[Oradlist] Oradlist Digest, Vol 75, Issue 17
Jan Sampermans
Jan.Sampermans at arseus-dental.be
Mon Jan 11 00:50:11 PST 2010
Dear Dr. Farman,
I couldn't agree more with you. That was actually the point I was trying to make :-)
Due to the conservative nature of many dentists I come in contact with every day, the analogy has been somewhat tuned down over the last years.
Kind Regards,
Jan Sampermans MSc
Key Account Manager Radiology
3D Solutions Expert
Arseus Dental Benelux
Tel: +32(0)499.96.51.02
Mail: jan.sampermans at arseus-dental.be
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Sent: Mon 1/11/2010 9:09
To: oradlist at lists.ucla.edu
Subject: Oradlist Digest, Vol 75, Issue 17
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Today's Topics:
1. Re: Oradlist Digest, Vol 75, Issue 10 (Lennart Flygare)
2. Re: Oradlist Digest, Vol 75, Issue 14 (bart vandenberghe)
----------------------------------------------------------------------
Message: 1
Date: Mon, 11 Jan 2010 08:52:43 +0100
From: Lennart Flygare <Lennart.Flygare at nll.se>
To: "'Ann Wenzel'" <awenzel at odont.au.dk>, "'Oral Radiology Discussion
Group'" <oradlist at lists.ucla.edu>
Subject: Re: [Oradlist] Oradlist Digest, Vol 75, Issue 10
Message-ID:
<06C09CF4689D074A97B6BE9291C05FC2028D5B8B83B3 at CSU131.nll.se>
Content-Type: text/plain; charset="iso-8859-1"
Dear Ann and Andrew,
You have a point - balance and evidence is needed.
We in Lule? would be glad to join forces in such multicenter RCT-studies anytime.
Best wishes
Lennart
-------------------------------------
Lennart Flygare, Odont Dr
Senior Consultant
Dentomaxillofacial Radiology
Dept of Radiology
Sunderby Hospital
SE-971 80 Lule?
SWEDEN
tel+46-920-282931
mob: +46-70-6743858
fax:+46-920-282942
P Think of the environment before printing this e-mail.
________________________________
Fr?n: oradlist-bounces at lists.ucla.edu [mailto:oradlist-bounces at lists.ucla.edu] F?r Ann Wenzel
Skickat: den 10 januari 2010 12:03
Till: Oral Radiology Discussion Group
?mne: Re: [Oradlist] Oradlist Digest, Vol 75, Issue 10
Why don't we just commit ourselves to do the studies, then we don't have to be for or against anything but evidence....
If these studies ar already not pssible in the States (the defendant problem), I know we can do them in Europe
;-) Ann
----- Original Message -----
From: James Howard<mailto:jhowarddds at hotmail.com>
To: oradlist at lists.ucla.edu<mailto:oradlist at lists.ucla.edu>
Sent: Sunday, January 10, 2010 4:40 AM
Subject: Re: [Oradlist] Oradlist Digest, Vol 75, Issue 10
I do not have the expertise/credentials that the other contributors clearly have, but thought the following was apropos regarding new technology:
Praise without end and the go ahead zeal
For whom ever it was invented the wheel;
But never a word for the poor soul's sake
That thought ahead and invented the brake.
Howard Nemeov
U.S. Poet Laureat 1990
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Message: 2
Date: Mon, 11 Jan 2010 09:09:31 +0100
From: bart vandenberghe <bartvdberghe at hotmail.com>
To: <oradlist at lists.ucla.edu>
Subject: Re: [Oradlist] Oradlist Digest, Vol 75, Issue 14
Message-ID: <SNT129-W634E004D66A5EA00D2F0D4C76D0 at phx.gbl>
Content-Type: text/plain; charset="iso-8859-1"
Dear Allan,
Also this is my first post on "the list"....But, as a dentist from Leuven specialized in oral imaging (topic PhD thesis: 2D and 3D radiographic techniques for periodontal diagnosis), I must stress out that me personally I would always recommend CBCT before implant placement. When making the cost-benefit analysis, I do not see why a small field (adjusted to the case) would not be recommended (importance of the FOV and scan protocol)... The time I have spend in the US (Temple U., Tufts U. & Univ of Maryland) I must say I have seen for many years surgeons use other techniques given CBCT's limited availability. Now things have changed, but coming back to Europe I do see many similarities in the transition. Still, my point being, guess there are still opinion differences everywhere... let's hope adequate guidelines will help to overcome these...
Kind regards,
Bart
Bart Vandenberghe
Oral Imaging Center
KULeuven
Kapucijnenvoer 7
3000 Leuven
Belgium
> Date: Sun, 10 Jan 2010 23:54:12 -0500
> From: agfarm01 at louisville.edu
> To: oradlist at lists.ucla.edu
> Subject: Re: [Oradlist] Oradlist Digest, Vol 75, Issue 14
>
> Not a good analagy as the units to build a building are of known dimensions and the bricks are generally standard. The human body is not composed of standard dimensions. One can never assess the third dimension with a single 2D image. Proparimg to place most dental implants without 3D imaging is akin to building on sand. I definitely will be telling folk to be very careful before trusting European dentists to make dental implants. What I am hearing is tantamount to malpractice. AGF
>
> Allan G. Farman, BDS, PhD, MBA, DSc, Diplomate ABOMR
>
> Prof. Radiology & Imaging Science
> Univ. Louisville School of Dentistry: SUHD
> 501 South Preston Street,
> Louisville, Kentucky 40292, USA
>
> Tel: +1(502) 852.1241
> Fax: +1(502)852.1626
>
>
> >>> Jan Sampermans <Jan.Sampermans at arseus-dental.be> 01/10/2010 06:25 AM >>>
> Hi everybody,
>
> This is actually my first post. I have been following this list since I graduated from the University of Leuven with a Masters Degree in Biomedical Sciences in 2005. I wrote my thesis on CBCT imaging with the kind help of Prof. Reinhilde Jacobs, head of oral imaging.
>
> There is an analogy that I frequently use to summarise these sort of discussions.
>
> 3D imaging can be compared with an architect drawing up the plans of your house.
> The surgeon is the contractor or builder that will execute these plans.
>
> The more precise your architect is in drawing up those plans (spot on millimeter measurements, perfect foundations, accurate stability calculations), the better ANY contractor can build this house.
> A very experienced builder will benefit due to cost-efficiency (no rebuilding walls when they come down halfway through the build due to bad planning), speed (no surprises) and longterm customer satisfaction (the house is still standing after a big storm).
> A less experienced builder will have the same benefits and added confidence in what he is doing because he can rely on the architect more.
>
> However:
>
> Any builder can make mistakes, that's just human, regardless of how good the architect has done his work. (frequency of these mistakes goes down with more and more experience under the belt, or I would hope so :-)
> Any builder "could" get the job done with exactly the same end-result, even with plans that weren't that precise (panoramic or intra-oral imaging).
>
> My two cents:
>
> Can any surgeon benefit from CBCT? yes
> Can any patient benefit from CBCT? yes
> Can any surgeon achieve the same endresult without CBCT? yes
> Does every surgeon NEED to take a CBCT before every implantcase? no
>
> Would you personally get a detailed CBCT before getting implants (if the cost of the scan was not a factor)?
>
> Kind Regards,
>
> Jan Sampermans MSc
>
> Teamleader Rx-Team
> 3D Solutions Expert
> Arseus Dental Benelux
>
> Tel: +32(0)499.96.51.02
> Mail: jan.sampermans at arseus-dental.be
>
> Arseus - Confidential Communication
> The information contained in this e-mail is confidential and may be subject to legal professional privilege. It is intended solely for the addressee. If you receive this e-mail by mistake please promptly inform us by reply e-mail and then delete the e-mail and destroy any printed copy. You must not disclose or use in any way the information in the e-mail. Thank you very much for your cooperation.
>
>
>
> -----Oorspronkelijk bericht-----
> Van: oradlist-bounces at lists.ucla.edu namens oradlist-request at lists.ucla.edu
> Verzonden: zo 1/10/2010 4:40
> Aan: oradlist at lists.ucla.edu
> Onderwerp: Oradlist Digest, Vol 75, Issue 14
>
> Send Oradlist mailing list submissions to
> oradlist at lists.ucla.edu
>
> To subscribe or unsubscribe via the World Wide Web, visit
> http://lists.ucla.edu/cgi-bin/mailman/listinfo/oradlist
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> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of Oradlist digest..."
>
>
> Today's Topics:
>
> 1. Re: Fw: Guidelines for CT/CBCT (Allan G Farman)
> 2. Re: Oradlist Digest, Vol 75, Issue 10 (James Howard)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Sat, 9 Jan 2010 20:53:50 -0500
> From: Allan G Farman <agfarm01 at louisville.edu>
> To: <oradlist at lists.ucla.edu>
> Subject: Re: [Oradlist] Fw: Guidelines for CT/CBCT
> Message-ID: <4B48ECDE0200009A0007D519 at gwise.louisville.edu>
> Content-Type: text/plain; charset="US-ASCII"
>
> Agreed that a surgeon can screw up irrespective of the information provided, but it is more likely to happen if ignorant of the 3D anatomy when placing the implant. If there is not enough bone in 3D where biomechanics suggest an implant is needed, then appropriate augmentation by bone grafting can be planned. We should not be blindfolding the profession and failing to provide information that can help the practitioner and patient choose the best course. What can look good on a 2D image and is accepted as success by many implantologists is actually symptomatic and far from ideal in many cases when viewed in 3D. AGF
>
> Allan G. Farman
> Professor of Radiology & Imaging Science
> Tel/Fax +1(502) 852.1241
>
> >>> AndrewDawood Dawood <andrewdawood at hotmail.com> 01/09/10 10:14 AM >>>
>
>
>
> Exactly, we do need more balance
>
>
>
> Computer Guided Surgery is exciting and can be incredibly accurate, but this is not what you are
> talking about.
>
> Without control of the transfer to the operative field,
> it is a tremendous extrapolation to say that access to 3D data
> would necessarily change the outcome of surgery. This is
> anecdotal, based primarily upon the views of radiologists, not
> surgeons - is not evidence based.
>
> We
> can not just assume that all implants placed after 3D imaging are going
> to be 'better' placed, either in respect to bone or prosthetic
> considerations.
>
>
>
> There are many excellent surgeons out there who do not always use 3D imaging routinely.
> No doubt it will become a standard of care one day. It will then also
> become the standard of care in endo and perio as well, because there is
> always something more we can learn where morphology is complex.
>
>
>
> MY concern, and the reason that I can not ignore this dialogue is that
> it is not yet fair to label all individuals who do not routinely carry
> out 3D imaging as 'defendants'. We should be carrying out the exposures
> because the patient needs them, not because we are covering our backs. The exposure also needs to be optimized for the patient - not all current apparatus allow this.
>
>
> One day all imaging will be in 3D; for now we need to handle that transition in a responsible fashion
>
>
>
> Andrew Dawood
>
>
>
> Cavendish Imaging, London
>
>
> From: shdesch at aol.com
> Date: Sat, 9 Jan 2010 09:26:06 -0500
> To: oradlist at lists.ucla.edu
> Subject: Re: [Oradlist] Fw: Guidelines for CT/CBCT
>
>
>
>
>
>
>
>
> Hello All,
>
> I read all the posts that appear on this board. Being in complex
> imaging for 30 years, first panoramic and periapical, tomography and now
> CBCT I've heard all the objections from clinicians. The best one is they
> hold up their two fingers, as if they were measuring the thickness of bone with
> them,and say" I know what I'm feeling and seeing and if there is
> enough bone for an implant." Maybe so....., I've never placed one.
> What I do see is that guidelines are needed for this technology. Users
> tend to think that more is better. Taking a full volume for every records
> patient in ortho is way too much information, especially if you want only one
> slice for the ceph and one slice for the pan. What about the rest of the
> volume?
>
> Having these data sets read by you guys is the right thing to do for
> the patient's sake.
>
> Interestingly enough, when asked if the scans are sent out to be read by a
> professional, the response is,,,why?
>
> I too have kept out of the discussion mainly because I subscribe to this
> list to learn and contribute in anyway possible to the profession.
>
> One question to Axel:
>
> May I borrow this?
>
> Question: What do you call people who use only periapicals and
> pantomographs for their implant planing?
> Answer: Defendants
>
> Steve Desch
>
>
>
> In a message dated 1/8/2010 2:32:48 P.M. Eastern Standard Time,
> axel-ruprecht at uiowa.edu writes:
> Hello
>
> Like Johan, I have kept out
> of this discussion, and like him, I am concerned about overuse of CBCT. Also,
> like him, I am on Allan's side of this argument. Unless you have done many
> CBCTs, and CTs before that, and tomographs before that, you really do not have
> much of a concept of what the cross-sections of bones in the jaws are really
> shaped like. And, like Allan, I have seen implants in places where one can but
> shake one's head. Usually these come from surgeons who have been asked by the
> original implant placer to help rescue the case.
>
> We have riddle around
> here, mainly from me.
>
>
>
> Question: What do you call
> people who use only periapicals and pantomographs for their implant
> planing?
> Answer: Defendants.
>
> I shall also sign off here from snowy
> Iowa, where the snow is between 1 foot and 6 feet, (30 cm and 180 cm) and the
> temperature is warmer today, around 0'F (~-15'C). Schools are closed. Many
> highways impassable, and the sun is shining brightly, waiting for the next
> storm to arrive.
>
> Rgds
> Axel
>
> Axel Ruprecht D.D.S., M.Sc.D.,
> F.R.C.D.(C)
> Diplomate of the American Board of Oral and Maxillofacial
> Radiology
> Gilbert E. Lilly Professor of Diagnostic Sciences
> Professor
> and Director of Oral and Maxillofacial Radiology
>
> Director of Advanced Education in Oral and Maxillofacial
> Radiology
> Professor of Radiology
> Professor of Anatomy and Cell
> Biology
> http://ruprecht.radiology.uiowa.edu <http://ruprecht.radiology.uiowa.edu/>
> 319-335-7341
>
>
>
> -----Original
> Message-----
> From: oradlist-bounces at lists.ucla.edu
> [mailto:oradlist-bounces at lists.ucla.edu] On Behalf Of Johan Aps
> Sent:
> Friday, January 08, 2010 12:44 PM
> To: Oral Radiology Discussion
> Group
> Subject: Re: [Oradlist] Fw: Guidelines for CT/CBCT
>
> Dear
> Friends,
>
> I kept quiet for some time around this discussion, but I can't
> anymore...
> ;-)
>
> I agree 100% with Allan's arguments (for those who
> know me...that's rare as
> I usually have some comments on how some of us
> overuse CBCT - sorry if my
> self-sarcasm doesn't suit you-)
>
> At our
> university, the implantologist in charge hardly ever asks for a 3D
> image.
> He also claims implants can be easily placed in many cases. He
> "relies" on
> his experience.
> His assistants, younger and maybe more keen on new
> technology and perhaps
> also more afraid of making mistakes as they have
> far more less experience
> than the 'guru', do ask more often for 3D
> imaging.
> I have seen several cases so far, in which on a 2D image there
> seemed to be
> enough bone, but where the patient came back complaining
> about pain,
> discomfort and so on. Implants perforating the lingual or
> buccal cortex,
> implants in or too close to the inferior alveolar canal
> -also in the incisor
> area-,...
>
> I recognize the situation Ann Wenzel
> described, where experienced
> implantologists think they can "see" enough
> on a 2D image. And also here in
> Ghent, our 'guru' is encouraging
> undergraduate and postgraduate students to
> do the same.
> Luckily for the
> patients, the students (who are also taught by me) do not
> always agree and
> ask for 3D imaging right away.
>
> So, Allan does not have to fear that the
> Europeans will not accept
> "change"....on the contrary.
> But I also
> understand, that if one has no access to CBCT or Dentascan or
> other ways
> of getting cross sectional images, one has to rely on the 2D
> information
> alone, with all disadvantages and risks involved. But this
> should not be
> an argument not to believe one does not really need 3D
>
> information...
>
> I wish you all a nice weekend (7.40 PM - I am going
> home now....)
>
> Greetings from a snow covered and cold
> Belgium!
>
> Johan
> ______________________________________________________________________
> Prof.
> Dr. Johan K.M. Aps
> (DDS, MSc Paed. Dent. & Special Care, MSc DMFR
> (King's College London, UK),
> PhD)
> Head of Dental & Maxillofacial
> Radiology
> Coordinator Postgraduate Teaching in Dentistry Ghent University
>
> (accreditation system Belgium)
> Senior Clinical Consultant Ghent
> University Hospital, Dental School
> UZG, P8, Dental School, De Pintelaan
> 185, 9000 Gent, Belgium
> tel; + 32 9 332 5102
> fax; +32 9 332
> 3851
> secretary; +32 9 332 3857
>
> ----- Original Message -----
>
> From: "Allan G Farman" <agfarm01 at louisville.edu>
> To: "Oral
> Radiology Discussion Group" <oradlist at lists.ucla.edu>
> Sent: Friday,
> January 08, 2010 6:52 PM
> Subject: Re: [Oradlist] Fw: Guidelines for
> CT/CBCT
>
>
> >I continue to disagree with these assertions. A
> panoramic radiograph or
> > periapical is totally unacceptable as it
> merely provides a 2-D view. I
> > will concur that there might be some
> instances where no radiographs are
> > needed whatsoever. The
> cross-sectional anatomy is needed and we have
> > the ability to create
> this with comparatively low dose in folk who are
> > usually those least
> affected by radiation - namely the elderly. Yes,
> > implants were placed
> prior to 3D imaging availability... but even then
> > linear tomography
> was possible. Viewing where implants that were
> > apparently acceptable
> on panoramic or periapical radiographs are
> > actually placed shows that
> many are marginal at best in 3D. I have seen
> > too many cases of
> fractured jaw, penetrated nerve canals, sectioning
> > roots of of an
> adjacent tooth, and even implants resting on or
> > penetrating the
> inferior conchae, or severasl mm past the lingual or
> > buccal plate of
> the mandible to accept that we should stick to imaging
> > procedures that
> are now outmoded for the purpose of implant placement
> > planning. The
> anterior mandible can be much narrower facio-lingually
> > than would ever
> be GUESSED on 2D images. I have also seen maxillary
> > sinus
> complications from membranes being raised above the sinus
> ostea.
> >
> > It has been my experience that clinicians who place a
> good number of
> > dental implants and previously used 2D imaging start
> slowly with CBCT
> > for implants, but soon find that there are no
> "simple" cases and that
> > what they had previously felt satisfactory was
> far from optimal. Such
> > clinicians usually quickly transfer the rest of
> their implant cases from
> > 2D to 3D. There are few Luddites against
> change, except Perhaps (?) the
> > European OM Radiology
> Community.
> >
> > AGF
> >
> > Allan G. Farman, BDS, PhD, MBA,
> DSc, Diplomate ABOMR
> >
> > Prof. Radiology & Imaging
> Science
> > Univ. Louisville School of Dentistry: SUHD
> > 501 South
> Preston Street,
> > Louisville, Kentucky 40292, USA
> >
> > Tel:
> +1(502) 852.1241
> > Fax:
> +1(502)852.1626
> >
> >
> >>>> Leif Kullman
> <leikul at yahoo.com> 01/08/2010 12:04 PM >>>
> > Dear
> Oradlisters
> > I also believe there are implant cases without need for
> tomography, not
> > at least in the anterior area of the upper and lower
> jaw. Intraoral and
> > panoramic radiographs can be enough.
> > We can
> use different other tools in such cases, at least in the
> > clinically
> simple cases: Like *poor man*s tomography* using our
> > fingers to get
> knowledge about the buccal-lingual dimension and
> > reducting estimated
> soft tissue thickness or we can use an
> > *osteometer* see my
> attachment!
> > A useful tool for measuring is also a metallic grid (1mm
> between each
> > line), put in close relationship to the film/sensor
> during exposure, see
> > my other attachments.
> > Best
> regardsLeif
> >
> > Leif Kullman DDS, PhD
> > Assoc.
> Professor
> > Oral and Maxillofacial Radiology
> > Faculty of
> Dentistry
> > Kuwait University
> >
> > --- On Fri, 1/8/10, Ann
> Wenzel <awenzel at odont.au.dk> wrote:
> >
> >
> > From: Ann
> Wenzel <awenzel at odont.au.dk>
> > Subject: [Oradlist] Fw: Guidelines
> for CT/CBCT
> > To: "Oral Radiology Discussion Group"
> <oradlist at lists.ucla.edu>
> > Date: Friday, January 8, 2010, 5:37
> AM
> >
> >
> >
> >
> >
> >
> > ----- Original
> Message -----
> > From: Ann Wenzel
> > To: SDGIMPLANT at aol.com
> >
> Sent: Friday, January 08, 2010 11:10 AM
> > Subject: Re: [Oradlist]
> Guidelines for CT/CBCT
> >
> >
> > hello all
> > It would be
> really interesting if surgeons would take part in this
> >
> discussion.
> > What about all of you in the Oradlist who are also
> surgeons? Ralf
> > Schulze and others?
> >
> > One of the surgeons
> here is now 60, and during approximately 30 years,
> > he has
> inserted 20700 implants.
> > He is one of the few who has kept a very
> detailed record on all events
> > before, during and after the
> operation.
> > He has had to give up on five patients in whom no implant
> could be
> > installed after he had opened and displayed the bone. These
> five could
> > have been avoided if CBCT was used. Some of the patients
> had a more
> > comprehensive operation than expected with additional
> surgical
> > procedures.These could have been warned of an increased
> operation time
> > a
> > nd the surgeon would have been more prepared
> if CBCT had been
> > performed. All patients are however told before the
> operation that
> > additional procedures may be needed.
> >
> >
> When balancing the weight, it is not only dose, but surely also all
> >
> types of resources used for CBCT that should be considered.We are
> trying
> > to analyze the data from that study, but even though the data
> are
> > sampled in a standardized way, the study is stll
> retrospective.
> > We are to do prospective, randomized trials to provide
> the evidence
> > needed. And not only in one country. I am sure we agree
> on this. So why
> > do we see so few RCTs in our
> literature?
> >
> > We will start a RCT on 3. molars; panoramic vs.
> CBCT. Maybe you will
> > find this "alarming" or even unethical. In my
> opinion it is unethical
> > not to do such studies - and the 3 surgeons
> involved have no problems in
> > this since they have until now removed
> thousands of 3. molars based on
> > panoramic images alone.
> > We
> hope soon to be able to start a RCT on implants in the same
> way.
> >
> > And try to read the literature in e.g. Clin Oral Implant
> Res - in the
> > RCTs on immediate implant placement, CBCT is never used,
> merely
> > periapical radiography. To me this is both logical and
> ethical.
> >
> > The implants inserted by students in supervision of
> surgeons at my
> > place are of course in very selected patients. No
> evidence can be
> > deducted from this.
> >
> >
> > all the
> best
> > Ann
> >
> >
> >
> >
> > ----- Original
> Message -----
> >
> > From: SDGIMPLANT at aol.com
> > To:
> awenzel at odont.au.dk
> > Cc: oradlist at lists.ucla.edu
> > Sent:
> Thursday, January 07, 2010 11:55 PM
> > Subject: Re: [Oradlist] Guidelines
> for CT/CBCT
> >
> >
> > Hello Ann -
> >
> > Thank you for
> your thoughts. While I certainly understand your
> > suggestion, I
> agree with Allan when he suggests that CBCT is important
> > as a
> diagnostic tool for dental implant placement - due to the
> > incredible
> variation in bone and root anatomy and clinical
> presentation.
> >
> >
> > That stated, you are correct that the
> person placing the implant should
> > have good training, and
> experience. As it is important to handle all
> > situations which
> may arise, with a proper clinical / surgical skill set,
> > wouldn't you
> agree that it is better to have an understanding of the
> > anatomy prior
> to the scalpel ever touching the patient? In this way, we
> > can
> plan ahead, and have everything ready, without the guesswork, and
> > full
> knowledge and disclosure to the patient of what will be done. In
> >
> my opinion, CT and CBCT imaging helps clinicians to appreciate these
> >
> anatomical variations, as each patient is unique, allowing us to have
> a
> > sound basis for our decision-making process.
> >
> > I, and
> perhaps many on this list, can cite a myriad of what appeared to
> > be
> simple, single tooth cases - immediate extractions even, where the
> >
> bone topography was completely different that what appeared on
> clinical
> > exam, panoramic or periapical radiograph. In fact
> sometimes the single
> > tooth application presents the most challenge -
> especially in the
> > esthetic zone with convergent roots, or facial
> concavities.
> >
> > Perhaps discussions like this help us to
> understand what type of
> > guidelines should be recommended - based upon
> sound clinical judgement
> > which relates to the treatment at hand.
> The end result should be a more
> > favorable outcome for the patient, the
> surgeon, and the restorative
> > dentist.
> >
> > Best regards to
> Denmark!
> >
> > Scott
> >
> ________________________________________________________
> > Scott D.
> Ganz, DMD
> > Prosthodontics, Maxillofacial Prosthetics & Implant
> Dentistry
> > President Computer Aided Implantology Academy: CAI
> Academy
> >
> > 158 Linwood Plaza - Suite 204 Fort Lee, NJ
> 07024
> > TEL:
> >
> >
> >
> >
> >
> _______________________________________________
> > Oradlist mailing
> list
> > Oradlist at lists.ucla.edu
> >
> http://lists.ucla.edu/cgi-bin/mailman/listinfo/oradlist
> >
>
>
> _______________________________________________
> Oradlist mailing
> list
> Oradlist at lists.ucla.edu
> http://lists.ucla.edu/cgi-bin/mailman/listinfo/oradlist
> _______________________________________________
> Oradlist
> mailing
> list
> Oradlist at lists.ucla.edu
> http://lists.ucla.edu/cgi-bin/mailman/listinfo/oradlist
>
>
>
>
> ------------------------------
>
> Message: 2
> Date: Sun, 10 Jan 2010 03:40:37 +0000
> From: James Howard <jhowarddds at hotmail.com>
> To: <oradlist at lists.ucla.edu>
> Subject: Re: [Oradlist] Oradlist Digest, Vol 75, Issue 10
> Message-ID: <COL109-W49A47A977F9947B555D7FBD16E0 at phx.gbl>
> Content-Type: text/plain; charset="windows-1252"
>
>
> I do not have the expertise/credentials that the other contributors clearly have, but thought the following was apropos regarding new technology:
>
>
>
>
> Praise without end and the go ahead zeal
>
>
> For whom ever it was invented the wheel;
>
>
>
> But never a word for the poor soul?s sake
>
> That thought ahead and invented the brake.
>
>
>
>
> Howard Nemeov
>
> U.S. Poet Laureat 1990
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>
> End of Oradlist Digest, Vol 75, Issue 14
> ****************************************
>
>
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