deformations in the Oral Environment Due to Dental Compression

t the AES 56th annual meeting, Dr. John Grippo began material and structures. So it is important that we examine his lecture on abfractions with the statement, “Every subjects of significance in biology such as the human dentition engineer knows that when a fly lands on a bridge, with a fresh point of view which brings us to Deformations in the there is a corresponding deflection.” He was talking about Oral Environment Due to Dental Compression Syndrome.

Newton’s (Sir Isaac Newton, 1642-1727) Third Law which is that Dental Compression Syndrome (DCS) is a contemporary term action and reaction are equal and for the age old condition of grinding opposite, and that all the forces acting and/or clenching of one’s teeth. One within a system must balance out. If a reason DCS has been so successful over weight presses down on the floor, the the centuries is that it works well within floor must press up on the weight with an one’s subconscious. Since few patients equal and opposite force. affected by DCS are aware, dentists But it was the British physicist Robert must recognize the visual signs of Hooke (1635-1703) who approached the compression in order to address the study of the effects of forces on different problem. Besides the obvious signs of a materials by measuring the resulting flattened dentition and hypertrophied deflections from that force. He muscles of mastication, there are certain discovered that when the load was deformations caused by compression progressively removed, the specimens that many dentists misdiagnose or don’t returned to their original length. Hooke understand. Nevertheless, these was saying that a solid material can resist deformations affect dentition, bone, and an applied force only by yielding to it, ie; restorative materials.

Fig. 1: Compression NCLs

Tips of Functional Cusps by contracting under a compressive load Deformations of the or by stretching under a tensile Dentition one. His work was the logical Classified as non-carious consequence of Newton’s lesions (NCLs), these defects Third Law. typically are site-specific, in Hooke and Newton’s ideas that they appear at the tips of were not confined to artificial functional cusps and the materials, but biological as gingival area of teeth where well. This gave birth to the new susceptibility to stress is high science of biomechanics, (Figs. 1 and 2) A finite element which is the study of the Fig. 2: Compression NCLs Gingival Area analysis of a tooth model mechanical behavior of living

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confirms that stress is highest in these areas (Fig 3).

There are two distinct mechanisms responsible for the loss of tooth structure during compression: tensile forces and positive ion egress . Engineers tell us that these high stresses may be responsible for the pain experienced by patients who have restorations in the gingival area where tensile forces are powerful enough to pull apart the enamel prisms.

Although NCLs can Fig. 3: Finite Element Analysis of Tooth Model be caused by a variety of agents, such as low pH and mechanical abrasion, compression NCLs are distinguished by a glassy sheen. Kornfeld wrote about this phenomenon in 1932, when he observed that these defects were hard, smooth, and almost glasslike in appearance . This glassy effect may be due to the exit of positive ions from these focal points of high stress . The ions are produced by the compression of apatite crystals in the dentition and alveolar bone—the piezoelectric effect.

It is to be noted that compression NCLs do not appear on all patients who clench their teeth, not only because of variations in the intensity and frequency of DCS, but primarily because of genetics. NCLs seem to be more prevalent and dramatic in patients with dense alveolar bone than in patients with periodontally compromised teeth. Compression NCLs have been the subject of controversy among dentists for decades.

W. I. Ferrier once wrote that “their etiology seems to be shrouded in mystery.” But NCLs are not such a mystery if we understand the science of biomechanics. Subject to distracting labels such as “McCoy’s notches” and “abfractions,” these defects require a more scientific identification, which is essential to understanding their significance. What we are actually seeing are multi-shaped examples of hard tissue fatigue (Figs. 4–9 due to compression failure).

Fatigue applies to changes in the properties of a material due to repeated applications of stress or strain—in this case,

Figs. 4 9: Various Examples of Compression NCLs

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

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compression failure from DCS. J. E. Gordon, a professor of materials at Reading University, describes fatigue as “one of the most insidious causes of loss of strength in a structure.” If an object, such as a tennis ball, rebounds to its original shape after repeated compression, it is said to be elastic in nature.

However, if an object exhibits residual defects after repeated compression, it is said to be plastic in nature. Biological structures, such as teeth and bone, are termed viscoelastic.

Compression fatigue also occurs in the spine (Fig. 10). In orthopedics, these sites of destructive stress are termed compression or wedge fractures.

Fig. 10: Vertebral Compression or Wedge Fracture

The compression failure of an object occurs at its most vulnerable site. Teeth are most susceptible at the gingival area (Fig. 11).

If alveolar bone recedes, the failure site will also be lowered.

Figs. 12 and 13 demonstrate defects that appear in tandem as the supporting bone atrophies, thus changing the fulcrum point.

Also note in Fig. 12 that the only occlusal contact is on the incline plane, forcing the bicuspid to be flexed toward the lingual when the patient clenches.

Deformations of Restorative Materials Fatigue easily manifests itself in prostheses and restorative materials such as amalgam and acrylic. In engineering, these wavy patterns are called “Luder Lines,” or molecular slipbands.

The explanation for the patterns is that molecules in the alloy are rearranging themselves under the influence of compressive strain. One can demonstrate the effect by bending a metal coat hanger back and forth and examining the stress configuration that is produced. Figs. 14–17 demonstrate Luder Lines in restorative materials.

Wedge Fracture

Fig. 11: Axisymmetric Finite Element Model Fig. 12

Fig. 13

Figs. 12 13: Gingival Fatigue in Tandem

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Fig. 15

Fig. 14

Figs. 14 15: Luder Lines in Amalgam

Fig. 16

Fig. 17

Figs. 16 17: Luder Lines in Acrylic

Deformations of Bone (Exostosis)

Overall %

Female %

Male %

Signs of DCS

95

96

94

Awareness of DCS

61

66

56

TMD

34

36

32

Sensitivity to cold

54

62

46

Muscle enlargement

12

10

14

Flattened teeth

58

56

60

Exostosis

54

48

60

Epidemiology

Gingival NCLs

58

54

62

A survey was taken of 100 patients (50 female; 50 male; age range, 17–76) to determine how many exhibited signs and symptoms of DCS and TMD (see Table).

Tip of Cusp NCLs

67

68

66

Articles on torus palatinus and torus mandibularis have appeared since 1814 (Figs. 18–21). Although there is not a consensus on their etiology, many associate their occurrence with TMDs and masticatory hyperfunction.

The author has long suggested that the compression of hydroxlapatire in the dentition and bone generates negative ions that result in exostosis (the piezoelectric effect). A situation such as this may well explain the metallic taste that people experience from time to time.

Table: Signs and Symptoms of DCS and TMD

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Fig. 18

Fig. 21

Figs. 18 21: Examples of Exostosis

Summary Why is the recognition and understanding of these deformations important? During the forty three years I have been in general practice, I have not seen one case of temporomandibular disorder or oral facial pain where the patient did not exhibit at least one or more signs of DCS. Treatment for DCS begins with the recognition that these deformations are important diagnostic tools, and proceeds with a simple three step management regimen of education, equilibration, and guard therapy in order to reduce the intensity of the compression.

Fig. 19

References i

Fig. 20

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L. G. Selna, H. T. Shillingburg, & P. A. Kerr (1975), “Finite Element Analysis of Dental Structures: Axisymmetric and Plane Stress Idealizations,” Journal of Biomedical Matter, 9: 237–252. ii A. L. Yettram, K. W. Wright, & H. M. Pickard (1976), “Finite Element Stress Analysis of the Crowns of Normal and Restored Teeth,” Journal of Dental Research, 55: 1004–11. iii G. McCoy (1995), “Examining the Role of Occlusion in the Function and Dysfunction of the Human Mastication System,” Dental Focus (South Korea), 169: 10–15. vi A. L. Yettram, K. W. Wright, & H. M. Pickard (1976), “Finite Element Stress Analysis of the Crowns of Normal and Restored Teeth,” Journal of Dental Research, 55: 1004–11.

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vi vii

viii

ix

x

xi xii xiii

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B. Kornfeld (1932), “Preliminary Report of Clinical Observations of Cervical Erosions: A Suggested Analysis of the Cause and the Treatment for Its Relief,” Dental Items of Interest, 54: 905–909.

G. McCoy (1997), “Occlusion and Dental Compression Syndrome,” Nippon Dental Review, 659: 163–183.

T. Kuroe, H. Itoh, A. A. Caputo, & H. Nakahara (1999).

“Potential for Load-Induced Cervical Stress Concentration as a Function of Periodontal Support,” Journal of Esthetic Dentistry, 1: 215–222.

W. I. Ferrier (1931, November–December), “Clinical Observations on Erosions and Their Restoration,” Journal of the California State Dental Association.

S. E. Kennedy (1987), “Biodental Theory Examines Stress,” Dentistry Today, 6 (4); C. Misch (1993), Contemporary Implant Dentistry (St. Louis: C. V. Mosby), pp. 161–162.

J. O. Grippo (1991), “Abfraction: A New Classification of Hard Tissue Lesions of Teeth,” Journal of Esthetic Dentistry, 3: 14–19.

Fig. 19 is courtesy of Reidan Sognnaes, D.M.D. J. E. Gordon (1978), Structures or Why Things Don’t Fall Down (New York, Da Capo Press), pp. 333–334.

J. L. Old & M. Calvert (2004), “Vertebral Compression Fractures in the Elderly,” American Family Physician, 69: 111–116.

Y. H. Seah (1995), “Torus Palatinus and Torus Mandibularis: A Review of the Literature,” Australian Dental Journal, 40: 318–321.

xv B. R. Pynn, N. S. Kurys-Kos, D. A. Walker, & J. T. Mayhall (1995), “Tori Mandibularis: A Case Report and Review of the Literature,” Journal of the Canadian Dental Association, 61: 1057–66; S. Sirirungrojying & D. K. H. Song Khln (1999), “Relationship Between Oral Tori and Temporomandibular Disorders,” International Dental Journal, 49: 101–104; K. E. Sonnier, G. M. Horning, & M. E. Cohen (1999), “Palatal Tubercles, Palatal Tori, and Mandibular Tori: Prevalence and Anatomical Features in a U.S. Population,” Journal of Periodontology, 70: 329–336. xvi G. McCoy (1995), “Examining the Role of Occlusion in the Function and Dysfunction of the Human Mastication System,” Dental Focus (South Korea), 169: 10–15; G. McCoy (1997), “Occlusion and Dental Compression Syndrome,” Nippon Dental Review, 659: 163–183; xvii G. McCoy (1999), “Dental Compression Syndrome: A New Look at an Old Disease,” Journal of Oral Implantology, 25: 35–49. xviii G. McCoy (1999), “Dental Compression Syndrome: A New Look at an Old Disease,” Journal of Oral Implantology, 25: 35–49.

About the Author: Dr. Gene McCoy graduated from Marquette University where he received an outstanding achievement award from the International College of Dentists. A member of AES and an honored fellow in the AAID, he teaches equilibration at the University of Peking in Beijing. Dr. McCoy has published over twenty articles on occlusion, plus a chapter on parafunction in the text Brusismo by Marciel. He practices in San Francisco.

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Levels Of Evidence In Our Professional Readings

ecently the American Equilibration Society Scientific determined. The levels utilized by Dr. Richards are as follows: Investigation Committee completed its first review of the dental literature dealing with Key to Evidence Graphic Used in the Evidence Based Dentistry Journal occlusion. The review of such a large topic generates a very wide variety of literature, dealing with the many Therapy/Prevention/ Evidence Graphic Evidence Level aspects of occlusion and its significance in various Aetiology/Harm dental therapies. I wanted to expand on one point that SR (with homogeneity*) 1A was considered in the search, and perhaps provide of RCTs 3A 2C 2B 2A 1B 1A some information that will be of value to every AES lndividual RCT (with narrow 1B member as they read articles of interest to them.

Confidence Interval) 3A 2C 2B 2A 1B 1A As we all know, there has been a dramatic increase SR (with homogeneity*) in the volume of dental literature over the past two 2A of cohort studies 3A 2C 2B 2A 1B 1A decades. Evidenced based dentistry has emerged as Individual cohort study an important factor in aiding the practitioner in (including low qualitY RCT; 2B determining the proper therapy for the patient in all 3A 2C 2B 2A 1B 1A e.g. <80% follow up) areas of treatment. The practitioner at times is deluged Ecological studies with a wide a variety and number of literature articles to 2C 3A 2C 2B 2A 1B 1A review to stay abreast of the latest recommendations in our profession.

SR (with homogeneity") of 31 case control studies 3A 2C 2B 2A 1B 1A One graphic and system used in our recent review was a â&#x20AC;&#x153;Grading Levels of Evidenceâ&#x20AC;? developed and * By homogeneity we mean a systematic review that is free of worrisome variations (heterogeneity) in the directions and degrees of results between individual studies. Not all systematic reviews with statistically significant heterogeneity need utilized by Dr. Derek Richards, Director, Centre for be worrisome, and not all worrisome heterogeneity need be statistically significant.

Evidence-based Dentistry, Oxford UK., and editor of the Evidenced-Based Dentistry Journal. The system can be used to identify varying levels of evidence used in a 1A Systematic Review (with homogeneity) of Randomized given article. We are all familiar with the basic design of Controlled Trials research or investigative projects. As a committee, we 1B Individual Randomized Controlled Trials (with narrow attempted to complete our review of the occlusion literature Confidence Interval) and give AES an idea of just where much of the literature fell.

2A Systematic Review (with homogeneity) of Cohort Studies While there is much discussion recently of high level, low level 2B Individual Cohort Study (including low level RCT, e.g. < 80% and mid level research, confusion can remain for the follow-up practitioner when decision making is required. In most of the 2C Ecological Studies articles we read as practitioners, levels of evidence can be 3A Systematic Review (with homogeneity) of Case Control Studies

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which we can be 95% sure that the true value for the whole population lies.

Lower levels of evidence are: 3B Individual Case-Controlled Studies 4 Case Series 5 Expert Opinion

Cohort study:

A few definitions may be helpful in aiding the reader. These definitions were provided to the AES Clinical Practice Guidelines Committee during a lecture by Dr. Richard Niederman in March 2006. Dr. Niederman is Director of the DSM-Forsyth Center for Evidence Based Dentistry.

Systematic Review (SR): A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research and to collect and analyze data from studies that are included in the review. Statistical methods (metaanalysis) may or may not be used to analyses and summarize the results of the included studies.

Randomized Controlled Trial: An experiment in which two or more interventions, possible including a control intervention or no intervention, are compared by being randomly allocated to participants. In most trials one intervention is assigned to each individual but sometimes assignment is to define groups of individuals (for example, in a household) or interventions are assigned within individuals (for example, in different orders or to different parts of the body).

An observational study in which a defined group of people (the cohort) is followed over time. The outcomes of people in subsets of this cohort are compared to examine people who are exposed or not exposed to particular intervention or other factor of interest. A prospective cohort study assembles participants and follows them into the future. A retrospective study (or historical) cohort study identifies subjects from past records and follows them from the time of those records to the present. Because subjects are not allocated by the investigator to different interventions or other exposures, adjusted analysis is usually required to minimize the influence of other factors (confounders).

Case control series: A study that compares people with specific disease or outcome of interest (cases) to people from the same population without that disease or outcome (controls), and which seeks to find associations between the outcome and prior exposure to particular factors. This design is particularly useful where the outcome is rare and past exposure can be reliably measured.

Case control studies are usually retrospective, but not always.

â&#x20AC;&#x153;Not all research projects can be constructed in such a way as to meet the highest level of evidence based dentistry.â&#x20AC;?

Homogeneity: 1. Used in a general sense to describe the variation in or diversity of participants interventions and measurement of outcomes across a set of studies, or the variation in internal validity of those studies.

2. Used specifically, as statistical heterogeneity, to describe the degree of variation in the effect estimates from a set of studies. Also used to indicate the presence of variability among studies beyond the amount expected due solely to the play of chance.

Confidence Interval (CI): Quantifies the uncertainty in measurement. It is usually reported as a 96% CI which is the range of values within

Case study: A study reporting observations on a single individual. Also called anecdote, case history, or single case report.

When reading articles, one can usually determine the level of evidence from the abstract. There are instances where the entire article must be read to determine the level of evidence, and one may find that a given article is written in a such a way that it is very difficult, if not impossible, to determine just where the articles falls in this level of evidence model.

There has been considerable discussion between well meaning persons in our profession regarding the use of high level evidence in decision making. One should remember that not all

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research can be subjected to certain evidence protocols. As Dr. Terry Donovan commented in his recent presentation at the AES 2011 annual meeting, “Not all research projects can be constructed in such a way as to meet the highest level of evidence based dentistry.” That should not mean that we reject conclusions from lower level research. We must realize at times that what we are reading may be the best evidence we have to aid us in our clinical decision making. While high evidence may be lacking, we as clinicians must employe the best levels available to us at the moment. Often there are comments in articles dealing with dental occlusion that state there is no “evidence” to support occlusal therapy. In reality there may be lower level articles, and these may just be the best we have to choose from in our decision making process. There is a need for increased levels of evidence in much of the dental literature, including the field of occlusion, however, it will take time to fulfill this need.

In completing this year’s review of the dental literature, we found that the articles reviewed could be categorized in the following categories.

1A 1B 2A 2B 2C 3A 3B 4 5

Systematic Review 0% Individual RCT 6% Systematic Review of Cohort Studies 0% Individual cohort Studies 31% Ecological Studies 1% Systematic Review of Case Control Studies 4% Individual case control studies 48% Case-series 0% Expert opinion 5%

I would encourage everyone to try applying the levels of evidence to their professional readings. It may seem cumbersome at first; however, as one utilizes the process more frequently it does become easier. The benefits of using it may be improved understanding of the dental literature, research methodology, and added help in our daily clinical decision making process. Long term, our patients will be the beneficiaries.

About the Author: Dr. Hancock has practiced in Scottsdale AZ for 35 years. He has a general practice, however, most of his time is spent in the area of restorative care and treatment of TMD disorders.

He has been a member of AES for 14 years, has been a member of the Scientific Investigation Committee since 1999, and has served as chairman since 2004. He is also a member of the Clinical Practice Guidelines Committee. He was elected to the Board of Directors in 2006, and has served as AES Secretary, and Vice President. Currently he is President-Elect of the society.

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Board to Survey Membership on Options for Rising Costs Guy Deyton, DDS

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n 1979, when unrest in the Middle East caused volatile fuel prices to escalate rapidly, American Airlines CEO Al Casey asked a consulting firm for options. The firm responded that the airline had 3 options when the transport cost per air-mile exceeded the ticket revenue:

cause greater losses. Because meeting registration is rolled into an annual membership fee, our more profitable years have been ones when fewer members attend our scientific session; hence the cost of the meeting decreases while our revenues stay the same.

1. The airline could continue its current pricing structure and hope that oil prices would fall.

2. Similar organizations have been more proactive in adjusting their business structure to avoid losses. Five comparable organizations were evaluated (AAOP, IACA, AACP, AHS, and AAFP). All have higher annual fees, ranging from 9% to 154% higher than AES. Most have a base membership fee to cover member benefits and services and a separate meeting registration fee to amortize the meeting costs over those that attend the meeting. Most have adjusted their fees more frequently than AES.

2. The airline could embark on a strategy to sell 10 -15% more tickets than available seats and hope that passenger noshow rates would maintain profit margins.

3. The airline could adopt a new business model to maximize seat occupancy and incorporate a new pricing strategy that avoided large losses when costs escalated beyond ticket prices.

In 2011 the AES is facing the same issue of costs exceeding revenues and will be asking membership to consider available options.

As you know, the AES has a pricing structure that combines membership and meeting registration in one annual membership fee. Over the last 13 years, we have only raised our fees $100, even though meeting costs have risen paralleling a 35% CPI increase for that time span. In 2011, after a very successful and well attended meeting, the AES lost $44,000 when meeting costs exceeded revenues.

The AES Board convened a Business Model Ad Hoc Committee to evaluate all options for our society. After a thorough evaluation of membership trends, meeting attendance, meeting costs, and business structures of similar organizations, the ad hoc came to the following conclusions: 1. We lose money with good meetings. Excellent meetings with a high percentage of member attendance actually

3. We need to actively survey and communicate with our membership. We have a tremendously talented and insightful membership and we need to more proactively educate you and ask your opinion.

Expect an important survey about business structure within the next month. Please read the information carefully and respond. Your opinions are important and will be thoroughly considered!

With your help, we will continue to make AES the pre-eminent organization devoted to the pursuit of knowledge about form, function, and pathology of the masticatory system.

About the Author: Guy Deyton is a Board Director and chairman of the Board Officer Ad Hoc Committee, which is commissioned to clarify and define the roles of Board officers as it relates to the AES vision and mission. Dr. Deyton is the director of the Leadership Development Continuum which develops leadership skills for aspiring leaders in healthcare. He practices comprehensive and reconstructive dentistry in Kansas City, Missouri.

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Abstracts

American Equilibration Society Annual Meeting Wednesday, February 23, 2011 Speaker: Dr. Terry Tanaka “Anatomical Guidelines for Restorative & Prosthodontics Treatment Planning” Abstract: John Rezaei, DDS Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry In this presentation Dr. Tanaka discussed topics that include anatomical observations of cadaver skull condylar eminentia. He also talked about the incidence of noncarious cervical lesions in the early civilization of man. He talked about how frequently working and nonworking contacts occur, as well as the average horizontal overlap (overbite) and vertical overlap (overjet) and how it changes with increasing age. Studies show that 50% of the population does not have canine guidance. He also talked about taking precaution when planning for implant surgery in an anterior severely resorbed mandible, due to the anatomical location of the lingual artery. He gave some suggestions about how to manage surgical complications, as well as methods to prevent severing arteries.

Speaker: Dr. Mark Piper “Facial Complex Regional Pain” Abstract: John Rezaei, DDS Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry In this presentation, Dr. Piper gave an overview of facial complex regional pain syndrome (CRPS). If untreated

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or misdiagnosed, the pain can spread to other extremities. The untreated disease can lead to permanent deformities or chronic pain. CRPS remains poorly understood and is frequently missed or misrecognized. The lecture focused on CRPS Type I, which is identifiable by the following characteristics: (1) initiated by noxious events, (2) area of pain has no definable nerve injury, and (3) was formerly called reflex sympathetic dystrophy. The onset of pain can be caused by dental procedures. Clinical features include painful movement of the body part, i.e. mandible.

Patients have difficulty initiating vertical and excursive movements. Treatment protocols for facial CRPS include therapeutic nerve blocks, medication management, and physical therapy.

Speaker: Dr. Barry Glassman “Chronic Pain Management” Abstract: Dr. Wendy Gregorius Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry Dr. Barry Glassman presented the topic of chronic pain management. He posed the question, “How does occlusion matter and why?” The complexity of an altered central nervous system, central sensitization syndrome (CSS), and chronic regional pain was discussed. Possible treatment options proposed included decreasing trigeminal nociceptive afferent signals and reducing noctur nal and diur nal parafunctional forces.

The definition of chronic pain is pain that persists past the healing phase following an injury. Neuropathic and inflammatory injuries that cause a persistent pain condition suggest that peripheral and spinal cord circuitry transmitting nociceptive signals undergo dramatic reorganization that involve plastic changes.

Chronic orofacial pain can be divided into three states: musculoskeletal, neurovascular and neuropathic.

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Musculoskeletal pain is found under the “umbrella” term Temporomandibular Disorder (TMD). The term TMD is of limited value, as it classifies articular problems with muscle disorders that have different etiologies and treatment approaches.

The neurobiological mechanism of pain involves the peripheral afferent sensitization, central sensitization and imbalance of descending inhibitory systems. Occlusion, hyper-muscle activity and the chronic pain model are a vicious cycle. The pain adaptation model replaces the vicious cycle model, as it eliminates trigger points and muscle spasms. The introduction of an occlusal interference does not necessarily cause chronic pain.

The complexity of the sympathetic nervous system must be understood to be able to interpret pain. CSS has a normal “signal” with an altered interpretation and response. The underlying etiological factors can be pain sensitivity or altered central pain regulatory mechanisms.

The evidence suggests that other common pain conditions do not exhibit signs of resting or postural muscle hyperactivity. Awake muscle activity in a chronic pain patient is different than that of nocturnal muscle activity. There is no difference between the resting muscle activity levels in subjects who report pain and those who do not in bruxers. It is important to understand the concept of “non-linear” relationships between bruxism and craniofacial pain to avoid oversimplification of diagnosis and management. Therefore, the rationale of treatment that is aimed at pain relief through the reduction of muscle hyperactivity is unsupported.

The term TMD was confusing when it was used as a diagnosis, and the diagnosis of TMD itself is a barrier.

For neurovascular and neuropathic orofacial pain, the diagnosis may not have a dental cause and the occlusal scheme may not be the best diagnostic perimeter for determination of etiology.

Speaker: Dr. David R. Newkirk “Factors of Functional Occlusion” Abstract: Dr. Catherine Kwon Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry The question of where to start in the treatment of a patient with an envelope of function problem can be

difficult to answer. A simple method is to determine if the occlusal plane is ideal. The mandibular anteriors are a good starting point if the occlusal plane is acceptable. If the occlusal plane is non-ideal, the maxillary centrals are the recommended starting point.

When natural function is developed, natural esthetics will follow. The correct proportion of the anterior teeth followed by the correct incisal position in the vertical and horizontal plane will produce the correct form and function that is desired. The form of the anterior teeth leads to their ideal function. The facial gingival third provides support for the upper lip while the incisal third supports the lower lip. The lingual incisal half aids in the production of the sibilants (“s”) while the lingual incisal third produces the linguodental sounds (“th”).

The cingulum provides a stable centric stop. Following these simple guidelines will help answer the difficult questions that arise when treating a patient with an envelope of function problem.

Speaker: Dr. William Bruce II “Factors of Functional Esthetic Success” Abstract: Dr. Catherine Kwon Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry Applying simple principles to blend the functional and esthetic disciplines will lead to results that are healthy, predictable, beautiful, and stable. The function parameters that are evaluated are (1) the temporomandibular joints, (2) the posterior teeth and (3) the anterior teeth. First, the temporomandibular joints must be fully seated. Then the posterior teeth are observed in excursive movements to ensure that interferences are not present. Lastly, the anterior guidance is observed to be in harmony with the posterior teeth. The result will be the precise harmony of the lateral pterygoid muscles. The esthetic parameters that are critical are (1) facial analysis, (2) anterior smile and (3) posterior smile. The facial analysis will provide information regarding the skeletal profile and the lip dynamics in a full smile and the “E” position. The anterior smile will determine the horizontal and vertical position of the maxillary central AES Contact

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Abstracts (continued) incisors. The posterior smile will reveal the amount of buccal corridor that is visible. These parameters are evaluated with the provisionals to test the esthetics, function, and phonetics. These three parameters will lead to functional stability of the occlusion.

Speaker: Dr. Robert F. Faukner “Occlusion for Dental Implants: The Critical Factor in Implant Success” Abstract: Dr. Alfredo Paredes Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry How important is occlusion? Occlusion may be the most critical factor for implant success. There are different types of occlusal schemes used in complete dentures and implant restorations, e.g., anterior guidance or mutually protected occlusion, group function and bilateral balanced occlusion. Bilateral balanced occlusion is necessary in complete denture stability, better tissue response and uniform inflammation. Balanced articulation becomes important in parafunction, which is a protective mechanism for the patient. Anterior guidance or mutually protective occlusion involving excursive and protrusive movements in a clinical scenario would be defined as parafunction. D’Amico described mutually protected occlusion as the guidance of closure of the mandible between the last millimeter and maximal intercuspal position, which is ideally carried out by the canines.

Functional occlusion demands an understanding of the masticatory cycle in a 3-dimensional representation, which directly impacts the loading of natural dentition and dental implants. When restoring dentition with dental implants, during bruxism and parafunction, allow natural teeth to control guidance and the implants to support centric stops. In addition, the natural dentition are inclined facially. In the same manner, the implant should have the same position and angulation as natural teeth, which will create the compensating curves of Spee and Wilson to achieve an optimal position of the dental implant.

In conclusion, the masticatory cycle is the most functional load placed on dental implants. Therefore, the most important consideration when designing an implant restoration is the masticatory cycle.

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Thursday, February 24, 2011 Speaker: Dr. John Kois “Occlusal Equilibration – How It’s Taught” Abstract: Dr. Wendy Gregorius Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry Dr. John Kois discussed a patient case, in which the patient presented with headaches, muscle fatigue and a night guard that had been used with limited success.

The patient had orthodontic treatment twice and was now suffering from bite problems. An occlusal stress test was performed for finding the threshold level at which symptoms occur. The diagnosis was occlusal dysfunction or disease of maximal intercuspal position.

This procedure was made in five deliberate appointments and the equilibration should take about one hour. Laboratory fabrication of a deprogrammer for suppression of ingrams, to read the biology of the patient by checking for absence of symptoms, and for controlling the centric relation was done. The deprogrammer was placed in the mouth and verification of 1.0 mm to 1.5 mm separation of the molar region was made. The back of the deprogrammer platform acrylic was reduced and flattened. A bite record was made at an open vertical position. The initial point of contact was found as the teeth were engaged and the patient was checked for absence of symptoms. The first point of contact was reduced keeping it level and horizontal using Bausch 200 Microns Articulating Paper. The teeth were verified for contact on both sides. AccuFilm® (20m) was used to find the second point of contact.

This point was verified on the mounted casts in the lab for the trial equilibration, which served as the guide for the clinical equilibration.

The patient retur ned for the equilibration appointment, during which only inclines and fossas were reduced. Cusp tips were not flattened, but only the fossas were deepened for the purpose of not reducing the memory concerns of the patient. When the patient was able to point to the tooth that was now

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touching, shim stock was used to create a mind body connection for the patient so that the patient could feel where the contact was. The fossas were reduced incrementally using TrollFoil™ articulating foil (8 m) while marks were checked. Adjustments were made to the marks in the fossas and inclines, but never cusp tips. At this point, both sides were now adjusted and the contacts were moving anteriorly. The deprogrammer was removed and the patient was able to activate on their teeth. The intensity of the contacts was evaluated, keeping in mind that equal simultaneous contact is critical. The patient was now asked to chew, and the chewing envelope was evaluated while the patient chewed only with the anterior teeth. Every tooth was checked for absence of fremitus. The patient’s treatment was successful and her symptoms resolved.

Speaker: Dr. Glenn E. DuPont “Equilibration Made Simple in Six Easy Steps” Abstract: Dr. Wendy Gregorius Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry Dr. Glenn E. DuPont presented the way occlusal equilibration is taught at the Dawson Academy in six easy steps.” Equilibration is important for the purpose of achieving a balance of forces on the whole stomatognathic system, creating stability and increasing predictability of restorative procedures.

Occlusal equilibration is done when the temporomandibular joints are stable and can accept force, when it is the best and most conservative treatment and when the patient understands the treatment. The six steps to accomplish an equilibration predictably and efficiently are: (1) perform a thorough evaluation of the temporomandibular joints, muscles and supporting tissues, (2) perform a trial equilibration on accurately mounted study casts, (3) provide definitive contacts on all teeth of equal intensity in centric relation, (4) eliminate posterior interferences in all excursions, (5) refine the anterior guidance, and (6) recheck and provide final check of each criteria.

Proper equilibration never harms the patient, never

restricts movements, never mutilates teeth and creates comfort and stability.

Speaker: Dr. Clayton A. Chan “Occlusal Equilibration – How It’s Taught” Abstract: Dr. Wendy Gregorius Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry Dr. Clayton A. Chan presented a discussion on occlusal equilibration in relationship to the neuromuscular concept. Occlusion is the foundation to advanced dentistry. Establishing a physiologic terminal contact position first is one of the paramount aspects that is taught. Occlusion affects the whole body, central nervous system, autonomic nervous system, teeth, muscles and temporomandibular joints (TMJ).

Occlusal equilibration should support stabilization of the periodontium and dental occlusion, reduction in TMJ clicks and pops, elimination of masticatory muscles pain and dysfunction, removal of abnormal jaw closure patterns, improved maxillary to mandibular posture and stability, and improving head, cervical spine, occiput and pelvis balance. Conservative reversible treatment is paramount by stabilization of the masticatory system using a removable anatomical orthotic appliance after identification of a physiologic optimal bite first. There are three stages of gneuromuscular occlusion: (1) establish myocentric first, (2) establish physiologic mandibular function, and (3) refine anatomical form of the incline planes.

Myocentric is established with the aid of low frequency TENS. Prior to reconstruction, homeostasis is established. Phase I includes orthopedic stabilization.

Torques are identified. Jaw tracking combined with transcutaneous electrical nerve stimulation (TENS) is used for finding a proper anterior overjet and overlap for proper cranial stabilization during functioning mode. Cuspid rise is incorporated into the orthotic appliance. Computerized mandibular scanning is used to measure mandibular positioning, quality of terminal contact and jaw closing patterns. A chew test scan is used to observe dynamic chewing patterns. The patient is restored with optimal occlusion.

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Abstracts (continued) Speaker: Dr. Robert B. Kerstein

Speaker: Dr. Christopher Orr

“How Computer-Guided Occlusion is Taught”

“How It’s Taught: Leaf Gauge (and Beyond)”

Abstract: Dr. Wendy Gregorius Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry

Abstract: Dr. Wendy Gregorius Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry

Dr. Robert B. Kerstein presented how computerguided occlusion is taught using the T-Scan. Students take a two-day interactive training seminar to learn, record and understand digital data, timing and forcemapping. They then treat patients by applying the digital data. The two-day training seminar objectives are to obtain better occlusal data with computerized occlusal analysis, analyze the time-sequencing and force-mapping recorded data, improve clinician’s visibility of occlusal problems, translate articulating paper marks with digital occlusion, improve patient outcomes and enhance education and case acceptance. Training involves proper recording techniques. The digital occlusion clinician learns how to record the timing of intercuspation contacts sequence, posterior disclusion sequence, sequence of delayed implant prosthesis contact, and the forcemapping of each occlusal contact in sequence. This timing and force data illustrates where the occlusal problems exist. The students’ goal is to obtain useful occlusal contact data with which to treat patients.

Training involves multi-bite recordings in excursive and centric relation. The data is then analyzed in dynamic movement. The training software features are force-mapping in 2- and 3-dimensions, timesequencing of each tooth contact, moving total force summation COF, force %/tooth, force%/arch half and force %/quadrant. Electromyography is synchronized with the T-scan for evaluation of timing and sequential data. A computer-guided occlusal adjustment is done using an essix retainer. The paper marks are correlated to the digital data for uniform equilibration.

The digital occlusion clinician is taught to use timesequencing to purposefully delay implants to contact after natural teeth.

Dr. Christopher Orr presented how centric relation records are made using the leaf gauge. A case complexity assessment is done. The patient’s adaptive capacity needs to be established. A leaf gauge is one of the simplest ways to record centric relation. A sufficient number of leaves are placed between the teeth anteriorly so that the posterior teeth are discluded and so that the lateral pterygoid muscles are stretched and the muscles of mastication are seating the joint.

The joint is also being load tested. The literature is inconclusive in terms of whether the leaf gauge is more or less accurate in relation to other methods of obtaining centric records. Leaves are added or subtracted until sufficient thickness of material can be placed to record centric relation. The sequence of treatment follows consultation, baseline records, preliminary treatment, provisional restorations, transition to definitive restorations, and maintenance. Repetition is needed for teaching equilibration. The leaf gauge is a good entry-level method for load testing the joint and achieving a centric relation and bite record.

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Speaker: Dr. Terry E. Donovan “Wear of Tooth Structure and Restorative Materials” Abstract: Dr. Wendy Gregorius Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry Dr. Terry E. Donovan discussed the wear of tooth structure and restorative materials and the evidence related to wear and why it is not stronger. He provided information gleaned from in vitro laboratory studies, showed the predictive ability of data gleaned from “wear” centers, explained the clinical implications related to materials selection, as well as gave a brief update on the wear of composite resin material.

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What are the hurdles preventing the conduction of random controlled clinical trials (RCTs) related to “wear” of enamel and restorative materials? The answer includes time, money, the number of subjects required and investigator calibration. The main reason for the lack of RCTs is due to its multifactorial etiology of “wear.” “Erosive tooth wear,” suggests the multifactorial etiology of “wear.”

Attrition is the wear of tooth structure resulting from tooth-to-tooth contact, which can be through mastication or bruxism or be physiologic or pathologic. Abrasion is pathologic wear of tooth structure due to an abnormal mechanical process. Erosion is chemical loss of tooth structure with no bacteria. The two types of erosion are extrinsic or extrinsic erosion. Extrinsic erosion is a result from the ingestion of acidic foods and beverages. The location of tooth structure is seen on the labial surfaces of the incisor teeth, buccal surfaces of the posterior teeth and the occlusal surfaces of the maxillary and mandibular arches. Intrinsic erosion results from bulimia and GERD. It occurs on the palatal surfaces of the maxillary teeth and the occlusal surfaces of the mandibular teeth. Four groups of patients are at risk for erosion: young females, teenage males, middle-age males and the elderly.

Abfraction is the multifactorial loss of tooth structure in the cervical area involving tooth flexure, toothpaste abrasion and chemical erosion.

The last reason that we do not have RCTs is a lack of validated indices for evaluating and measuring wear.

Laboratory studies have been done that show trends. The rougher the porcelain, the greater the wear of enamel.

Polished porcelain produces less enamel wear than overglazed and unglazed porcelain. Shaded Dicor caused 10 times to 15 times the wear of enamel than gold. The least abrasive ceramic wore 10 times the amount of enamel when to compared to cast gold. Wear in citric acid (pH 4) is considerably greater than wear in water. All of the ceramic materials tested wore enamel 6 times to 15 times compared to gold.

In summary, studies regarding enamel wear compared to materials showed that it is impossible to compare studies.

In-vitro studies do not duplicate intraoral conditions. All ceramic materials wear enamel more than opposing surfaces of enamel or gold. The hardness of ceramic is not an issue, but the roughness of the ceramic is the critical property. Studies on ceramic material compared to enamel showed that there is no best ceramic or surface, all ceramics have the potential to wear enamel, surface

roughness is the major factor, all external glazes and stains are abrasive and opaque porcelain and core materials are abrasive and polish is equal to glaze roughness. The surface roughness of porcelain is dependent on microcrystalline structure, laboratory processing and occlusal adjustment and wear over time. Porcelain polishing is recommended in the literature. There is a need to polish porcelain post-adjustment. Layered materials are more esthetic than monolithic materials; however, monolithic restorations are stronger but more abrasive.

When gold restorations are compared to ceramic, they remain the longer lasting restoration.

In summary, wear is a complex process that can hardly be simulated while controlling all variables. Extrapolation of the in-vitro wear results to the in-vivo situation is difficult because of interplay with biological variables that are difficult to mimic. It is not the degree of sophistication, but the right mix of controllable variables that will make a wear simulator predictive.

In conclusion, wear of enamel and restorative material is a complex mutifactorial process. Wear of enamel vs. enamel, gold and amalgam is clinically insignificant.

Contemporary composite resins have adequate wear resistance in small cavities. All contemporary ceramic materials are potentially abrasive to enamel materials.

Preferred couplings are enamel with enamel, gold with enamel and porcelain with porcelain. In-vitro wear research is not correlated to clinical performance. Patient (biological) factors are more important than material factors.

Randomized controlled clinical trials are needed.

Speaker: Dr. John O. Grippo “The Dynamics of Occlusion” Abstract: Dr. Wendy Gregorius Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry Dr. John O. Grippo lectured on the dynamics of occlusion.

The pathodynamic mechanism of tooth surface lesions is multifactorial and includes friction (wear), corrosion (chemical degradation) and stress (abfraction). Force can be dynamic or static, and stress is defined as the force per unit area. Teeth exert forces during swallowing, chewing and biting. It was proposed that the precise term corrosion or biocorrosion be used to replace the term “erosion” and to AES Contact

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Abstracts (continued) recognize the mechanisms of stress corrosion and fatigue corrosion. Corrosion is the loss of tooth substance by chemical action. Causes of biocorrosion can be acidic and proteolytic corrosion. The effects of occlusion on teeth are infractions, non-carious lesions, carious lesions, complete fracture of teeth, cervical dentin hypersensitivity, bruxism, mobility and loss of cementum. Case studies were shown to illustrate the concept of the pathodynamic mechanism.

Speaker: Dr. Jack Turbyfill “Occlusion and Esthetics for Dentures/Implant Overdentures” Abstract: Dr. Doris Kore Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry The placement of the anterior teeth in dentures is critical not only for outstanding esthetics but to prevent anterior restriction for the envelope of function. Quality, quantity and preservation of bone are the key factors in dentistry.

Porcelain teeth preserve bone and everything we do in dentistry is to preserve bone. Plastic teeth destroy bone because there is no stability.

The speaker presented a way to place anterior teeth that has served him well for forty years. The anterior teeth should be set with anatomical harmony as follows: Mark the height of the canine fossa and the insertion of the frenum and the midpoint between the two is usually 20 mm from the incisal edge 20 mm down and 10 mm out from the incisive papilla. When looking straight at the patient you should see only the mesial half of the cuspid. For vertical dimension of occlusion and phonetics, place speaking wax and have the patient read until they have a beautiful “S” clearance. Have 1 mm clearance for freeway space— speech. The edentulous mandible is like a tripod that has lost one leg. With the two condylar elements, the anterior determinant becomes the third leg on the tripod.

The most critical step in removable prosthetics is to accurately record centric relation. The speaker showed the use of a central bearing point for use with complete dentures as well as in combination cases where there are teeth present in one arch that will occlude with a denture in the opposing arch. The central bearing device works in the edentulous mouth like an anterior deprogrammer works on natural teeth.A Gothic arch tracing confirms you are in

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centric. A central bearing device without tracing is all right.

Everything we do in dentistry is to preserve bone. The speaker also demonstrated the use of custom gold and other metal occlusal surfaces during the presentation.

Speaker: Dr. Jeff Rouse “Programming Complex Restorative Cases: A Global Approach” Abstract: Dr. Doris Kore Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry The purpose of this lecture was to present a diagnostic method based on the concept of “global” diagnosis.

Complex restorative dentistry is interdisciplinary dentistry.

The speaker’s goal and vision has been to teach interdisciplinary dentistry. Interdisciplinary dentistry purposefully or indirectly alters the gingival architecture, which leads to restorative dentistry. At the end of gingival treatment, it should become restorative dentistry. Complex restorative cases in the past were occlusally driven, but now we know that the gingival architecture has to be taken into consideration or the teeth have to be moved around or taken out. So now complex restorative cases become interdisciplinary dentistry.

After the collection of data, it used to be restoratively or occlusally driven. Occlusion is important, but the teeth have to be in the right place to be esthetic and also function well.

Facially generated diagnosis by Drs. Kois and Spear suggest that occlusion is important, but the teeth have to be in the right place for function and esthetics as well. Over the last 40 years we have worked through clear-cut rules of occlusion and we have set ways of working through occlusion and coming to the end product. In the last 15 years the speaker and his partner has been trying to teach this facially generated diagnosis with a more simplified and more teachable approach and called it “global” analysis diagnosis. Comparing the “global” analysis diagnosis to a medical model makes it easier to understand. Form is through measurements and photographs. Regional includes diagnostic records, and regional treatment planning involves regional data collection, experience based treatment planning and error based revised treatment planning. These alone are not good teachers.

“Global” diagnosis is naming the problem: “Global” and

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“Regional” data collection, “Global” interdisciplinary diagnosis, the sequential treatment plan is based on diagnosis not experience, and “Regional” data modifies a “Global” plan. How the data is handled after it has been collected leads us to the five core questions to be asked—What is the face height, lip length and mobility, gingival line, tooth length and CEJ? The average numbers for a 30 year old are 1:1, 20-24 mm, 6-8 mm, straight and 10 mm. The average numbers will be a little different for older individuals. Any number that is outside these numbers will help us make a diagnosis. There are six tools to correct this problem, which include connective tissue graft, crown lengthening, intrusion, extrusion, plastic procedures (Botox and fillers) and orthognathic surgery. Basically they are gingival architecture problems.

Think of interdisciplinary dentistry as simply altering a denture. Somehow make it into a restorative case. Find a tooth that you like and leave it alone and work on the ones that you do not like.

Speaker: Dr. Jimmy B. Eubank “Combining Esthetics and Occlusion for Longevity”

Abstract: Dr. Alfredo Paredes Graduate Student, Advanced Education Program in Prosthodontics, Loma Linda University School of Dentistry The most important reason for why people go to the dentist is for appearance related issues. In a patient whose current occlusal condition is affecting the masticatory system and dentition, it is important to understand how we can test that the new restorations will work and last the longest. For this, it is necessary to achieve “end-to-end” harmony that will provide the appropriate occlusal contacts and disclusion in eccentric movements of the mandible, reality views that consist of educating the patient about his or her dental conditions. This involves using photos and a comprehensive bite analysis, which involves analysis of the chewing cycle of a patient and force management, which lowers the occlusal forces. Lateral and working interferences activate the masticatory muscles, which then increase the biting forces, which will affect the longevity of the restorations. Comprehensive dentistry requires an esthetic intraoral mock-up and a direct technique, which is done by bonding composite resin to the ideal occlusion in centric relation. This will allow for determination of the length of the teeth, occlusal vertical dimension, occlusal plane and stabilization of the occlusion. Stability of the comprehensive treatment is monitored over time by using a dual arch occlusal appliance (E-Appliance).

Tips on Utilization of the AES Website: www.aes-tmj.org Under Membership you will find information about member benefits including the annual meeting, journals, TMJ Update and the AES newsletter. Details about upcoming meetings and registration information are under the Annual Meeting section. Finally, in the section labeled About Us you will find our mission and vision for AES.

PUT THE AES WEBSITE TO WORK FOR YOU! Adding your information to our site will allow prospective patients to find you when they are looking for someone to help them with their TMJ issues. Member Login is in upper right hand corner. Once you have logged into the AES website you can update your profile and the visibility of your profile. Simply log in, select the blue My Directory Listing at the top of the page. You may then edit the profile via the edit choices on the right side of the page. In the Contact Information section, you can upload a picture and list your office website as well. Make sure to go to the Membership Directory section and select your level of visibility. If this is not selected, your information cannot be viewed by anyone performing a search inside the site. There is even a Social Networking area to link your Facebook, LinkedIn, MySpace and Twitter accounts. Links with pictures are more likely to be viewed and accessed for referrals. Once you’ve logged in, you can also access the AES Mentor’s Forum.

AES Contact

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AMERICAN EQUILIBRATION SOCIETY

57th Annual Meeting Registration February 22–23, 2012, Chicago, IL Name____________________________________________________________________________________________________________________ (Last)

(First)

(Middle Initial)

(Degrees)

Complete mailing address _____________________________________________________________________________________________________ (Street Address)

(P.O. Box, if applicable)

________________________________________________________________________________________________________________________ (City)

(State/Province)

(Zip/Postal Code)

(Country)

________________________________________________________________________________________________________________________ (Phone: Area Code and Number)

(Fax: Area Code and Number)

(Email)

What first name would you prefer printed on your badge? ______________________________________________________________________________

Meeting Registration Fee Category

Regular Fee

On site Fee

No Charge

No Charge

Graduate Student (accompanied by letter from Director of Program)

$ 350

$ 350

Life Member

$ 350

$ 400

Exhibitor

$1750

N/A

Non Member Dentist

$ 650

$ 750

AES Member Registration

Social Events

Total

Fee

President's Reception

No Charge

Total Attending Reception

Wednesday, February 22, 2012, 6:30pm 8:30pm Please note that while there is no additional cost to attend the President's Reception, space is limited, so please let us know if you are attending and bringing a guest.

Are you attending the President’s Reception?

Yes

No

If you are attending the reception, is someone going to accompany you? If so, please give us the name: ___________________________________________________________________________ Are you attending lunch on Wednesday the 22nd?

Yes

No

Thursday the 23rd?

Return this registration form to: AES Central Office, 207 E. Ohio Street, Suite 399, Chicago, IL 60611

Yes

No

Total Enclosed (or to be billed by credit card):

Make checks payable to: American Equilibration Society (US $ Only) • If you wish to pay by credit card, please complete the following information (Please print): Name On Card:_________________________________________________________________________________ ____________________________ (Last)

Card Type:

Visa

Mastercard

(First)

Amex

(Middle Initial)

Card Number:______________________________________________ Expiration Date: _________

Validation Code: _________ (The last 3 digits of the non embossed number printed on the back of your Visa or MC. The 4 digits on the front of your AMEX.) Payments will not be processed without this code.

Signature:___________________________________________________________ Date:_________________________________________________

Fax Registration to: 609.573.5064

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Register online at: www.aes tmj.org

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AMERICAN EQUILIBRATION SOCIETY 2011 Scientific Program

•

February 23 24, 2011, Chicago IL

A portion of all sales is returned to AES to help fund educational programs. Thank you for your support!

FULL SET SPECIAL OFFER: ORDER A FULL SET OF CONFERENCE DVDS AND PAY ONLY $425 AT MEETING ONLY. (AFTER 2/24/11, FULL SETS ARE $565) WEDNESDAY SESSIONS, FEBRUARY 23

QTY

Dr. Terry Tanaka (Audio Only) $40 Onsite only $55 after 2/24/11 Anatomical Guidelines for Restorative & Prosthodontic Treatment Planning Dr. Mark Piper $40 Onsite only $55 after 2/24/11 Facial Complex Regional Pain Dr. Barry Glassman $40 Onsite only $55 after 2/24/11 Chronic Pain Management Dr. David R. Newkirk (Audio Only) $40 Onsite only $55 after 2/24/11 Factors of Functional Occlusion V.D.O., A.G. Dr. William “Bo” Bruce, II (Audio Only) $40 Onsite only $55 after 2/24/11 Factors of Functional Esthetic Success Dr. Robert F. Faulkner $40 Onsite only $55 after 2/24/11 Occlusion for Dental Implants: The Critical Factor in Implant Success

THURSDAY SESSIONS, FEBRUARY 24

QTY

Dr. John Kois (Audio Only) $25 Onsite only $35 after 2/24/11 Occlusal Equilibration How it’s Taught @ Kois Dr. Glenn DuPont $25 Onsite only $35 after 2/24/11 Occlusal Equilibration How it’s Taught @ Dawson Dr. Clayton Chan $25 Onsite only $35 after 2/24/11 Occlusal Equilibration How it’s Taught Neuromuscular Dr. Robert Kerstein $25 Onsite only $35 after 2/24/11 Occlusal Equilibration How it’s Taught T Scan Dr. Christopher Orr $25 Onsite only $35 after 2/24/11 Occlusal Equilibration How it’s Taught Leaf Gauge Dr. Terry Donovan $40 Onsite only $55 after 2/24/11 Wear of Tooth Structure & Restorative Materials Dr. John O. Grippo $40 Onsite only $55 after 2/24/11 The Dynamics of Occlusion Dr. Jack Turbyfill $40 Onsite only $55 after 2/24/11 Occlusion and Esthetics for Dentures/Implant Overdentures Dr. Jeff Rouse $40 Onsite only $55 after 2/24/11 Programming Complex Restorative Cases: A Global Approach Dr. Jimmy B. Eubank (Audio Only) $40 Onsite only $55 after 2/24/11 Combining Esthetics and Occlusion for Longevity AES 2011 Scientific Program

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•

DVD Order Form

•

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AMERICAN EQUILIBRATION SOCIETY 2011 Scientific Program

•

February 23 24, 2011, Chicago IL

DOMESTIC SHIPPING All orders are shipped via U.S. Postal, unless special domestic shipping is requested. Cost is $5.00 for the first DVD and $3.00 for each additional DVD shipped within the United States, up to a maximum of $15.00. For special domestic shipping, see below.

INTERNATIONAL SHIPPING AND SPECIAL DOMESTIC SHIPPING Because shipping rates vary between carriers, we cannot determine ahead of time what it will cost to ship your order. We will prepare your package and pay shipping charges for the carrier you choose. You will be charged the actual shipping costs plus a handling fee of $10.00 to cover packaging materials, completion of forms, etc. Shipping charges will show up as a separate charge on your credit card statement.

We accept: Cash, Check (Payable to Aesthetic Visual Solutions, Inc.), Visa, Mastercard or American Express MAIL OR FAX ORDER FORM TO: AESTHETIC VISUAL SOLUTIONS 7565 Commercial Way, Ste. D, Henderson, NV 89011 • p. 702.248.4123 • f. 702.446.5640 • e. dvdsales.avs@gmail.com Name On Card:________________________________________________________________________________________________________________ (Last)

(First)

(Middle Initial)

____________________________________________________________________________________________________________________________ Shipping Address

____________________________________________________________________________________________________________________________ City

State/Province

Zip/Postal Code

____________________________________________________________________________________________________________________________ County

Tel

Email

____________________________________________________________________________________________________________________________ Billing Address (if different)

____________________________________________________________________________________________________________________________ City

State/Province

Zip/Postal Code

____________________________________________________________________________________________________________________________ County

Card Type:

Tel

Visa

Mastercard

Email

Amex

Card Number:_________________________________________________ Expiration Date: _________

Validation Code: _________ (The last 3 digits of the non embossed number printed on the back of your Visa or MC. The 4 digits on the front of your AMEX.) Payments will not be processed without this code.

Signature:____________________________________________________________Date:____________________________________________________

Fax Order Form to: 702.466.5640 Mail Order Form to: Aesthetic Visual Solutions, 7565 Commercial Way, Ste. D, Henderson, NV 89011

AES 2011 Scientific Program

•

DVD Order Form

•

Page 2 AES Contact

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AMERICAN EQUILIBRATION SOCIETY

APPLICATION FOR MEMBERSHIP Each section of application must be answered. If answer is “none,” this should be stated. Wherever space is inadequate, use additional sheet.

1. Name____________________________________________________________________________________________________________________ (Last)

(First)

(Middle Initial)

(Degrees)

2. Complete mailing address _____________________________________________________________________________________________________ (Street Address)

(P.O. Box, if applicable)

________________________________________________________________________________________________________________________ (City)

(State/Province)

(Zip/Postal Code)

(Country)

________________________________________________________________________________________________________________________ (Phone: Area Code and Number)

(Fax: Area Code and Number)

3. Date of birth _____________________________________________

(Email)

How many years in practice _________________________________________

4. Have you previously applied for membership in the American Equilibration Society?

Have you previously been a member of the American Equilibration Society?

Yes

No

When? _______________________

Yes

No

When? _______________________

5. Dental/Medical education ____________________________________________________________________ (Institution)

Year _________________________

(Degree)

6. Graduate education_________________________________________________________________________ (Institution)

Year _________________________

(Degree)

7. Are you a member of the American Dental Association?

Are you a member of another national Dental Association?

Yes

No

Yes

No

Name_____________________________________________

8. Licensed in what States/Provinces/Countries: _______________________________________________________________________________________ 9. Do you have a recognized specialty?

Yes

No

Specialty ___________________________________________________________

10. What percentage of your practice is devoted to treatment of TMJ, Muscle or Occlusal dysfunction? ________________________________________________ 11. University Affiliation: (Teaching or Research) ________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________________________

Full time

Part time

12. Other Affiliations: (Hospital, Governmental, Military, etc.) _______________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________________________

Full time

Part time

13. Postgraduate Education: ______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

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14. Publications and Presentations: _________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ 15. Participation in Professional Organizations: (Include offices and committee chairmanships) ______________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ 16. What is your purpose in wishing to join the Society? ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ 17. If elected to membership in the American Equilibration Society, I agree to abide by the Constitution, By Laws and other rulings of the Society. ________________________________________________________________________________________________________________________ (Signature of Applicant)

(Date)

18. MEMBER RECOMMENDATION (This recommendation must be signed by the member recommending the applicant.)

Name Printed ______________________________________________________________________________________________________________ Address ________________________________________________________ City _____________________ State____________ Zip _____________ Country_________________________________________________________ Phone Number ______________________________________________

In order to be considered for membership at the next Annual Meeting in February, a fee of $650.00 must accompany this application, made payable to THE AMERICAN EQUILIBRATION SOCIETY ($100.00 covers application fee, $550.00 covers first year’s dues covering the membership year). The annual dues include: (a) The Journal of Prosthetic Dentistry during the year voted in as a member, new members to receive back issues from first of year. (b) TMJ UPDATE, published six times each year, presenting latest scientific information in this field, (c) Attendance at the Annual Meeting and the President’s Reception, (d) New membership embossed certificate, (e) Annual updated International Membership Directory, (f) AES Newsletter. Dues are not pro rated for the year. If an applicant is not voted into the Society, he is only entitled to a dues refund.

DEADLINE FOR APPLYING, JANUARY 31.

FOR USE BY THE CENTRAL OFFICE ONLY Date Received by the Central Office

_________________

Acknowledgement Letter Sent

_________________

Approved by Membership Committee

_________________

Rejected Approved by Executive Council

_________________

Rejected Approved by Society at regular meeting

_________________

Rejected Acceptance letter sent ______________________________________________________

MEMBERSHIP YEAR (MAY 1 – APRIL 30)

Remarks: _______________________________________________________________

RETURN TO: Total Enclosed (or to be billed by credit card): Membership Committee AMERICAN EQUILIBRATION SOCIETY, 207 E. Ohio Street, Suite 399, Chicago, IL 60611 All funds from Outside the United States must be paid in U.S. Bank Draft or International Money Order only!

Journal of Prosthetic Dentistry subscription rate of $94.00 domestic, $140.00 Canadian and $131.00 International are included in the annual dues.

Name On Card:_________________________________________________________________________________ ____________________________ (Last)

Card Type:

Visa

Mastercard

(First)

(Middle Initial)

Card Number:__________________________________________________Expiration Date: ______________

Validation Code: _________ (The last 3 digits of the non embossed number printed on the back of your Visa or MC. The 4 digits on the front of your AMEX.) Payments will not be processed without this code.

Signature:____________________________________________________________Date:_________________________________________________

AES Contact

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AMERICAN EQUILIBRATION SOCIETY Poster and Table Clinic Program Application Please return this form (no later than December 31, 2011) to:

Jacob G. Park, D.D.S. 7434 Louis Pasteur Dr. Ste. 303 San Antonio, TX 78229 Phone: 210.857.3632

Fax: 210.615.7229

Email: parkj@uthscsa.edu

Acceptances will be notified by January 13, 2012

Name of Primary Clinician: _____________________________________________________________________________________________________ Last Name

First Name

Middle Initial/Name

____________________________________________________________________________________________________________________________ Address Line 1

____________________________________________________________________________________________________________________________ Address Line 2

____________________________________________________________________________________________________________________________ City

State/Province

Zip/Postal Code

____________________________________________________________________________________________________________________________ Country

____________________________________________________________________________________________________________________________ Cell Phone

Home Phone

Fax

Email

Names of 2nd Clinicians (if appropriate): _________________________________________________________________________________________ ____________________________________________________________________________________________________________________________

Presenter Category:

Pre doctoral

Post doctoral

Clinician

Faculty

Title of Proposed Table Clinic: ___________________________________________________________________________________________________ Synopsis of Proposed Poster & Table Clinic: _______________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________

The AES will accept only 16 clinics, and all of those will be furnished an appropriately draped table and poster board.

The AES cannot provide any computer of video support. Lap top computer presentations relying on computer screens are not acceptable since viewing is difficult for attendees. Pre recorded soundtracks are not approved for use on the AES Poster program.

In appreciation for your willingness to contribute to the program, the AES will provide one complimentary registration for the primary clinician of each Poster and Table Clinic accepted. Other presenters will be required to pay the appropriate registration fee. The AES will meet in Chicago in February every year. You will be advised of the exact date and time of your presentation if it is accepted.

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AES Central Office 207 E. Ohio Street, Suite 399 Chicago, IL 60611 USA

Call For Poster Presentations Deadline for the submission of abstracts is December 31, 2011 We invite you to share your knowledge and experience with your colleagues, members and guests of the American Equilibration Society by submitting an abstract for poster presentation during 57th Annual Meeting.

Please follow these recommendations in preparing your abstract.

Each participant must initially contact Dr. Jacob G. Park, Poster Committee Chair, via email at parkj@uthscsa.edu. The application process will begin with contacting Dr. Park. Participant may contact him either (210) 615-7224 or directly at (210) 857-3632.

After contact has been made with Dr. Park, each participant must submit an application and an abstract of their poster presentation not to exceed 300 words in length via email at parkj@uthscsa.edu. Participant can download the application and Poster Program Manual from AES official website www.aes-tmj.org.

Jacob G. Park, D.D.S. Chairman Poster & Table Clinic Committee AES

Calling All Authors

News for AES Contact?

The editorial staff of AES CONTACT is looking for articles contributed by its members. Your contribution will go towards making AES CONTACT an outstanding educational publication committed to Continuing Education and research for all of us. Please send your submissions via email to Tara Griffin, Editor at drtaragriffin@gmail.com or by mail to:

Members are invited to direct comments, suggestions and news items of interest to Society members to:

AES Contact, Attn: Managing Editor 207 E. Ohio Street, Suite 399 Chicago, IL 60611

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AES Contact

AES Central Office 207 E. Ohio Street, Suite 399 Chicago, IL 60611 Email: exec@aes-tmj.org