* Instant Crowns. The CEREC machine, which uses CAD/CAM (computer-aided design/computer-aided manufacturing) technology, allows dentists to make instant crowns, inlays or onlays in their offices in one visit.  A camera is used to take a digital picture of your tooth, software converts it into a three-dimensional virtual model on the computer screen, and the dentist then sends the data to a separate milling machine in the office.  About ten to twenty minutes later, your all-ceramic, tooth-colored restoration is finished and ready to bond in place.  No temporaries, no return visits for fittings. The cost of an in-office crown is about the same as one made in the lab.  It’s mostly used for back teeth, since the restorations it creates aren’t aesthetic enough for front teeth

* 3-D imaging. Those flat x-rays your dentist used to put up on a light box in his office are obsolete.  In addition to digital x-rays, today dentists have technology similar to cat scans, called cone beam 3-D radiology, which allows the dentist to see the whole tooth structure rather than just one surface.  “This allows more precise placement of implants, making it easier to avoid nerves, and improve orthodontic care,” explains Howard S. Glazer, DDS, a dentist in Fort Lee, New Jersey and spokesperson for the Academy of General Dentistry

* Better dental materials. The latest is lithium disilicate, known under the brand name, Ivoclare Vivadent, a harder material than any ceramic previously available.   The usual method of making a crown involves bonding two dissimilar materials (metal plus porcelain or other ceramic) which can be problematic.  Studies show that lithium disilicate allows for fabrication of all-ceramic CAD/CAM crowns that are cosmetically attractive but also can withstand chewing forces with less fracture.

* Pain-free anesthesia. The worst part of getting a tooth filled for many people is the dreaded Novocain shot which is not only painful, but causes your face and lips to go numb for hours.  A new type of injection called Vibraject uses a vibrator clipped onto the syringe to eliminate pain, which also facilitates a more precise delivery of anesthetic.   Dr. Glazer explains how it works: “Pain is caused by heat and pressure, so if we can distract you by giving you something vibrating, you won’t feel the pinch of the needle.  I use an injection technique that infiltrates on a tooth-by-tooth basis.  This allows for a short duration but equally effective anesthetic.”

* Drills with electric motors. Until recently dentists have used air-driven high-speed drills which whine and vibrate.   The new electric drills generate one-third of the noise, are far faster and more efficient than air-driven drills, and cut more smoothly and painlessly.   The result is a more precise interface between your tooth and your new restoration (crown, veneer, or filling).

* Lasers. The hard tissue laser can replace the drill in some instances for painless dentistry but “it won’t remove old fillings, it’s very costly and not necessarily as effective,” according to Dr. Glazer.   The real advance is in soft tissue lasers, called LANAP, for periodontal work such as cleaning out pockets or gum surgery.   “Soft tissue lasers have revolutionized gum surgery, which now can be done virtually painlessly, without stitches, swelling or risk of infection,” says Glazer.  “I use it for gum recontouring, partially erupted third molars, a whole variety of different uses.”

* The smart drill. The Smart Bur II removes only tooth decay, not healthy tooth structure. With this device used to access decay that is close to the nerve, dentists can remove just the decay without damaging the nerve, which can help avoid root canals.

CONNECT THE DOTS

What is the future of high-tech dentistry?   Here are some exciting developments we may see in the next few years:  a pain free way to reverse decay and re-build teeth; prevention of periodontal disease by testing saliva; and regeneration of gum tissue with gene therapy.

Millions of Americans who suffer from major depression are prescribed antidepressant medication that doesn’t offer them relief, or results in intolerable or disagreeable side effects.

A new therapy, Transcranial Magnetic Stimulation or TMS, which uses highly focused magnetic pulses to stimulate key neurons in the brain that control mood, has been an effective alternative for patients in whom anti-depressant drugs have been ineffective.

“Some people feel like it’s a miracle in their lives,” says Dr. Alan Manevitz, a clinical psychiatrist who practices in New York City and a clinical associate professor of psychology at Cornell University. He was the first doctor in New York State to administer the treatment that is gaining increasing attention in the United States.

“It’s really quite exciting to be able to offer what almost feels like a Star Trek device. Patients sit in a chair, read the newspaper, watch television or talk to our technicians and they go from these really sad stories of not functioning and feeling overwhelmed by their depression to hope.”

Patients come weekdays for about 20 to 30 daily non-invasive treatments, which last about 40 minutes, Manevitz says. After about six weeks, more than half of his patients report significant improvement in their depressive symptoms, and one-third of patients experience a complete remission.

A study published the October 2010 edition of Brain Stimulation showed that TMS keeps patients with major depressive disorder on antidepressants from relapsing within six months.  Long term persistence of this benefit, however, has not been thoroughly studied.

Without insurance, the magnetic stimulation costs about $10,500, but many insurance plans now cover it.  However, approval may require an appeal, Manevitz says. In general, patients also must have experienced at least one unsuccessful treatment to get insurance approval for TMS.

The TMS has been used to treat other brain conditions for nearly 10 years, but the procedure was cleared by the Food and Drug Administration in December 2008 for Neuronetics to market it for use in treatment of major depression.  It also has recently been included in the American Psychiatric Association’s depression treatment guidelines.

“Because it’s administered by the treating physician, the patient is not responsible for administering the treatment,” Manevitz says. “We observe the treatment, so there is no under dosing, inadequate treatment and there are no systemic side effects such as weight gain, sexual side effects or energy depletion.”

CONNECT THE DOTS

For more information about major depression, visit the World Health Organization, PubMed Health or Wed MD.  You might also want to check out these earlier healthymagination posts: “Transcranial Magnetic Stimulation May Offer New Hope for Severe Depression” and “Deep Brain Stimulation for Depression.”

The device uses a non-invasive nasal catheter to spray a liquid coolant into the nasal cavity at room temperature. As the liquid evaporates, heat is directly removed from the base of the skull and surrounding tissues via conduction and indirectly through the blood via convection. This helps stabilize a patient and improves the odds for successful recovery. The RhinoChill system is an easily transportable, battery-powered 10.6-pound handheld unit. It’s designed for ambulances and med-techs as well as the emergency room and general hospital environments.

Research shows that mild therapeutic hypothermia improves neurologic recovery and survival after cardiac arrest. A 2010 study of the RhinoChill system in the journal Resuscitation found that the device effectively lowered core temperatures in patients following cardiac arrest. Thirty-four of 84 patients (40 percent) survived and 76 percent experienced a favorable neurological outcome. The same study reported that the estimated number of out-of-hospital cardiac arrest cases is 300,000 per year in the US. The median rate of survival to hospital discharge in the US is 7.9 percent.

“Therapeutic hypothermia should be performed for selected patients following cardiac arrest and some other clinical conditions that share ischemia as the primary pathological process,” writes Lance B. Becker, MD, director of the Center for Resuscitation Science at the University of Pennsylvania Health System.

Systems that cool the brain following cardiac arrest or a stroke have been in use for a number of years. However, surface cooling devices, typically water-filled blankets and pads, are often cumbersome. Intravascular cooling devices, which chill the blood, are more efficient than blankets but require large refrigeration units and trained physicians who must use them under restricted conditions.

The American Heart Association supports the use of therapeutic cooling following cardiac arrest. At present, BeneChill is seeking FDA 510(k) clearance for the RhinoChill device. It is already being used in Europe. Concludes Becker: “Evidence suggests that full implementation of therapeutic hypothermia after cardiac arrest could save thousands of lives each year.”

CONNECT THE DOTS

For more information about therapeutic cooling and its use for cardiac arrest and stroke, read an article by Dr. Becker that appeared in the American Heart Association’s journal Circulation. Read these related healthymagination articles: “Cold Suit Combats Brain Damage After Cardiac Arrest,” “Rehab Robots Help Stroke Patients” and “Rewiring the Brain After Traumatic Injury or Stroke.”

About 60,000 doctors, scientists, and thought leaders from more than 100 countries convened in Chicago to witness the latest discoveries in medical imaging, at the most spectacular technical exhibition in the industry: RSNA 2011, the annual meeting of the Radiological Society of North America, held from November 27 to December 2. The event’s theme was “Celebrate the Image,” with 3,000 scientific presentations and posters covering new scientific research and nearly 500,000 square feet devoted to showcasing cutting-edge imaging technologies.

RSNA crowned an extraordinarily innovative year for GE Healthcare, with more new products and solutions than ever before. “We’re part of a changing paradigm in medical imaging,” says Dr. William (Pepper) Denman, Chief Medical Officer of GE Healthcare. “Traditionally, GE has been very technologically focused, but using rigorous science to create a better device is just one leg of the stool. We also need to be a leader in driving improved patient outcomes and enhancing the quality of the imaging experience.”

Among the major consumer trends the company’s latest medical imaging innovations address are:

“Humanizing” radiology exams. “As a pediatric anesthesiologist at Massachusetts General Hospital in the 1990s, I had to anesthetize 4 or 5 children a day for MR tests because they hated the noise and claustrophobia,” says Dr. Denman. At RSNA, GE unveiled an innovative solution to help address this issue: the Magnetic Radiology (MR) Experience Suite, aimed at reducing the stress and anxiety of the exam for patients of all ages. Incorporating the “caring hands” design philosophy of the Discovery MR750 system, the suite transforms the conventional cold, clinical exam environment to one that’s more comfortable and calming.

Instead of the usual white walls and clutter of cords on the floor, both the suite and the sides of the MR machine have wood paneling. All medical devices are tucked away in wood cupboards. Before the exam, says Jodette Roberts, one of GE’s MRI specialists, “instead of lying there and counting dots on the ceiling, the patient is given an iPad and asked, ‘Would you like to go to the beach or visit a tulip garden in Amsterdam?’” A variety of images are available for patients of different ages, including cartoons for kids, with the scenes displayed on an overhead screen, as music is played. Patients can customize the sounds, using a portable media player.

A breakthrough in low-dose CT imaging. Computed tomography (CT) is one of medicine’s most powerful diagnostic tools, with the high-resolution images used by physicians to quickly identify internal injuries in trauma patients in the ER, to diagnose and track treatment progress of cancer patients, and detect and diagnose blood vessel diseases. “When you ask doctors what features they look for in CT (computer tomography) scanners, radiation dose is important because physicians want to give patients the best care with the lowest dose exposure needed for accurate diagnostic information,” says Nilesh Shah, general manager of Global CT Marketing for GE Healthcare. “Traditionally, however, physicians had to weigh the balance between lowering dose and maintaining image quality.”

Now, GE’s revolutionary new CT technology, Veo, provides high image clarity, at previously unheard of low-dose levels. Veo users have reported successful sub-millisievert chest CTs, some of which are significantly below this level. “A superb image quality, sub-millisievert (mSv) CT exam has in many ways been seen as CT’s holy grail,” says Dr. William Shuman, Professor and Vice Chairman, Department of Radiology at the University of Washington.

An $800 million investment in low-dose technologies. At RSNA, GE announced an additional $300 million commitment to innovative radiation-dose management technologies, on top of the more than $500 million the company has invested since 2000. Among the solutions showcased at RSNA was DoseWatch, which tracks and reports the radiation dose patients receive during an exam. It captures standardized dose indices on CT, interventional, mammography and x-ray systems from a range of manufacturers, to help healthcare facilities analyze patient exposure levels over time.

“DoseWatch helps radiologists focus on the dose levels they’re delivering, which can vary by doctor, and this information can help them optimize patient care,” says Antoine Jomier, Dose General Manager of GE Healthcare, France. The company is also integrating dose-alert technology on its new and existing CT systems, as part of its ongoing commitment to improving patient care, and offers free radiation safety iPad apps and low-dose educational seminars for healthcare professionals.

CONECT THE DOTS

To learn more about GE’s low-dose solutions, visit its new Responsible Imaging website. For additional highlights of RSNA 2011, click here.

When a heart attack occurs, seconds count and prompt attention is often the difference between life and death. Yet, while medical science has made significant advances in treating cardiac arrest—defibrillators are now available in many public buildings and doctors have emergency room anti-arrhythmic drugs available—little has been done to detect the onset of an actual attack.

Researchers at the Cleveland Clinic hope to change the situation. Led by John Rickard, MD, they’ve developed a watch-size monitor aptly dubbed the Wriskwatch. The device, which correctly signaled artificially induced pulselessness in trials, offers a non-invasive way to detect sudden cardiac arrest. The device displayed a false-positive (false alarm) rate of about 10 percent, Dr. Rickard says.

The Wriskwatch incorporates a piezoelectric disk strapped snugly against the wrist. As a result, it’s able to detect arterial swelling at the radial pulse point and identify pulselessness or ventricular fibrillation. The device uses a wireless Bluetooth connection to contact emergency response personnel or caretakers in an old age home or assisted care facility, he says. A built in motion sensor blocks the alert unless the wrist is still.

In the early-stage trial—which was reported in the online journal HeartRhythm—34 patients participated in the study and the device worked effectively on all but five. The patients wore the watch for 20-minute intervals and the research team artificially induced pulselessness by inflating a blood pressure cuff under the device. The failures were related to inadequate signals on two subjects, an inability for two others to remain still and one other had the device fall off. The sensitivity of the watch to detect pulse status (based on 15 second intervals) was 99.9 percent.

Researchers are now working on a more advanced system that will activate an alert only when the wearer is unconscious. This is designed to reduce the number of false alarms. A company, Emergency Medical Technologies, is developing the Wristwatch commercially and hopes to introduce it within the next few years.

Notes Rickard: “The Wriskwatch is a novel device that shows promise as a tool to hasten activation of emergency medical systems and facilitate early defibrillation in patients with cardiac arrest.”

CONNECT THE DOTS

For an abstract of the Cleveland Clinic study on the Wristwatch, click to HeartRhythm. For a discussion about another heart attack detection system with implantable sensors, visit MITnews online.

Hate the dentist’s drill? A new Canadian dental device detects the size and depth of early cavities so that they can be treated, rather than needing to be drilled and filled later.

The Canary System is the brainchild of dentist Stephen Abrams and one of his patients, Andreas Mandelis, Ph.D., a physicist with the Centre for Advanced Diffusion-Wave Technologies at the University of Toronto. Eleven years ago, while Mandelis was in the chair, Abrams complained about the difficulty of diagnosing tooth decay on the biting surface of a molar. Mandelis said he had a novel technology to image crystal structure, and their company Quantum Dental Technologies was born.

Over the next ten years, they developed a hand-held instrument the same size and weight as a dentist’s drill. The Canary System uses a novel technology called PRT-LUM, a combination of Photothermal Radiometry and Modulated Luminescence.

Here’s how it works. The device shines a low-energy pulsing laser light onto a tooth. That energy is absorbed and then radiates back as heat and glow, which are measured by a camera to determine enamel porosity and the extent of decay. Readings are converted to a Canary Number to indicate the extent of decay, and the result it displayed on a touch-screen monitor for immediate review. Patients receive a printed report and can access the confidential system from home to see their image scans and treatment plans.

Currently, dentists detect tooth decay using three methods: by performing a visual inspection; taking an x-ray; and using an explorer pick to check trouble spots. But none of these methods work well to detect small, early lesions, particularly those in-between teeth. While using the pick, Abrams says, “You are actually breaking down the enamel around that fissure, making it more difficult to re-crystallize.”

Perhaps your dentist has recommended ‘watching’ an area until decay progresses. Abrams says, “You’re watching it until it develops a hole large enough to put in a filling, but if you think about it, you are really waiting for the end of the disease process that starts as soon as the enamel breaks down.”

The Canary System offers dentists and patients a radical shift from restorative to preventive dentistry. It can detect decay on smooth enamel, root surfaces, biting surfaces, between the teeth and around existing fillings. The scan is safe, non-invasive, painless, and one tooth scan takes about five seconds. The Canary System is different from many other laser light detectors on the market because the PRT-LUM technology can provide readings below the tooth’s surface, up to a depth of 5 mm.

To remineralize a small lesion, a hygienist applies a priming varnish and the dentist dispenses special higher-fluoride toothpaste such as 3M ESPE’s Clinpro 5000 for patients to use at home. Progress can be monitored with repeat scans in follow-up visits scheduled in three-month intervals.

In a clinical study, The Canary System showed no adverse effects, no tissue damage and proved that it could detect tooth decay as small as 50 microns (20 times smaller than a millimeter), regardless of whether the tooth was wet or dry, stained or had biofilm.

The award-winning device was approved for sale by Health Canada in April 2011. FDA 510(k) clearance for sale in the U.S. is pending and a submission for authorization to sell in the European Union is in progress.

Wouldn’t you prefer to heal cavities when they are small rather than have them drilled and filled later?

CONNECT THE DOTS

Find out more about The Canary System and how it detects early dental decay. Watch a video of Dr. Stephen Abrams explaining how The Canary System works. The Canary System has been featured in over 40 published research papers and abstracts in peer-reviewed dental and clinical journals. Read an article published in UK journal, The Engineer, “Quantum canary detects tooth decay fast.” You may also like our earlier post, “Turning Adult Wisdom Teeth Into Stem Cells.”

These days, there’s no shortage of apps for smartphones. You can use them for everything from scanning barcodes and comparing prices at a retailer to tracking your heart rate and performance on runs or bike rides.

But smartphones—handheld computers that are hundreds of times more powerful then the systems that went to the moon in the late 1960s—also offer the promise of redefining medicine and helping amputees move in a more natural way. Researchers at Vanderbilt University are currently developing bionic limbs that, using smartphone components, have the potential to help patients develop a more natural gait.

“Our device illustrates the progress we are making at integrating man and machine,” states Michael Goldfarb, PhD, a professor of mechanical engineering and director of the university’s Center for Intelligent Mechatronics. The bionic leg is the result of seven years of research. “With our latest model, we have validated our hypothesis that the right technology was available to make a lower-limb prosthetic with powered knee and ankle joints,” he adds.

The bionic leg is being designed for everyday life and it has already been tested on a number of patients. It’s possible to walk, sit, stand and walk up or down stairs with the device. In fact, the leg’s construction—it weighs only about 9 pounds—allows those wearing it move about 25 percent faster than counterparts wearing more conventional prostheses. This means that a recipient expends about 30 percent to 40 percent less energy, according to Dr. Goldfarb.

Researchers used smartphone components—including sensors, motors, microprocessors and batteries from iPhones and other devices—to power the artificial leg for up to 14 kilometers (about 8.7 miles), or about 72 hours. The technology anticipates a person’s movements, thereby reducing the lag time typically associated with prosthetic limbs. In fact, the university claims this is the first prosthetic with powered knee and ankle joints that operate in unison. It has built 15 different electronics boards before coming up with the current smartphone-powered model.

The research team hopes to make the “Vanderbilt leg” commercially available within the next few years. It is working with Freedom Innovations, a leading manufacturer of prosthetic devices. The Center is also developing an artificial arm and an advanced exoskeleton to aid in physical therapy.

Connect the Dots

For a closer look at the Vanderbilt prosthetic leg and its use of smartphone components, read this press release from the Vanderbilt Center for Intelligent Mechatronics. You can learn more about state of the art prosthetics and rehabilitation techniques at the Rehabilitation Institute of Chicago’s Center for Bionic Medicine.

Many people with high blood pressure can get it down to normal by losing weight, exercising and cutting their salt intake. If that doesn’t work, downing daily pills usually does the trick – the medication works by helping blood vessels relax. But in about 15 percent of all patients, blood pressure can remain too high despite taking three or four different medications per day.

That’s not a good situation for the hundreds of thousands of people worldwide whose stubbornly high blood pressure won’t come down. Hypertension increases the risk of heart disease and stroke, which is why doctors make such a fuss about lowering it to healthier levels.

They may soon have a new high-tech tool for use when medication doesn’t work. New research from Australia suggests that these difficult cases can be treated by zapping nerves surrounding the kidney with radio waves. These nerves affect blood pressure by boosting salt and water retention in the body and constricting blood vessels.

The nerves in question are within the wall of the renal (kidney) artery. The new method relies on a radio-wave probe that heats the artery by 10° centigrade. This has the effect of dialing down the activity of the nerve by 30 to 80 percent without injuring the artery, the investigators reported to the American Heart Association.

“We know that constriction of the arteries to the kidneys make them release hormones that can strongly increase blood pressure so this novel way of reducing the constriction of the arteries had a big effect,” said cardiologist Christopher P. Cannon, M.D., associate professor of medicine at Harvard Medical School and author of The New Heart Disease Handbook (Fair Winds Press, 2009). However, while Dr. Cannon calls the new approach “promising” and notes that “the science is strong”, he cautions that it is an experimental procedure tested so far in just a hundred patients and that larger studies will be needed before it would be approved for use in the United States.

In patients treated during the study blood pressure dropped by 32 mm HG (top number) and 12 mg HG (bottom number). At the outset, their blood pressure was 160 mg Hg even though they all were taking three or more drugs daily, the researchers reported. In a comparison group of patients who continued drug treatment, blood pressure didn’t budge.

Six months later, blood pressure remained at least 10 percent lower in 84 percent of the patients treated, and no serious side effects were reported. Team leader Murray D. Esler, MD was quoted in news reports as saying he wasn’t sure why the treatment didn’t work on all the patients but suggested that some may not have been “zapped enough.”

Although new and bigger studies are needed to confirm these findings, so far, the results of treatment appear long-lasting: blood pressure is still under control in the first patient treated when the method was tested in 2008.

If you have high blood pressure, what treatment are you using? How well is it working?

CONNECT THE DOTS

Check your risks of high blood pressure here. Blood pressure is considered high when the top (systolic) number is above 140 millimeters of mercury (mmHG) and the bottom (diastolic) number is above 90 mmHG. Here’s some good information about lifestyle changes that can help lower high blood pressure. For more news about blood pressure, read our blog posts, “Track Your Health With Home Medical Tests,” “Chronotherapy: Medicine by the Clock,” and “In the Shadow of Disease.”

For healthcare providers, monitoring patients is no simple task. In most cases, it’s necessary to use bulky equipment or rely on individuals to wear monitors or take readings at regular intervals. Too often, all of this translates into more costly and time-consuming monitoring as well as more frequent medical problems.

Researchers at the University of Illinois are literally hoping to patch up the situation. They’ve begun building a wireless patch—think of it as a temporary tattoo—that could monitor vital signs and a number of other functions, and transmit important information to medical professionals wirelessly. The patch could offer an alternative to cumbersome and sometimes irritating devices, electrodes, wires and gels.

“We think that this represents a new way of integrating electronics with the human body.  The long-term goal is to blur the distinction between electronics and biological tissues, in a manner that will enable advances in human healthcare,” explains John A. Rogers, chair in engineering at the University of Illinois at Urbana-Champaign. He says that patch technology could change wound management, neonatal care, physical rehabilitation, sports monitoring, cognitive state and awareness monitoring and many other areas—some beyond the medical field.

So far, Rogers and the research team have embedded electronic sensors in a film smaller than the diameter of a human hair. The electronics were mounted on a soft silicon sheet that’s similar to what’s used for temporary tattoos. This creates a flexible patch that can move with the skin. The researchers were successful in keeping the patch on the skin for 24 hours and obtaining readings for brain, heart and muscle activity. They hope to eventually construct a patch that could stay on the body for up to two weeks.

The remaining hurdle, Dr. Rogers says, is to improve ways of powering the device so that it can communicate wirelessly with external systems. “The work is still in the early research phase,” he notes. However, he is confident that a patch—which is still a couple of years away from commercial development—could revolutionize medicine by providing a far more convenient, effective and comfortable way to monitor various body functions. Says Dr. Rogers: “The devices have promise to advance the state of the art in human healthcare. In that sense, everyone benefits.”

CONNECT THE DOTS

For a look at research into patch monitoring technology, visit The Rogers Research Group website. The research paper, An Electronic Second Skin, can be read in the August 12, 2011 issue of Science.