1	Why Do We Accept Secondary Caries As A Normal Occurrence?
2	Studies on Longevity of Dental Restorations 71% of all restorative treatments are performed on previously restored teeth with recurrent caries as the predominant cause. (Fontana and Gonzales-Cabezas; Compendium, Vol. 21, No. 1, January 2000; “Secondary Caries and Restoration Replacement: An Unresolved Problem”) One short term study reported a 50% failure of Class II gold inlays within seven years. (Donovan, Simonsen, Guertin, Tucker; Journal of Esthetic and Restorative Dentistry, Volume 16, Issue 03, May 2004; “Restorations In Service from 1 to 52 Years”.)
3	More Longevity Studies A study of 114 patients with a total of 1314 cast gold restorations presented the following survival rates: 97% at 9 years, 90.3% at 20 years, 94.9% at 30 years and 94.1% at greater than 40 years- cementations of zinc phosphate cements. (Donovan, Simonsen, Guertin, Tucker; Journal of Esthetic and Restorative Dentistry, May 2004; “Restorations In Service From 1 to 52 Years”.
4	Why the Discrepancy in Longevity Studies? Clinical Technique Dental Materials Individual Physiological Resistance to Decay
5	Dental Physiology Lessons From Dr. Ralph R. Steinman
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7	Procedure Steinman injected acriflavin hydrochloride (radioactive material) into the abdominal cavities of rats and was able to recover it in the solid structure of teeth within minutes (six minutes to the dentin and within one hour on the surface).
8	Conclusion The flow of interstitial fluid moves from the pulp chamber through the dentin, through the enamel and into the mouth. The flow can also reverse itself or become stagnant. It can be self-cleansing or self-contaminating. What does this say about the idea of creating and maintaining a sterile field?
9	Dentinal Fluid Transport
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11	Other Thought Provoking Observations By Dr. Steinman
12	“On identical, poor diets, exercised animals developed 4.8 cavities per animal compared to non-exercised rats who developed 14.9 cavities per animal.” Decay is more predominant when the system is “sympathetic dominant”. He commented, “Local factors play a role,but they are not the initiating factors in dental decay. Decay is a systemic disease.”
13	Secondary Decay is One Of The Primary Causes Of Systemic Infection Let’s learn more about how it occurs. Let’s learn more about what actually causes it. Let’s learn how to prevent it.
14	Planktonic Microorganisms Dr. Robert Koch developed the methods to create a solid nutrient media in order to grow and isolate pure cultures of microorganisms. As productive as the strategy has been, it tends to perpetuate a misconception that pure cultures are the norm in nature. Planktonic microorganisms are like strains that exist either singularly or in groups in a free-floating state. They are a serious threat in this state, but are usually susceptible to antibiotics and the body’s immune system. Planktonic bacteria or microorganisms have been the basis for study and the focus for treatment by the medical and scientific community for over a century.
15	Biofilms Through the use of the electron microscope and other such advances we now can see that microorganisms exist in communal environments, called biofilms. While planktonic forms of microorganisms are free -floating, one of the outstanding attributes of biofilms is their attachment to surfaces. 95% of bacteria found in nature exist in biofilm colonies. Biofilm colonies are natural to our world and produce desirable outcomes in many instances, but they can wreck havoc in our bodies.
16	How Do Biofilms Form?
17	Surface Attachment Gravity can cause organisms to settle-out and end up resting on a surface. Bacteria often have negative charges and may be attracted to the positive charges on surfaces. Many surfaces attract and concentrate nutrients which bacteria have the capacity to detect and move toward (chemotaxis).
18	Slime Matrix After attachment, copious amounts of extracellular polysaccharides, called slime are produced. The slime helps hold the microorganisms together in microcolonies and helps maintain attachment. A protective layer is created by the slime. The slime also helps attract other microorganisms as well as nutrients.
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24	Physical Properties The biofilm structure is approximately 73 – 98% noncellular material with fluid channels running throughout allowing for nutrient flow and removal of wastes. Different shapes form such as mushroom structures and corn cob stacks which are found in dental plaque. They can adapt to environmental situations by changing shape, sending out appendages to aid attachment and filamentous streamers with heads to withstand turbulent fluid flows.
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29	Chemotherapeutic Resistance The polysaccharide slime layer helps to protect the biofilm communities from invasion by antibiotics and the immune system. The outer cells also act as protective barriers, allowing the inner cells to thrive. Bacteria encased in biofilms may be 50 to 500 times more resistant to chemotherapy than planktonic bacteria of the same strain.
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31	Biofilms and Disease Biofilms have adaptability and mobility and can spread throughout the body. Biofilms act as a manufacturing plant for planktonic forms of microbes. The planktonic microbes can break-off and become released throughout the body where they are responsible for serious and chronic systemic infection.
32	Where are Biofilms in the Mouth? Dental Plaque On Decaying Surfaces Within Dentin Tubules Attached to Restorations
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35	"Biofilm infected dentin tubules" Biofilm infected dentin tubules.
36	Problems with Polymers Hydrophilic Porous Organic chains subject to chemical change Ideal surface areas for biofilm attachment
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38	“How To Kill A Tooth” Gordon J. Christensen, D.D.S., M.S.D., PhD. states in his article “How To Kill A Tooth” in JADA, Vol. 136, December 2005 that “I have been told by numerous endodontists that one of the most significant factors related to the increase in need for endodontic therapy has been the popularity of resin-based composites to restore posterior teeth”. He goes on to suggest that the primary cause of this is damage to the pulp. He also states that dentinal canals are now sealed by impregnating them with resin or coagulate which could further irritate the pulp.
39	“Achieving Optimum Retention for Restorations” by Gordon Christensen, D.D.S.,M.S.D.,PhD. JADA, Vol. 135, No. 8, Aug. 2004 “However, clinical observations show that when either type of dentin bonding is used alone, without mechanical retention, some restorations fall off during service.” “These failures present a confusing phenomenon, since dentin bond strengths in vitro show values as strong as or stronger than bonds to enamel.”
40	Eradication of Biofilms in the Oral Cavity Except in acute conditions, antibiotics will have no long-term effect. Mechanical removal is effective, but as we know recurrent decay is common. Copper ions have been shown to kill planktonic microbial forms, but not biofilms. Copper ions activated with silver or iron have been shown to destroy biofilms.
41	Copper-Containing Cements Was the Baby Thrown Out With the Bath Water?
42	Doc Holliday and a Brief History of Copper-Containing Cements
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44	Studies Showing the Safety of Copper
45	Cytotoxicity Testing of Doc’s Best Copper Cement with Copalite Varnish Evaluation of Cytotoxicity of the Mixture of Doc’s Best Antibiofilm Cement Powder with Copalite Varnish Using the Agar Diffusion Method, Yiming Li, DDS., PhD., Wu Zhang, MD., Omari Onyango, DDS., MPH.,Biocompatibility and Toxicology Research Laboratory, Loma Linda Univ. School of Dentistry, Sept. 2, 2005. Testing for decolorization, cell lysis, cell response and cytotoxicity measured at 24 and 48 hours. Conclusion: The mixture of Doc’s Best Antibiofilm Cement Powder with Copalite varnish is not cytotoxic as evaluated using the agar diffusion method.
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49	Criteria for an Ideal Dental Cement Inorganic material, not subject to chemical changes Prolonged anticariogenic activity Noncytotoxic, nonmutagenic, biocompatible Provides necessary trace elements Infintesimal solubility Dependable cementation applications
50	Doc’s Best Products Eliminate Biofilm Causing Microorganisms In Vitro Study performed at Center for Biofilm Engineering; Montana State University; Bozeman, Montana, January 28, 2005 by Paul Sturman, PhD., Director- William Costerton, PhD. Organisms tested in stagnant media to best simulate oral conditions. Streptococcus mutans and Lactobacillus paracasei were innoculants used as tests for biofilm formation. Conclusion: No biofilm colonization was formed using Doc’s Best Red Copper Cement or White Copper Cement.
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52	Biofilm Testing Table
53	A solution using a combination of silver, iodine and copper to prevent biofilm growth in wounds has been introduced by the University of Florida and QuickMed Technologies. Medical Product Manufacturing News, January/February, 2006
54	Evaluation of Mutagenic Potential of the Mixture of Doc’s Best White Copper Activated Copper Cement with Copalite Varnish Using the Ames Salmonella/Microsome Mutagenicity Test Study conducted at Loma Linda University School of Dentistry, Biocompatibility and Toxicology Research Laboratory, Submitted December 22, 2005. Researchers: Yiming Li, D.D.S., Phd., Wu Zhang, M.D., Minling Zheng, D.D.S., M.S. Conclusion: The Mixture of Doc’s Best White Copper Activated Copper Cement with Copalite Varnish is not mutagenic in the Ames Salmonella mutagenicity test with or without the S9 microsomal activation. Tables of Results on following pages.
55	Mechanical Study
56	Clinical Case Studies Using Doc’s Best Products
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63	Clinical Applications Using Doc’s Best Products
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74	Adding Red Copper Cement Powder to Copalite
75	Mixing a Slurry of Copalite and Doc’s Best Red Copper Powder
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77	Slurry Saturated Canals
78	Placement of Posts with Red Copper Cement
79	Complete Cementation of Posts
80	Geriatric, Special Needs and Pedodontic Patients
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86	Creating a Base Additional powder may be incorporated to obtain the consistency necessary for a base.
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