LLUSD Articulator - Volume 28, Number 2

Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works Articulator (Dentistry Journal) Loma Linda University Publications Fall 2017 LLUSD Articulator - Volume 28, Number 2 Loma Linda University School of Dentistry Montry S. Suprono Loma Linda University Follow this and additional works at: https://scholarsrepository.llu.edu/articulator Part of the Other Dentistry Commons Recommended Citation Loma Linda University School of Dentistry and Suprono, Montry S., "LLUSD Articulator - Volume 28, Number 2" (2017). Articulator (Dentistry Journal). https://scholarsrepository.llu.edu/articulator/9 This Book is brought to you for free and open access by the Loma Linda University Publications at TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in Articulator (Dentistry Journal) by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact scholarsrepository@llu.edu. LLUSD ARTICULATOR The melding of compassion and competence in dental education Jess Hayden collection Commencement 2017 Bonding and zirconia: a literature review New LLUSD dean appointed Volume 28, Number 2 Summer / Autumn 2017 You are not a benchmark. You are also not a sales goal or a quota or a statistic. You are a dentist. And if you’re looking for a company that understands that distinction, we’d like to introduce ourselves. We are The Dentists Insurance Company, TDIC. We only protect dentists and are relentless in our pursuit of innovative ways to protect you, your first year in the profession and every year after. Take our New Dentist Program. New Dentist Program $50 Professional Liability insurance for your first year.* 45% discount in your second year and 25% in your third.** Guidance through our Risk Management Advice Line. Five-minute short form and e-signature make the online application process a breeze. Apply today at tdicinsurance.com/newgrad * First year TDIC Professional Liability coverage rate depicted is for newly licensed and never practiced dentists in the state of California, Minnesota, Nevada or North Dakota and is valid for a $1M/$3M coverage amount. ** Discounts apply to full premium rates for years two and three. Rates subject to increase per schedule in years two through eight until they reach maturity. ® Protecting dentists. It’s all we do. 800.733.0633 | tdicinsurance.com | CA Insurance Lic. #0652783 Volume 28, Number 2 LLUSD ARTICULATOR We wanted to give something back to the School of Dentistry. By donating a piece of property, we benefited from immediate tax savings while having the satisfaction of knowing our gift would make a difference in the lives of students. — Clyde (SD ’70) and Kirsty Roggenkamp Professor at LLUSD What’s Your Plan? 1 For the Future of our Students We LIVE to Give We prepare students to care for the whole person — body, mind and spirit. You can play an important role in impacting Loma Linda University Health by establishing a legacy gift to benefit Vision 2020 — The Campaign for a Whole Tomorrow. To learn more about estate gifts or other ways to give, contact the office of planned giving. Office of Planned Giving 11175 Mountain View Avenue, Suite B, Loma Linda, CA 92354 909-558-4553 | legacy@llu.edu | llulegacy.org MANY STRENGTHS. ONE MISSION. LLUSD ARTICULATOR Summer / Autumn 2017 LLUSD ARTICULATOR The melding of competence and compassion in dental education. Volume 28, Number II Summer/Autumn 2017 Articulator (formerly Dentistry) celebrates with alumni and friends the School of Dentistry’s efforts to combine compassion and competence in the education of oral healthcare professionals. LLUSD alumni represent the strength of that amalgam. The journal is published twice each year by the Loma Linda University School of Dentistry Office of Marketing. Interim dean Joseph M. Caruso, DDS, MS, MPH Alumni director Kathleen Moore, MHIS Director, Office of Marketing Krista Weymar, MBA Director of Publications Managing editor Douglas Hackleman, MA Contributing editor Edna Maye Loveless, PhD Science editor Yiming Li, PhD, DDS, MSD Photographers Carmen Fernandez Daryl Osborne LLUSD Mission Loma Linda University School of Dentistry seeks to further the healing and teaching ministry of Jesus Christ by providing an environment wherein: Students learn to provide high quality oral healthcare based on sound scientific principles Patients receive competent care, which is preventive in purpose, comprehensive in scope, and provided with compassion and respect Faculty, students, and staff value the patient relationship, respect diversity, and share responsibility by working together toward academic, professional, spiritual, and personal growth Scholarly activity and research provide a foundation for evidence-based learning and enhance whole person care The workplace environment attracts and retains a superior and diverse faculty and staff who motivate, educate, and serve Our communities (local, global, and professional) benefit from our service, stewardship, and commitment to lifelong learning. Incoming LLUSD Dean Robert Handysides (left) visits with outgoing Interim Dean Joseph Caruso. The next Articulator will feature an extended interview with Dr. Handysides. Editors note: Beginning this summer, a search committee comprised of LLUSD faculty members, administrators, alumni, and board members of Loma Linda University undertook an extended consideration of candidates from which to select a new dean for the School of Dentistry. On November 8, the search committee recommended to LLU administration that associate dean for Academic Affairs, Robert Handysides, DDS, be appointed Dean. This was referred to the LLU Board of Directors which voted on December 12, 2017, for Dr. Handysides to become Dean, effective January 1, 2018. It was determined to withhold publication of the Articulator until Dr. Handysides selection was made official by Board of Trustees and could be announced in this issue of the alumni journal. The School of Dentistry has been led since its inception in 1953 by five deans—Webster Prince, Charles Smith, Judson Klooster, Charles Goodacre, and Ronald Dailey (and that is not to ignore the vigorous, yeoman leadership that Interim Dean Joseph Caruso, DDS’73, MS’75, has provided during recent months that leads us to Dr. Handyside’s inauguration in January). If that seems like a lot, or if an average of nearly 13 years per dean seems long, consider the fact that the mean tenure of American dental school deans is two years. Those five deans were blessed to direct the education of more than 6,400 oral healthcare practitioners who have bettered the world with the compassionate and competent professionalism they learned under this School’s unique Christian ethos of whole person service. The incoming and outgoing LLUSD deans are one in their confidence that the LLU School of Dentistry has little to fear for the future as we recognize how Providence has rewarded our sincere past efforts. To each of our readers, we wish a most meaningful 2018, Doug Hackleman, MA Editor Cover: Incoming LLUSD Dean Robert Handysides (left) prepares to receive the administrative baton from Interim Dean Joseph Caruso. Volume 28, Number 2 LLUSD ARTICULATOR CONTENTS 4 The dean’s brown bag 9 Handysides appointed 6th LLUSD dean 10 Tory Silvestrin runs life’s marathon at a sprint 16 Jess Hayden family donates his 50,000 prosection slides 20 LLUSD’s 61st Commencement 32 Bonding & zirconia: a literature review 44 Falling in L-O-V-E with dentistry 3 46 Postgraduate Endo celebrates 50 years 48 LLUSD News Direct advertising inquiries and correspondence to: Publications Director LLU School of Dentistry 11245 Anderson Street, Ste 120 Loma Linda, CA 92354 Phone: (909) 558-4984 Fax: (909) 558-0992 To reach School of Dentistry Alumni Affairs, contact: Jeri Fowler, assistant director LLUSD Alumni Affairs 11245 Anderson Street, Ste 120 Loma Linda, CA 92354 For admissions information contact: School of Dentistry Office of Admissions 11092 Anderson Street Loma Linda, CA 92350 Phone: (909) 558-4399 Fax: (909) 558-4858 Admissions.sd@llu.edu Phone: (909) 558-4621 LLUSD ARTICULATOR Summer / Autumn 2017 DEAN’S MESSAGE The dean’s brown bag A fter several months as interim dean of the LLU School of Dentistry, and following many years as a faculty member, chair, program director, and associate dean, I have an informed sense of the challenges and the possibilities that leave me optimistic, energized, and encouraged about the opportunities that face Robert Handysides, DDS’93, this new year as he transitions from associate dean for Academic Affairs to dean, School of Dentistry. There is cause for optimism, even joy, because, unlike the lower forms of life, humans have agency—we can be the masters of our fate as individuals and, as collaborating individuals, the masters of the fate/future of our School of Dentistry. Because I share my predecessor Dr. Ronald Dailey’s commitment to the importance of communication, I have continued his habit of meeting periodically with the entire faculty in what are referred to as “Brown Bag” lunches. Similar meetings are held periodically with the dental classes (D1/D2 together and D3/ D4 together) and with various School supervisors. Each of these assemblies, along with other department meetings, combine to provide a cascade of communication that facilitates the operations of our alma mater. At a recent Brown Bag the following items were discussed. 4 We won’t stand still Those of you who have an attachment to the School, and who have been following the considerable, substantive changes to our profession, may be interested in knowing how your alma mater is adjusting to the relentless arrival of new realities. Professional and business models are shape shifting, and we must graduate dentists and dental hygienists who are prepared for new and moving care provision targets. There is little or no time for murmuring about the good old days. We have things to do and we are doing them. California path to licensure The Portfolio Curriculum Integrated Pathway Examination to Qualify for a California Dental License is a path to licensure piloted by dental schools at the University of California, San Francisco (UCSF) and University of the Pacific (UOP), as it was sanctioned by the Dental Board of California in 2009 and became operational in 2014. Now in the second year of that process, LLUSD has experienced what other dental schools report: many students express interest, several sign up for Dr. Joseph Caruso the process, but only a few complete the entire program. The expense to California dental schools is not justified currently by the number of students who participate. Representatives of the Dental Board of California recently met with administrators and faculty at each of the six California dental schools to develop a better understanding of the challenges involved with the Portfolio Examination process and what the Dental Board can do to mitigate those challenges. We are continuing to make available to students the California Portfolio Examination with LLUSD-calibrated faculty as an opportunity for our students with the understanding that California Dental Schools will be working with the State of California to determine ways to improve the Portfolio process. LLUSD patient pool/tuition There are a sufficient number of people waiting for services at the LLUSD predoctoral student clinics. But the population growth of the Inland Empire has experienced a lowering socioeconomic reality and a paucity of patients who can afford to pay for the care they need and the procedures LLUSD students need to perform. Because clinic income affects budgets, and consequently tuition, the acquisition and distribution of patients among the School’s programs requires a continual, judicious balance. It is a topic that leads naturally to consideration of alternative models of dental instruction and dental care delivery. Models of dental instruction and dental care delivery Models of dental care delivery are migrating from predominately single-proprietor private practice to Dental Service Organization (DSO), to modified DSO, to the Federally Qualified Health Center Volume 28, Number 2 (FQHC), and others. The growth rate of these organizations in the State of California has outpaced their proliferation elsewhere. This evolution in the care delivery models necessarily drives adjustments to our educational and business model. A number of websites address these trends in depth: <http://tinyurl.com/ y94cnx4j> At your alma mater we are making strategic curriculum adjustments to meet the transformation in care delivery models that prepare our students with not only clinical skills but an operational understanding of the revised practice opportunities they will encounter. Is it possible that some of the experiences we used to get in the LLUSD main clinic are no longer available? Are there experiences that will better prepare our students that should be acquired in private and public clinics? These are important questions. Some dental schools already are providing their students external clinical experiences. We are considering among models what will work best for LLUSD. LLUSD’s place at the table The School of Dentistry embodies an essential part of the healthcare delivered by LLUH, and it contributes to and enjoys the benefits of collegial reciprocity with seven LLU sister schools. Despite that fact, dental faculty and alumni sometimes wonder, “How does the School of Dentistry fit into Loma Linda University’s family of schools?” There is a widely shared perception that the Medical Center and the School of Medicine are the big dogs on campus and that the other schools have merely supporting or auxiliary roles. There is evidence that Dentistry’s contribution is much more substantive; the LLUSD annual revenue budget ($64M) matches that of the next two schools (Medicine and Allied Health Professions) combined. Further review of the School of Dentistry’s technology and process contributions to the University and sister schools should continue to provide opportunities for perceptual adjustment. The School’s Administrative Council (comprised of its assistant and associate deans) considers LLUSD to be a third hospital on campus, along with the Medical Center and the Children’s Hospital. As such, the School of Dentistry’s relationship to the University is not unlike the relationship to LLU of the School of Medicine, the LLU Medical Center, and the Children’s Hospital. First articulated by Graham Stacey, PhD, associate dean for Admissions and Student affairs, the hospital analogy has taken root and we assert it on all appropriate occasions, especially because it is spiritually and professionally consistent with the LLUH commitment to whole person care. We have found that when LLUSD is at the table with LLU leadership, when your alma mater is represented at earlier LLUSD ARTICULATOR stages in strategic planning—before rather than after plans are finalized—this participation improves the options, projections, and results of our School’s own decision making. So often in the past, without our involvement in University-wide planning, we have found ourselves scrambling to make do with work arounds. I have purposefully requested appointments of LLUSD faculty members to committees that have overarching, Universitywide significance Their participation has already improved communication, awareness, and conviviality. It’s not perfect, but this earlier participation is mutually beneficial to our reciprocal relationships and strategic planning with both sister schools and the University as a whole. For the One Loma Linda (LLUH) to succeed, the School of Dentistry must participate as an excelling partner. Perception of LLUSD graduates’ practice readiness My conversations with the deans of other dental schools reveals a common perception among alumni that recent graduates are less prepared for dental practice than those of decades passed. It is understandable that there are questions about whether the students of today are as well prepared as the students of . . . you pick a class: 1973 (my class), 1986, 1996, 2006, etc. In response to that question, one might say, ‘Relative to what?’ That is not to be cavalier; it’s important. When comparing today’s graduates to those of earlier years it is essential to realize that their training is different because the practice of dentistry today is different. Third millennium dentistry is more effective because its materials, procedures, and techniques are more sophisticated and require additional training and practice. The difference between graduates of yesterday and today’s LLUSD graduates (and the dentistry they are being prepared to deliver) is that students today have more “stuff in their educational wheel barrow.” Our current curriculum is considerably more comprehensive than it was just a few years ago, not to mention so far back as 1973! As they confront 21st century dentistry, 2017 graduates enter a profession that requires expertise in procedures supported by advanced technologies and new materials that were hardly contemplated when many of us were taking dentistry and using gold foil to restore carious or fractured teeth. Examples include the application of cone beam imaging, CAD/CAM dentistry, 3D printing, and digital impressions, not to mention just the changes in today’s amalgams. Alumni may observe and judge a recent graduate, perhaps unfairly, against their own current level of experienced proficiency, as an accomplished expert. And some alumni might think that currriculum changes at their alma mater are being made to correct deficiencies in our graduating students 5 LLUSD ARTICULATOR when in fact the revised curriculum is due to our faculty and administration’s efforts to anticipate rapidly arriving revisions to the practice of dentistry. It would be a mistake to construe curriculum remodelling as evidence of deficiencies in our recently graduated dentists. Changing curriculum is due to a changing future. Conversations with our current students impress me that they want to be held to a high standard, but they also want redundancy removed from the curriculum. Strange concept! And one with which we totally concur. So, while as associate dean for Academic Affairs, Dr. Handysides was working with his task force to streamline the curriculum and integrate it with concepts of just-in-time delivery of didactics, two members of our faculty, Holli Riter, DDS’98 (recently appointed director of Quality Assurance), and Michael Fitzpatrick, DDS’87, professor, Division of General Dentistry, have been tasked with 1) minimizing waste that may burden either students or instructors with poorly designed processes and unrealistic costs without additional benefit to either didactic or clinical experiences, and 2) determining the most efficient and consistent way to deliver any operative procedure with optimal quality, in the least possible time, and with minimal failure. Any student who graduates here must represent the compassionate competence our School requires. Every student must have the opportunity to excel at the “LLU School of Dentistry” level. 6 Advancing faculty Without doubt, LLUSD faculty members are professionally extended. They stand between what a student needs to know and what those students know they need to be. Students, being students, want to progress quickly, which is understandable but not always in their best interest. Faculty members are guiding students into their futures, which involves more than just teaching. The simple teaching of students means faculty members must grade 100-plus papers for each quiz or test, develop course materials that are current and evidenced based, meet all issues of compliance to work with patients (believe it or not to stay eligible to maintain your position on the clinic you are required to take eight compliance courses consuming approximately six-plus hours—necessary but time consuming), remain current in a profession that requires their own continuing education, counsel with students, develop their own curriculum vitaes for faculty advancement (including research projects), all of that on compensation that is at the median for American educators. How does all of that get done? It happens because our faculty members care deeply about educating our students to become competent dentists who practice whole person oral healthcare. Summer / Autumn 2017 They are dedicated teachers who take students who are new to dentistry and mentor them into the professional ranks of what we call Christian dentistry. It is a calling that turns college graduates into oral healthcare providers with skills and compassion, dentists and dental hygienists that can become educators, researchers, church or community leaders, missionoriented dental providers, dental product developers, local or state politicians, healthcare policy advocates, and even CDA or CDHA presidents. LLUSD graduates have taken on all of these roles. Our faculty members take meaning from the growth and excelling of their students. It’s what keeps them here and keeps them going. Developing faculty for the future requires dentists and dental hygienists who are willing to challenge themselves. Finding and nurturing those individuals is a continuing administrative responsibility. It is the obligation of LLUSD leadership to provide educational opportunities in skills enhancement, administration, and curriculum development, along with protected time that permits faculty to explore, study, and think. The logic of Descartes, “I think, therefor I am,” suggests an ontological dilemma: if you don’t have time to think, you hardly have time to become. Other deans and graduate program directors concur that the need for protected time for faculty improvement is a pervasive problem. Of course, protected opportunities necessitate accountability, not only to the School as an employer but to the intended goal of growth. The future and its obligations/needs 1. Research: Through the leadership of Yiming Li, DDS, PhD, MSD, associate dean for Research, we have acquired the MicroCT, and several internal and external research projects are scheduled for its advantages. We are in the process of acquiring a new, high-resolution scanning electron microscope (SEM) that will not destroy samples during the imaging process. Like our MicroCT, the new SEM will generate both internal and fee-for-service, external use. We are on track to exceed last year’s research revenue with sponsored projects. Our water system testing lab continues to grow under the guidance of Wu Zhang, MD, professor and director, Research Services, Center for Dental Research, who has developed the School’s Dental Unit Waterline (DUWL) Testing and Sterilization Assurance Service (SAS) into one of the premier such services in the country, serving over 800 dental offices, a number of universities, veterans hospitals, medical/dental centers, and other agencies across the nation. 2. Classroom remodeling: We are requesting bids for the remodeling of the classrooms on Prince Hall’s third and Volume 28, Number 2 fourth floors as well as Room 1176. These improvements, 20 years in the making, will include interactive technology, video conferencing, and the capacity to capture classroom lectures. 3. IDP and adjoining lab overhaul: A review of the layout for the International Dentist Program (IDP) lab (PH1110) made it evident that the adjacent DDS (D2/ D3, PH1112) labs are also in need of updating. Many IDP alumni have donated to their lab’s renovation, and the funds that they have donated already are earmarked for that lab renewal. Renovations to the adjacent labs will require additional funding. Mark Estey, DDS’98, program director, International Dentist Program, is meeting with the various users to determine among other things utilization flow and current and future needs including the possibility of acquiring simulation stations. We are reassessing the possible employment of an educational tool first considered by former dean and Distinguished Professor Charles Goodacre, DDS’71, MSD, several years ago—the use of common simulation environments, including a virtual patient, using augmented reality and haptic technology to provide the experience as if at the chair. Considering the advantages of eliminated patient risk and extended life usability, a few dental schools in both the US and Europe already have moved in this direction. 4. Oral and Maxillofacial Surgery area: The growth of Department of Oral and Maxillofacial Surgery real estate needs must be addressed. Alan Herford, DDS’94, MD, chair, Department of OMFS Oral and Maxillofacial Surgery, is developing a proposal that our philanthropy team can use with corporate and alumni supporters to facilitate this much needed expansion. 5. 3D planning, printing, and milling: Oh my! As you are well aware, a lot of what we are now doing is either of the virtual world or soon will be. Since 2001, the use of advanced CBCT at the School has prompted the obvious: “If I have it in the 3D world, why can’t I keep it there until I need the real object?” This evolution of thought made the manufacturers of 3D printing and milling view dentistry as a viable market and, Bam! we have printing and milling readily available. Your School’s central lab has been utilizing 3D milling of wax for many years and ceramic milling of all types. We are moving forward with new scanners and machines available through our corporate relationships and through our association with CRET, sponsors—along with LLUSD ARTICULATOR alumni donors—of the Hugh Love Center for Research & Education in Technology. Provided by alumni contributions, LLUSD currently has 3D printers in the Departments of Orthodontics, Periodontics, Prosthodontics and Implant Dentistry. These machines are comprised of an assortment of industrial-strength ABS printers and small medical-capable SLA or DLP printers. The School is embarking into the area of bio-film printing in the coming months, and 3D metal printing for many types of dental restorations that only a short time ago were cast or milled. Software at LLUSD is now available on the computer desktop for students to design restorations and submit for fabrication! In the near future, a design center will be created to provide instruction and support to faculty and students in the management of such software and the principles of computer aided manufacturing. Operations and procedures that really matter are progressing in several areas. We are working and planning in parallel, prioritizing for effective value, cost, education realized, and financial return. As determined by earlier strategic sessions, our core business is the education of general dentists. When we evaluate a proposal, project, curriculum adjustment, or capital improvement, that is the primary consideration. During my brief tenure as dean, it has been a pleasure to meet with several alumni groups as well as a number of alumni individually. And how encouraging it has been to hear from them almost uniformly, “How can I help? And we do so appreciate your help! So we have called on several of our alumni to form a committee of past Alumni Association presidents who are re-envisioning the LLUSD Alumni Association to determine how it can best support our School’s endeavor to continually graduate outstanding oral healthcare professionals who can say, “Service Is Our Calling” to a changing world. Respectfully yours, Joseph M. Caruso, DDS’73, MS’75, MPH Interim Dean 7 Dental Unit Waterline Testing and Sterilization Assurance Service Dental Unit Waterline (DUWL) Testing Service has been in operation since 2000. We evaluate microbial contamination of DUWLs and are actively involved in research on DUWL biofilm removal and treatment methods. Over 800 dental offices, a number of universities, Veterans hospitals, medical/ dental centers, and other agencies nationwide use this service for monitoring the quality of their DUWLs. What are the advantages of using LLU School of Dentistry’s DUWL service? • The Standard Method 9215 D (membrane filter method) of American Public Health Association (APHA) is used to examine microbial contamination in DUWLs. • Multiple dilutions to detect heterotrophic plate count (HPC) bacteria counts up to 20,000 CFU/mL • More than 18 years’ experience • Free consultations by experienced staff • All-inclusive test kit containing sterile sample vials, ice packs, and detailed instructions in insulated test packages • Test reports sent after the seven-day incubation • Local customers may deliver samples directly to our research laboratory. Find SAS & L W DU ms on r o f r orde 43. page Sterilization Assurance Service (SAS) was established in 1998 and provides biological monitoring of sterilizers for over a thousand dental clinics, community colleges, and medical/ dental centers and other institutions in more than 30 states. What are some of the advantages of using LLU School of Dentistry’s SAS? • 20 years of experience • Choice of Basic, BasicPlus, and Intensive spore testing services to help you meet infection control requirements within your budget • Return envelopes or prepaid envelopes are included based on your choice. • Option of weekly or monthly reports with available Certificate of Participation • Failure notification by phone or e-mail on same business day • Class V integrators for steam sterilizer is available to order. The combined use of spore test and STEAMPlus Integrators provide early detection by visually confirming the performance of your sterilizers. • Online test results will be available soon. Volume 28, Number 2 LLUSD ARTICULATOR TRANSITIONS Robert Handysides, DDS’93, appointed sixth LLU School of Dentistry dean R obert Handysides, DDS’93, associate dean for academic affairs since 2013, has been appointed dean, Loma Linda University School of Dentistry, effective January 1, 2018. Joseph Caruso, DDS’73, MS’75, who has served first as acting and then as interim dean since April 2017, will continue through the academic year his positions as associate dean for Strategic Initiatives and Faculty Practices and as program director for the Advanced Specialty Education Program in Orthodontics and Dentofacial Orthopedics. “I am deeply honored and humbled to learn that my colleagues and peers have chosen me to lead the School of Dentistry,” Dr. Handysides said in response to his appoiontment. ”Although LLUSD has a proud tradition of excellence and is recognized as having one of the profession’s premier clinical programs, we have no interest Dr. Robert Handysides in resting on our laurels. I look forward to collaborating with our School’s highly dedicated faculty, staff, alumni, and students as we strive to improve on our laudable past.” LLU Provost Ronald Carter, PhD, affirmed the appointment: “It has been my privilege to work closely with Dr. Handysides as the School of Dentistry’s associate dean for Academic Affairs. Rob demonstrates a delightful blend of attention to detail and process with a cheer and humor that lightens the load of serious decision making. Dean Handysides has a vision for academic and professional excellence and the commitment to forge a faculty and administration equal to the challenges of 21st century dental education.” Shortly after graduation from LLUSD in 1993, Dr. Handysides established and maintained for five years a solo practice in Kingston, Ontario, his Canadian home. He returned to LLUSD in 1999 and earned a certificate in endodontics that he completed in 2001 at the School’s Advanced Specialty Education Program in Endodontics. Commencing immediately upon completion of his specialty program in 2001, Dr. Handysides served the Department of Endodontics in a variety of roles: course director, lecturer, clinical educator, and researcher. In 2003, he became director of the LLU Faculty Endodontics practice, a position he held in that busy dental practice until 2013. Because of accumulating teaching and administrative responsibilities, his involvement with patient care is somewhat reduced. In 2007, Dr. Handysides was added to the LLU Faculty of Graduate Studies as associate professor, and in 2008 he was promoted to associate professor status with the Department of Endodontics. In November 2008, he was named a Diplomate by the American Board of Endodontists. In 2009, when Leif Bakland, DDS’63, distinguished emeritus professor, retired, Dr. Handysides replaced his mentor and friend as chair, Department of Endodontics. Appointed to the position of associate dean for Academic Affairs in 2013, Dr. Handysides for four years has helped to guide and direct the decision-making and implementation of both clinical training and curriculum design so essential to the maintenance, integrity, and growth of the School. Dr. Handysides has authored or coauthored a number of peer reviewed articles and textbook chapters in endodontics and dental education. He has also presented numerous continuing education seminars both nationally and internationally, enjoying the various cultures and customs of the places he has visited. Dr. Handysides and his wife, Minnie, have three daughters: Nicole, Carina, and Alison. 9 LLUSD ARTICULATOR Summer / Autumn 2017 TRANSITIONS Tory Silvestrin: running life’s marathon at a sprint ven though Tory Silvestrin, DDS, MSD’15 (Endo), MSHPE E In college, Tory did what was necessary to qualify for most (2014) associate professor, Department of Endodontics, has any healthcare-related degree program, graduating summa been running life’s marathon at a sprint, it has been his habit to cum laude at Pacific Lutheran University (PLU) in 2008 with a make very considered life choices. Those BA in biology. His academic excellence decisions—and what he has done with was not impeded by the work he did at them—have brought him, five years out the University’s writing center, where for of dental school, to be named chair for three years he tutored undergraduate, LLU School of Dentistry’s Department of graduate, and ESL students. And among Endodontics. the awards he received at PLU was As a University of Washington, the Regents Scholarship—a 4-year Seattle, School of Dentistry senior in full-tuition scholarship awarded for 2012, Tory applied to the endodontics leadership, community service, and advanced training programs of sixteen academic achievement. American dental schools. Tory (Sixteen dentistry at the happened to be the number of his father’s University of Washington School of football jersey and his own soccer Dentistry, Seattle, thirty miles north of jersey, he recalls with amusement.) home, where he graduated in 2012 first After considerable due diligence and in a class of 63 and with more than a Dr. Tory Silvestrin dozen awards for academic, clinical, and a two-hour phone conversation with Mahmoud Torabinejad, DMD, MSD, PhD, professor, Department of Endodontics, he chose LLUSD. 10 studied research excellence. But then he chose endodontics for specialty education, Tory grew up in Fife, a suburb of Tacoma, Washington, in a despite the need for endodontists to be available weekends (at healthcare-oriented family—his dad is a public health specialist least by phone) to alleviate pain. Tory actually began to consider (sex-education) and his mother a nurse practitioner (OBGYN). endodontics when he and his classmates were introduced to One of the family’s neighbors was a dentist who wasn’t called the rather intricate procedures involved in rescuing damaged or out on weekends to deliver babies. Dentistry, Tory noticed, was endangered teeth. He also noticed that most of his classmates a health profession that offered the opportunity to benefit others were not particularly drawn to that dental specialty and figured on a more controlled schedule. there would always be a need for its services. An academic and athletic overachiever, Tory was captain of Tory took considerable care with perhaps his most important his high school tennis and golf teams and played for three years life decision—whom to marry—and then plotted the moment on Pacific Lutheran University’s varsity tennis team. He worked of asking to maximize its memorialization. He’d shared a through high school and college at Lakewood Racket and Sports health sciences dental immersion day booth with a dental Club teaching tennis, stringing rackets, scheduling members’ school classmate named Alexandria Brent during their summer appointments, and maintaining the clubhouse. prior to beginning dental school; they enjoyed the occasion’s Volume 28, Number 2 LLUSD ARTICULATOR fraternity enough to become Science in Health Professions study partners. In 2014, Education that he received they ran together in her from the LLU School of Allied first marathon, the Seattle Health in 2014. “I hold the Marathon, on the Sunday responsibility that rests on after Thanksgiving in 2014. an educator’s shoulders in Just before the finish line, high regard,” he says, “and, Tory stopped the University as such, want to ensure that of student I come to the classroom with council president, took a every tool available in my knee, and asked her if she teaching toolbox. The MSHPE would marry him. He wanted program helped ensure that I it on the record, and he knew could stand behind the podium that so many cameras (still and work with students in and video) were focused the clinic with full assurance continually on the finish of my abilities to be an line. He says, “I knew that effective health professions she was distracted by the educator.” He began teaching Washington finish line looming ahead, so she’d say yes to anything at Just married, Dr. Alexandria Brent-Silvestrin and Dr. Tory Silvestrin spent their honeymoon on Maui. that moment, as long as I let her finish and get her hard-earned at LLUSD in June 2015, almost immediately after graduation from LLUSD’s graduate program in endodontics. medal. She may well have said yes regardless, but I wanted When terrorists marred with horror the conclusion of the to stack the odds in my favor; . . . after all she is the woman I 2013 Boston Marathon (three killed, 264 injured), running want to spend the rest of my life with.” On September 12, 2015, acquired for Dr. Silvestrin a role beyond stress relief and physical the young dentists married and honeymooned on the Hawaiian conditioning. He determined to run the 2014 Boston Marathon island of Maui. in solidarity with the victims who were affected by the tragic Tory had begun long-distance running during the summer between his junior and senior year of dental school as a way of events and to stand as a member of the running community to show a united desire to seek a lifestyle of fitness undeterred. relieving stress after taking the National Boards Part II. Despite He qualified for Boston in August 2013 by running the Surf his enjoyment of tennis, with the tighter schedule and greater City Marathon (Huntington Beach, California) in three hours demands of dental school, he found running an outlet he could and five minutes—approximately seven minutes per mile. As exercise at will. He participated in the Portland Marathon, his “a member of the running community I felt the need to run in first, on October 9, 2011. solidarity with those that were profoundly affected by the events Now Doctor Silvestrin, he continued distance running during of the 2013 Boston Marathon. It was a unique experience— his three-year journey through LLUSD’s Advanced Specialty running the Boston Marathon—and one that I will hold dear Education Program in Endodontics, not to mention the Master of forever. Crossing the finish line was enthralling (knowing how 11 LLUSD ARTICULATOR Summer / Autumn 2017 many hours I’d dedicated to qualify for and run this iconic Kelly as Seventh-day Adventist Christians on September 2, event) and saddening (remembering the scenes and tragedy 2017, in the company of several dental family members as well that occurred at that very place one year prior). I found myself as their Mt. Rubidoux friends. nearly in tears with the concomitant pride in my achievement Dr. Silvestrin completed the end of the 2017 academic and knowing what this race means to the running community.” year with four substantial professional advancements. He was Dr. Silvestrin’s three hours and one minute completion time at the 2014 Boston Marathon placed him in the top 7 percent of finishers and qualified him to run again in 2015. He has not missed running in a Boston Marathon since—finishing “I hold the responsibility that rests on an educator’s shoulders in high regard and, as such, want to ensure that I come to the classroom with every tool available in my teaching toolbox.” 12 Diplomate status by the American Board of Endodontics; at the recommendation the LLUSD of promotions committee, he was awarded the status of associate professor; and he accepted the position of chair, Department of Endodontics. 2015 in 2:54; 2016 in 2:58; and 2017 in 3:04. awarded He subsequently was appointed (August 1) associate graduate Meanwhile he has run several ironman triathlons, including director of the Advanced Specialty Education Program in the November 2015 Arizona IRONMAN in Tempe where he Endodontics. “I’m honored to undertake the responsibilities competed with first time Ironman racer Brandon Soelberg, entrusted to me in guiding predoctoral and graduate students DDS’16. Dr. Silvestrin finished 101st out of 2,681 racers. through their endodontic curriculum journeys. I’ve had great While Dr. Silvestrin was juggling advanced degree programs, mentors to guide me and provide sage advice through this undergraduate instruction, and his running, Dr. Alexandria transition and feel fully capable to succeed and excel in this Brent-Silvestrin joined a team of five other private practitioners new capacity.” at Canyon Crest Dental in Riverside, to which she brings her His sober engagement with the major issues of life illustrates expertise as an oral conscious sedation provider, DOCS member, Dr. Silvestrin’s profound belief in the interdependence of faith, and Invisalign provider. community, and service that was the foundation of his choice One very meaningful activity the Drs. Silvestrin did together after three years of studying and working at LLUSD to commit away from dentistry was study the beliefs of their adopted himself to the School and its programs as a faculty member and community with a Seventh-day Adventist Church and its now as an administrative participant as well. Without question, pastor, Michael Kelly, as they assessed the biblical support for he brings to his academic and professional accomplishments Adventist Church doctrines. After engaging a number of local the kind of energy and focus his marathon (and regular daily) SDA congregations, the couple found at the Mt. Rubidoux running habits imply. SDA Church a welcoming community of faith. Following a lot That running remains an important counterpoint to his of considered Bible study and a growing conviction that they professional life. With running comes endorphins and with wanted to become seventh-day Sabbath-keeping Adventists, endorphins comes cheer, and in the case of Dr. Silvestrin the Tory and Alexandria made the decision to be baptized by Pastor rule is borne out. It’s a wonderfully vicious cycle. Volume 28, Number 2 LLUSD ARTICULATOR TRANSITIONS Jessica Kim named director of Hugh Love Center for Research & Education in Technology essica Kim, DDS’05, assistant professor, Division of General Dentistry, was recently appointed (September 8, 2017) director of the Hugh Love Center for Research & Education in Technology. A former director of the LLUSD International Dentist Program, Dr. Kim replaces Nadim Baba, DMD, MSD, professor, Division of General Dentistry, whom Dean Joseph Caruso thanked “for his five years of service in the capacity of Technology Center leadership that has provided a solid foundation on which we will continue to build.” Dr. Kim graduated in 2000 from Loma Linda University School of Allied Health Dr. Jessica Kim Professions with a Bachelor of Science degree in Clinical Laboratory Sciences. It was during her undergraduate studies, while working as a clinic laboratory scientist at the LLU Medical Center, that Dr. Kim chose a career in dentistry. J After graduating with her DDS in 2005, Dr. Kim earned a certificate in Dental General Practice from the University of Nevada School of Medicine in 2006. With certificate in hand, she returned to LLU as an assistant professor in the Department of Restorative Dentistry, where she mentored junior and senior dental students in the School’s clinic while working part time with a couple of nearby dental practices, before joining the LLU Faculty Dental Practice in 2008 and then the Koppel Special Care Dentistry Center one day each week beginning in 2010. Dr. Kim was born in South Korea and at the age of three moved to California with her parents and sister. She is married to Michael Kim, DDS’11, who practices privately in the Inland Empire. Pooyah Soltanzadeh has been appointed an educator dentist ooyah Soltanzadeh, DDS, has been appointed an educator dentist at LLUSD’s P Division of General Dentistry, beginning September 29, 2017. Dr. Soltanzadeh received his DDS in 2009 from Tehran University of Medical Sciences School of Dentistry in Iran, where he practiced dentistry for three years before spending two years in a post-doctoral program at UCLA School of Dentistry in prosthodontics while conducting research in implant dentistry. In 2014, Dr. Soltanzadeh began LLUSD’s Advanced Specialty Education Program in Prosthodontics from which he earned in 2017 a certificate and honors for excellent performance in prosthodontics. Dr. Pooyah Soltanzadeh 13 LLUSD ARTICULATOR Summer / Autumn 2017 BY THE NUMBERS Profiling the DDS class of 2021 GPA (cumulative) Non-science average Science average DAT Academic average Total Science Reading Comprehension 20.04 19.98 20.70 Applicants Total applicants SDA 1,844 149 84 3.51 3.68 3.39 Gender Female Male 30 73 Ethnicity African American 1 Asian Pacific Islander 55 Caucasian 26 Hispanic 13 Mixed ethnicity 4 Unknown 3 Number of 2017 graduates 24 Class of 2017 doctor of dental surgery 29 More than half the class of 2021 matriculated from these six schools: Pacific Union College 18 La Sierra University 10 Southern Adventist University 10 Andrews University 7 Cal State University–Fullerton 5 Walla Walla University 4 Average Age 23.24 Number of 2017 graduates Class of 2017 doctor of dental surgery (International Dentist Program) 27 Number of 2017 graduates Class of 2017 dental hygiene (19 BS degrees; 10 AS degrees) Number of 2017 graduates Class of 2017 Advanced Specialty Education Programs (25 professional certificates; 21 advanced degrees, MS or MSD) $61.4 M One Loma Linda: eight schools Annual budgets in dollars Annual enrollment in students $38.5 M $25.6 M $14.7 M $10.9 M $38.5 M $7.7 M $3.0 M 1,294 360 SAHP SBH 608 841 754 294 278 22 SD SM SN SP SPH SR Volume 28, Number 2 LLUSD ARTICULATOR WHERE ARE THEY NOW? Brief updates on the noteworthy professional and personal activities of LLUSD alumni Phil Hardy Phil Hardy, DDS’73, lives near Croscombe Nr Wells in Somerset, Great Britain, a short distance from his birthplace and the church he attended as a child. But Dr. Hardy has not always lived in England. In an interview while practicing dentistry in Victoria, B.C., 1973-76, he heard the proposal, “You’re the kind of guy Saudi Arabia needs.” After agreeing to go, he received a phone message, “Doc, you maybe should Dr. Phil Hardy know you will be dentist to the royal family.” Thus began 40 years of dental practice in Saudi Arabia. Dr. Hardy saw the first traffic light go into the capital city. Treating the richest man in the world was quite a shift. The patient would show usually after three no-show appointments, after hours naturally. His family and friends were regulars at the dental office. “I left Saudi after 40 years,” Dr. Hardy says. “I thought when I hung it up life would be all over for me at 80. Now my orchids love me. They reside in our conservatory. Underneath the conservatory the sauna is on. In a few days I am off to New Zealand at 83.” As he tends his vegetable garden, his neighbor calls him a rabbit. “Life is a ball,” he asserts. Brian Nový Discouraged by a high school teacher who told him he wasn’t cut out to be a dentist, Brian Nový, DDS’06, became a successful counter tenor in opera. But in his recurring panic, “Oh, am I going to hit that high note?” he turned to dentistry. It became a fit. In the dental classroom as a teacher, he found that opera performance had reduced his anxiety about facing an audience; he welcomed the challenge to make dental materials Dr. Brian Novy interesting. Now Dr. Nový is exploring new steps in use of dental materials. He has placed more than 3,800 ionometer sealants on 500 children between the ages of two and sixteen, documenting each with before/after photos. He describes the project pursued during LLUSD trips to Nicaragua: “Unlike most mission trips, the focus is on preventing new disease rather than extracting the worst tooth in the mouth, and we are gathering data on our success.” Dr. Nový’s experience in clinical research, teaching, and practicing dentistry has contributed to his expertise in risk-assessment and evidence-based dentistry. Now located in Westborough, Massachusetts, he serves as director of practice improvement at DentaQuest Institute and president of the DentaQuest Oral Health Center. He calls his career “the best job in the world.” Janice Klim-Lemann Janice Klim-Lemann, DDS’’84, is one of the country’s 86 diplomates boarded by the American Board of Forensic Odontology. Her expertise was honed by performing a rigid set of procedures: two years’ affiliation with a forensic agency and performing a minimum of 35 cases, identifying at least 20 or more, 15 of them with positive results. During 20 years of dental practice in Fontana, California, Dr. Lemann Dr. Janice Klim-Lemann processed the specified cases and became a boarded forensic odontologist. Because teeth have such hard substance, they provide evidence when the body otherwise is destroyed. Dr. Lemann describes a challenging homicide case. The victim’s body parts were chopped and burned in three different fire pits. Sifting through the pits recovered parts of two upper molars. Spotting unique root and pulpal anatomy, Dr. Lemann made a one-to-one record of the x-ray and the molars. Superimposed, they provided a positive ID. Dr. Lemann arrived at the twin towers in New York City on September 14, after the 9/11 attack. In the ante mortem section, she entered information into a computer. Many identifications depended on bits and pieces. Relatives came by, putting up pictures and offering dental records of their loved ones. Yes, the work is satisfying, says Dr. Lemann. “You’re helping solve a puzzle and thereby permit closure.” Sunie Nelson-Keller Combined nursing and dental hygiene skills enhance the status of Sunie Nelson-Keller, RN’77, BS’79 (DH), of Rocklin, California. She is a certified legal nurse consultant. Her dual role brings a variety of business. She recalls the case of an endodontist charged with doing a procedure on the wrong tooth. After examining the records she reported to the attorney, “No malpractice involved. The client is claiming that Ms. Sunie Nelson-Keller the procedure occurred on a tooth that is obviously a virgin tooth.” In a wrongful death case, an 80-year-old woman coded during cosmetic leg surgery. Reading the records, Sunie found that while the surgeon was absent for 40 minutes, the patient was turning blue as the nurse pumped IV sedation—a forbidden procedure without the presence of a physician. Alerted, Sunie’s attorney/client made a five-minute call to the defense, settled the case for $250, 000 and said to Sunie, “It was well worth having you review the case for me.” “I get paid for sleuthing through medical and dental records,” says Sunie, who also lectures to attorney groups on malpractice. Her latest publication is pertinent: Dental infection issues that contribute to dental malpractice, Journal of Legal Nurse Consulting, 2016; 27:2: 31-35. 15 LLUSD ARTICULATOR Summer / Autumn 2017 DEVELOPMENT Hayden family donates valuable research material A stunning collection of fetal anatomic prosections, and ‘approximately 50,000 glass slides’ of tissues originally prepared and stained for light microscopy by Edwin Christiansen, DDS, PhD, and Dwight Rice, DDS ollowing the death of LLUSD teaching alumnus Jess Hayden Jr., DMD, MS, PhD, in 2012, a sequence of contacts between the School of Dentistry and Dr. Hayden’s widow, Anita Hayden, and his son, Gregory Hayden, resulted in a unique gift to LLU School of Dentistry—Dr. Hayden’s collection of professional books, journals, teaching materials, and archived research. At the suggestion of LLUSD alumnus Gerald Denehy, DDS’68, Gregory Hayden reached out initially to William Hooker, PhD, associate professor, School of Medicine, who contacted Charles Dr. Jess Hayden, Jr Goodacre, DDS’71, MSD, distinguished professor, Advanced Specialty Education Program in Prosthodontics; both encouraged Dwight Rice, DDS’96, associate professor, Radiology and Imaging Sciences, to oversee the Hayden collection donation. Under the supervision of Dr. Hooker and Dr. Rice, the collection was moved from Dr. Hayden’s garage, where it had been stored for over 15 years, to the more controlled environment of Prince Hall, where it remains under the curatorship of Dr. Rice. F 16 What makes the gift of Dr. Hayden’s collected professional work product so important is the nature of his preserved research (see box page 18) that includes a stunning collection of fetal anatomic prosections, and approximately 50,000 glass slides of tissues originally prepared and stained (either standard hematoxylin and eosin or other tissue-specific special staining) for light microscopy. According to Gregory Hayden, following a change of deans, his father left his position as associate dean for research at the University of Iowa School of Dentistry to pursue a fellowship in anesthesia at the University of Denver, where he became senior clinical fellow. He remained in Denver to practice privately before closing his office in the late 1980s. Subsequently called to active duty with the Navy for the Persian Gulf War, he was stationed at Balboa Naval Hospital in San Diego. After his discharge from the Navy, Dr. Hayden lived for a time at his hometown of Eugene, Oregon, before retiring to Loma Linda. “Dr. Hayden was ahead of his time,” says Dr. Rice. “All the Volume 28, Number 2 LLUSD ARTICULATOR Photo courtesy of Dr. Dwight Rice, Hayden Collection curator and contact for images. From the Hayden Collection: This micro-sectioned and histologically stained slide depicting the formation of mandibular tooth buds was imaged using the Zeiss Axio Scan Z1 scanner. The high resolution of the scan enables the illustration of structures down to the cellular level. In this example, odontoblasts and the developing enamel are shown at various zoom levels. 17 slides are serially registered, meaning that scanned slides can be ‘electronically stacked’ in a way that may allow them to be reconstructed as 3D images using computed tomography (CT) imaging software.” The scanning process is necessary to accomplish the complex manipulations necessary to electronically archive each slide in a digital format. Once digitized and organized, the collection will become a dynamic research tool available to research scientists everywhere. What was it that led Dr. Hayden to spend more than a decade of effort to produce the 50,000 slides? The ongoing search for understanding. The task he assigned himself was funded by three independent research grants: NIDR, 19571960; NIDR, NICHHD, 1961-1965; NIDR, NICHHD, 1967-1972. Dr. Hayden spent 12 years recording anatomical variability in the development of fetal jaw neurovascular pathways in his “laboratory” located in a small room below the Shryock Anatomy Amphitheater (see Shryock Hall adjacent page), where he meticulously recorded, numbered, and cross referenced in a logbook each step of his anatomical indexing project. As far as can be determined, the Hayden Collection is not just rare but the only such aggregation of fetal jaw prosections in the world—a “one-off” collection, the only one in existence! Since the “rediscovery” and donation of Dr. Hayden’s work, academic and research scholars have expressed strong interest in having open access to his collection as a valuable supplement to their instructional and research efforts. Interested readers may contact Dwight Rice at: drice@llu.edu LLUSD ARTICULATOR L-R: Edwin Christiansen, Dwight Rice, Anita Hayden, William Hooker, and Gregory Hayden The Hayden Collection contents 18 • 180 large microscopic glass slide cases holding approximately 240 glass slides per box (43,200) • 30 medium microscopic glass slide cases holding approximately 100 glass slides per box (3,000) • 50 small microscopic glass slide cases holding approximately 50 glass slides per box (2,500-total slide collection is approximately 48,700 slides) • 30 dry mandibles • 1 dried bone teaching skull • 400 historic teaching glass projection slides • 2 (16mm) movies used in teaching of the project • 100 photos of hand-drawn illustrations used in publications and teaching • Jess Hayden, Jr. DMD, PhD, histology slides documents (1 box) • Jess Hayden, Jr. PhD thesis Summer / Autumn 2017 The Zeiss Axio Scan.Z1 is a rapid slide scanner for brightfield and fluorescence that digitizes specimens and creates high-resolution, virtual images for demanding virtual microscopy. Making it happen The availability of Dr. Hayden’s stunning archives to forthcoming research projects is entirely dependent on the optimal preservation of the collection. This requires that each slide be cleaned, reconditioned, digitally scanned, and catalogued to enable accessibility that will transform this asset to one that is digitized and archived online for research scientists worldwide. This transformation will require a ZEISS, highresolution, optical scanner. Contributions to that acquisition are more than welcome and can be made by contacting the LLUSD philanthropy team at (909) 558-4754, email: sdgiving@llu.edu or go to: tinyurl.com/ jycabbj Volume 28, Number 2 LLUSD ARTICULATOR Pediatric Dentistry receives large gift to fund PNAM for cleft lip/palate babies n behalf of the Advanced Specialty Education Program in cosmetically effective PNAM has been with the LLUSD Pediatric Dentistry, Jung-Wei “Anna” Chen, DDS, MS, PhD, graduate program’s young cleft lip and palate patients. MS, its program director, was presented a check on July 17, Dr. and Mrs. Oh were impressed and touched by how 2017, for $200,000 to advance the use of effectively the PNAM procedures fulfill Mr. Pre-surgical Nasal Alveolar Molding (PNAM) Olsen’s intentions. on infants with cleft palate/cleft lip. Dr. Oh was surprised to learn that The gift from the late Eric Olsen’s this was the first time a donation has estate was presented by its executors been made to support cleft lip and palate (Olsen’s next door neighbors and friends), patients treated with the PNAM procedure Dr. Ron Oh and his wife Marge Oh (sister and appliance at LLUSD. He believes this is of LLUSD Professor Dan Tan, DDS’75A). a [near] miracle that should be well known Mr. Olsen concluded his career working in and widely available to the public. labor relations at LLU’s Human Resources A small committee will oversee the department. disposition of the gift’s annual interest, The Ohs approached the LLUSD Office which will be used to spread cleft lip and of Philanthropy because Mr. Olsen’s will Eric Olsen, PNAM benefactor palate awareness and to let families of the stated that he wanted to help children with Inland Empire and beyond know that PNAM cleft lip and palate. Mr. Olsen was born with a deformed arm treatment is available at LLUSD. The gift will support financially and throughout his life felt diminished by people noticing the families of cleft lip/cleft palate babies by covering small his abnormality. He was particularly attracted to the idea of but important aspects of their lives such as child care and gas minimizing the embarrassment of cleft lip children and sparing money for their treatment appointments that involve weekly them the pain he felt at being noticeably different. visits to closely monitor the progress of such young patients. LLUSD development officer Juliana Powell arranged a 2019 will mark the 10-year reunion for patients who were meeting with Dr. Chen and the Ohs on behalf of Mr. Olsen, first treated with the PNAM appliance in LLU’s Pediatric who died in April this year. Dentistry Clinic. This event will bring together a large Using two PowerPoint presentations, Dr. Chen reviewed gathering of PNAM alumni and their parents to celebrate with Dr. and Mrs. Oh the significant advantages of the PNAM the success stories of so many PNAM babies and the life process and shared with them past copies of the School of enhancing possibilities Mr. Olsen’s generous gift will expand. Dentistry’s alumni journal that included examples of how O L-R: Juliana Powell, Dr. Chen, Dr. Oh, Mrs. Oh, and Dr. Tan. 19 LLUSD ARTICULATOR Summer / Autumn 2017 COMMENCEMENT 2017 LLUSD’S 61st conferring of degrees B acked by a blur of international flags and a cordon of LLUSD faculty, the School of Dentistry’s May 28, 2017, commencement address was given by Jim Wood, DDS’86, second term assemblyman for California’s 2nd District. Dr. Wood chose to attend LLUSD “because I valued its mission—’Service Is Our Calling.’ They said if you give back, become an excellent clinician, and do the best for your patients, you’ll be successful. And its absolutely true.” Victoria Kha: “The Mighty 19” are “prepared for any challenges.” He closed with a couple of statements he finds most meaningful. From David Viscott: “The purpose of life is to discover your gift. . . .The meaning of life is to give your gift away.” And his personal favorite from Nelson Mandela: “I never lose; I either win or I learn.” “You have all won here today,” he congratulated the classes of 2017. “I hope you always win.” Dr. Jim Wood: “You have all won here today.” 20 For Dr. Wood, giving back meant 26 years of private practice in the small town of Cloverdale where he became increasingly involved in its community life—Rotary Club, planning commission, and city council. He also became engaged in the wider world as a designated forensic dentist representing the North Coast counties of California and as a member of the national emergency team responding to the attack on the World Trade Center after 9/11 and to the aftermath of hurricane Katrina in New Orleans. “Those events left me changed in many ways,” he noted. “I returned with an even stronger passion to serve others.” As a result of his extensive community engagement, he also “heard a new calling and ran for the state legislature,” where he has become particularly instrumental in the issue of healthcare accessibility and environmental protections. “You have a gift,” he reminded the class of 2017. “You’ve become a dentist to care for people, to help people, to educate and encourage them to take care of themselves. Your gift can change someone’s life. It can change their trajectory in life.” Listing a variety of opportunities in the dental profession, Dr. Wood added, “But I hope all of you will open yourselves up to the larger community and know that your education has just begun.” The Mighty 19 Dental Hygiene BS degree class of 2017 president Victoria Kha thanked faculty, family, friends, and “especially those who were brave enough to be our patients.” Reconfigurations of recruitment and admissions processes had provided the class of 2017 a smaller than normal 19 students—what the Department of Dental Hygiene faculty called The mighty 19. “The smaller class size,” Ms. Kha noted, “provided advantages of extra faculty attention, more one-onone with professors, and more time on the clinic.” The Mighty 19 “motivated each other as each quarter got exponentially harder . . . with strength, laughter, and clarity.” “These challenges facilitated growth,” Ms. Kha was confident. “And our education at Loma Linda has prepared us for any challenges that our careers may throw at us.” We’ve walked a tightrope. Dentistry class of 2017 president Evan Agnetta thanked “my wife, Locha, and all the spouses that endured with us and carried us through. You are our inspiration, never failing or wavering in your faith in us, you’ve been patient and you’ve made our goals your own. This accomplishment is just as much yours as ours. Volume 28, Number 2 LLUSD ARTICULATOR Dr. Young is congratulated by Dr. Hart and Dr. Caruso. Evan Agnetta” “Our trust was well placed.” “When we began this journey . . . naively [we were] armed only with the essentials: faith, hope, confidence, determination and, perhaps most importantly, profound ignorance.” Agnetta relied on C. S. Lewis (The Problem of Pain) to explain that we too often associate love with happiness and ease: “We are, not metaphorically but in very truth, divine works of art, something that is being made, and therefore something with which the artist will not be satisfied until it has a certain character.” “While ‘it may be natural,’ as Lewis wrote, ‘for us to wish a less difficult and arduous destiny, we would be wishing for one with less love and not more.’ And while it may not have always felt like it [love] when Dr. Taylor’s mass emails went out, or when we read Dr. Young’s comments on our lab slips, we have experienced a great privilege to be here. “This journey started with approximately 1,700 applicants. Of those, 93 were accepted. Of those original 93, 82 are here today. . . . When I look out at our class, I see the beginnings of many beautiful masterpieces. And as our freefall has ended, we have found that our trust was well placed.” Agnetta left his classmates with one final thought and a quote. “Rather than allowing yourself to be defined by your past and where you have been, insist on defining yourself by where you are going. Winston Churchill said, ‘Success is not final, failure is not fatal: it is the courage to continue that counts.’” Faculty awards Before the conferring of degrees, three faculty members were selected for special recognition. Ronald Young, DMD, assistant professor, Division of General Dentistry, was presented the Teacher of the Year Award by Robert Handysides, DDS’93, associate dean, Office of Academic Affairs, who said in citing Dr. Young: Dr. Ronald Young is an Inland Empire native raised in Cherry Valley and attended high school in Beaumont. He earned his bachelor’s degree in chemistry from USC in 1977 and his DMD from Fairleigh Dickinson University School of Dentistry in 1981. Dr. Young spent most of his career as a solo practitioner in Hawaii. He returned to the mainland and assumed a teaching position here at Loma Linda in 2005. Since his arrival, students have appreciated his warm, caring demeanor, his clinical experience and knowledge, as well as his flamboyant Hawaiian shirts. . . . As evidence of the students’ respect for Dr. Young’s teaching, one only has to look at the consistently outstanding evaluations that are submitted about him by students. From this year’s graduating students: “Dr. Young is funny and energetic. He is extremely knowledgeable to work with.” “He’s a great person to have on clinic; he challenges you; but makes sure you get through on a positive note.” “Dr. Young has been a valuable mentor to me on clinic. He brings a real-world approach to the clinic that is very applicable to me moving forward in my career.” While Ron has been teaching here for 12 years, it is viewed by many as not nearly long enough. Despite these feelings, he has announced his desire to step down at the end of this school year. But before he goes into a well-deserved retirement, and in appreciation for what he has contributed to Loma Linda University, and in particular to the School of Dentistry family, it is my honor to present Dr. Ronald Young the 2017, School of Dentistry Teacher of the Year Award by saying, “Mahalo and congratulations, Ronald!” Presenting the other two LLUSD faculty award recipients with awards for their distinguished contributions to the School of Dentistry, Interim Dean Joseph Caruso said, After completing his dental degree at Loma Linda University in 1975, Edwin Christiansen, DDS’75, MA, PhD, joined a dental practice in South Lancaster, Massachusetts. The following 21 LLUSD ARTICULATOR Dr. Christiansen accepts congratulations from Dr. Hart and Dr. Caruso. 22 year, Dr. Christiansen returned to the West Coast and a group practice until 1977, when he began practicing privately in San Bernardino, California. In 1979 he joined Loma Linda University’s School of Dentistry faculty and subsequently became coordinator of its temporomandibular joint (TMJ) Clinic. His interest in research began early in his career when studying the use of advanced imaging modalities to identify temporomandibular disorders. In the early 1980s, Dr. Christiansen completed an externship at the LLUMC Radiology Department exploring magnetic resonance imaging and computed tomography related to TMJ imaging and interpretation. It is of note that LLU was identified as a leader in the field of TMJ imaging during the 1970s and l980s. Dr. Christiansen has continued his research and has published over 60 scientific papers and abstracts in peerreviewed journals. In addition he has presented over 40 papers and posters at scientific sessions of national, state, and local professional organizations. His publication record has helped form the basis for co-authoring two textbooks on TMJ imaging, and, in addition, he has co-authored six textbook chapters – all relating to advanced imaging of head and neck anatomy. In recognition of his outstanding scholarship and for his invaluable contributions to the dental profession in the field of head and neck research and treatment, the School of Dentistry names Dr. Edwin Christiansen recipient of the School Distinguished Research Award. Yiming Li, DDS, MSD, PhD, spent five years at a Chinese government-mandated farm, operating farm machinery, navigating boats, and filling in as electrician and plumber before aptitude tests enabled him to take dentistry at Shanghai’s College of Stomatology. He subsequently joined its faculty. Further assessment earned Dr. Li an overseas student grant to Indiana University. Summer / Autumn 2017 Dr. Li is congratulated by Dr. Hart. When recruited in 1997 by Loma Linda University, Dr. Li was serving as director of Indiana University’s Cell Culture Research Laboratory, director of the Biocompatibility Core Facility of its Biomechanics and Biomaterials Research Center, and director of its Electron Microscopy/Confocal Microscope Facility. At LLU School of Dentistry, Dr. Li joined the Biocompatibility and Toxicology Research Laboratory at the Center for Dental Research, becoming in 2004 its director. He has worked tirelessly to update and upgrade the Center, ultimately designing and overseeing installation of its new facility in Chan Shun Pavilion, which opened in February 2015, a year after he was appointed LLUSD associate dean for Research. A prolific researcher, Dr. Li has generated 305 publications (including 127 articles/book chapters and 178 abstracts) during his professional career. In addition, he has given more than 139 presentations worldwide. Dr. Li has served his profession in many capacities including teaching in pre-doctoral and post-doctoral classes; he has been a member of the Graduate Student Advisory and Research committees for 25 students, is a member of the editorial board of four dental journals, reviews manuscripts for 16 journals, and is a special reviewer for NIH/NIDR grant applications. Highly esteemed for his professional expertise, achievements, and contributions to his profession, Dr. Li has received numerous invitations for international professorships. In recognition of his outstanding scholarship and invaluable contribution to the field of dentistry, the School of Dentistry names Dr. Yiming Li recipient of the School Distinguished Service Award. A few pictorial memories from LLUSD’s 2017 Commencement service, including photos from LLUSD’s dental hygiene, dentistry, dentistry (IDP) and advanced education programs appear on the adjacent and following pages. Volume 28, Number 2 1 4 LLUSD ARTICULATOR 2 As these photos illlustrate, at least a dozen 2017 graduating dentists were either the offspring, siblings, or spouses of LLUSD alumni (follow the numbers): 1. David You with his sister, Julia You, DDS’14; 2. Jordan Higa, with his father, Edward Higa, DDS’87 and his mother, Peggy Higa, BS’88 (DH); 3. Alyssa MeisterBurns, with her father, Robert Meister, DDS’78; 4. Ereni Sellas, with her father, James Sellas, DDS’83, and her sister, Sophia Sellas-Gile, DDS’11; 5. Mason Segura, with his father, Thomas Segura, DDS; 6. Miranda Kore, with her mother, Rachel Kore, DDS’01; 7. Jessica Kwon, with her sister, Catherine Kwon, DDS’09; 8. Kelly Kaban, with her father, Lawrence Kaban, DDS’86; 9. Jonathan Stuart, with his brother, Geoff Stuart, DDS’03; 10. Bryan Otis, with his father, David Otis, DDS’85; 11. Tanner Song, with his father, Ki Song, DDS’90, and his mother, Tamara Elloway-Song, DDS’90; 12. Timothy Prewitt, with his father, Randall Prewitt, DDS’82 3 5 23 6 9 7 8 10 11 12 LLUSD ARTICULATOR Summer / Autumn 2017 2 3 4 1 These dentistry class of 2017 graduates demonstrate that happiness has many faces as they celebrate their diplomas (From upper left and clockwise): 10 1. Jim Ervil with acting dean, Dr. Caruso; 2. Jason Ahn; 3. Valecia Liew; 4. Macy Fuhs; 5. Fabiola Giron with Dr. Caruso; 6. Bashar Fargo and Bassam Fargo; 7. Samuel Sauza; 8. Ashley Atkins with Dr. Caruso; 9. Osman Cruz with Dr. Caruso; 10. Richard Le. 5 6 24 9 8 7 Volume 28, Number 2 LLUSD ARTICULATOR 1 3 2 Eight class of 2017 Dental Hygiene graduates with their diplomas (and five of their mentors) are pictured (some with Interim Dean Joseph Caruso) clockwise from upper left: 9 1. Jessica Daniel, AS (DH); 2. Tiffany Francis, AS (DH); 3. Estefany Hernandez, BS (DH); 4. Tricia Rodriguez, BS (DH); 5. Lemuel Feceu, BS (DH); 6. Dental hygiene mentors (L-R): Kris Wilkins, BS’80 (DH), MA’02; Shirley Lee, BS’82 (DH), MS’07; Shelly Hayton, BS’82 (DH), MA’10; Bethany Shears, BS (DH); and Patricia Lennan, BS (DH), MS’14 7. Alycia Lopez, BS (DH) 8. Rachel Norman, BS (DH) 9. Joufika Gestoso, AS (DH) 8 25 4 10 7 6 5 LLUSD ARTICULATOR Summer / Autumn 2017 1 2 3 A sampling of the International Dentist Program (IDP) class of 2017 graduates appear from top left and clockwise: 1. Laila Hadid and her husband, Omran Bishbish, DDS’16 (IDP), are bracketed by IDP director, Dr. Mark Estey, and acting dean, Dr. Joseph Caruso; 2. Artur Arkelakyan holds his diploma between Dr. Estey and Dr. Caruso; 3. A pleased Hussam Aloka (class representative) stands with his DDS diploma; 4. Jane Kenneth Zarate is congratulated by Dr. Estey and Dr. Caruso; 5. Olga Leizerovitz displays her diploma; 6. Yulia Chigir presents her diploma to the camera; 7. Anahita Akbari Farahani delights in her accomplishment; 8. Reza Abaei-Tafreshi receives his diploma from Dr. Estey and Dr. Caruso; 9. Lokesh Kumar has reason to smile. 9 8 4 26 7 6 5 Volume 28, Number 2 LLUSD ARTICULATOR Advanced endontic program graduates Brent Hiebert, DDS’10; Rita Hung, DMD; Gregory Sprague, DDS; and Kiarash Yeganegi, DDS, anticipate their MSD diplomas. Advanced pediatric dentistry program graduate Linda Ngo, DDS, holds her MSD diploma between program director, Dr. Jung Wei Chen and acting dean, Dr. Joseph Caruso. Advanced OMFS graduate, Glenn Green, DDS receives his certificate bracketed by OMFS program director, Dr. Jayini Thakker and acting dean, Dr. Joseph Caruso. 27 Advanced periodontics graduate Munehiko Ro, DDS, holds his certificate between program director, Dr. Erik Sahl, and acting dean, Dr. Joseph Caruso. Advanced orthodontics and facial orthopedics prgram graduate, Skyler Liatti, DDS’14, exults in his MS diploma as he hugs orthodontics department chair, Dr. Leroy Leggitt. Advanced periodontics program graduates, Munehiko Ro, DDS, (Cert); Fallon Livingston, DDS’14, MS; and Caitlyn Bell, DDS, MS, celebrate. Advanced prosthodontic program graduates, Abdulkareem Alshehri, BDS, MS; Sarah Bukhari, BDS, MS; and Brian Goodacre, DDS’13, MSD (dual major: implant dentistry & prosthodontics) anticipate their diplomas. LLUSD ARTICULATOR Summer / Autumn 2017 LLUSD officers commissioned and promoted L-R: Mason Segura, DDS’17, Lieutenant, US Navy; Stephan Barrington, DDS’17, Lieutenant, US Navy; Michael Siy, DDS’17, Lieutenant, US Navy; Michael Schwer, DDS’17, Lieutenant, US Navy; Dr. Gary Golden; Dr. Clyde Roggenkamp; Dr. Leslie Arnett; Alyssa Meister-Burns, DDS’17, Captain, US Army; Charlie Kim, DDS’17, Captain, US Army; and Jason Ahn, DDS’17, Captain, US Air Force Seven graduating dental students participated in the Sunday morning, May 28, 2017, Commissioning Ceremony conducted by Michael Walter, MD, Brigadier General, US Army (retired) at the Randall Visitor Center. Gary Golden, DDS’76, assistant professor, Division of General Dentistry, Colonel, USAF (Retired), offered prayer. Also standing in support with the newly commissioned LLUSD graduates were Clyde Roggenkamp, DDS’70, MSD, MPH, associate professor, Division of General Dentistry, Lt Colonel, US Air Force (Retired), and Leslie Arnett, DDS, MS’68, professor, Department of Periodontics, US Navy Lieutenant (Retired). Mrs. Marianne Walter offered encouraging remarks to the spouses, General Walter recited the Oath of Office and Promotion, and the audience joined the newly commissioned and promoted officers in singing “God Bless America.” 2017 officer commissioning photos are available at: https://llusd.shutterfly.com/pictures/20576 Volume 28, Number 2 LLUSD ARTICULATOR Dental hygiene students pinned T wenty-nine graduating dental hygiene students from the BS and AS programs, 19 and 10 respectively, took part in the School of Dentistry’s annual dental hygiene pinning ceremony. Pictured below, class of 2017 dental hygiene students anticipate their pinning ceremony at the entrance to the Loma Linda Campus Hill SDA Church. 29 Dental hygiene student awards—2017 American Association of Public Health Dentistry Lemuel Feceu, BS’17 Bates Award Uyen To, BS’17 California Dental Hygienists’ Association Outstanding Leadership Award Simone McClelland, AS’17, Cammie Antell, BS’17 Clinician’s Award Jessica Daniel, BS’17 Colgate STAR Award Andi Chau, BS’17 Dean’s Award Bethany Shears, BS’17 Joni Stephens’ Preventive Dentistry Award for Research (BS’17) Cammie Antell, Kiarra Gist, Bethany Shears, Uyen To Klooster Humanitarian Award Rachel Norman, BS’17, Amanda Lopez, AS’17 Middleton Award Bethany Shears, BS’17, Joufika Gestoso, BS’17 Mitchell Award Norma Juarez, BS’17, Tiffany Gurrola, BS’17 Service Learning Award Lemuel Feceu, BS’17, Bethany Shears, BS’17 Sigma Phi Alpha Award Cammie Antell, BS’17, Vicoria Kha, BS’17, Kiarra Gist, BS’17 Tri-County Dental Hygienist’s Society Award Cammie Antell, BS’17 Western Society of Periodontology Award Melissa Cardenas, AS’17 LLUSD ARTICULATOR Summer / Autumn 2017 STUDENT AWARDS Student Achievement Awards 2017 During the School’s annual banquets for DDS and IDP students and during graduation weekend, 55 different awards were presented or recognized as having been received elsewhere. The awards and their recipients are listed below alphabetically. Academy of Dentistry International Student Servant Leadership Award Christopher Chan, DDS’17 Academy of General Dentistry Award Kelly Kaban, DDS’17, Mason Segura, DDS’17 Academy of Operative Dentistry Award Cara Jones, DDS’17 Academy of Osseointegration Implant Dentistry June Kim, DDS’17 Alpha Omega Certificate of Academic Achievement Meryl Liu, DDS’17 Alumni Association Award Timothy Prewitt, DDS’17 American Academy of Gold Foil Operators David You, DDS’17 American Academy of Implant Dentistry Kelly Kaban, DDS’17 American Academy of Oral and Maxillofacial Pathology Award Meryl Liu, DDS’17 American Academy of Oral and Maxillofacial Radiology Award Bryan Otis, DDS’17 American Academy of Oral Medicine Award Meryl Liu, DDS’17 American College of Prosthodontists Award Kenton Dalen-Gryckiewicz, DDS’17 American Dental Association Foundation Scholarship (D2) Bianca Esparza, DDS’17, Kelly Kaban, DDS’17, Amanda Manzano, DDS’17, Melissa Seidel, DDS’17 American Dental Society of Anesthesiology Horace Wells Award Dana Yoon, DDS’17 American Student Dental Association Evan Agnetta, DDS’17 Annual Colgate Student Research Recognition Stephan Barrington, DDS’17 Boyko Award for Christ-like Service Michael Siy, DDS’17 Brian D. Stone Memorial Award Eric Gutierrez, DDS’17 California Dental Association Senior Award Chamandeep Brar, DDS’17 CDA Foundation Research Table Clinic Scholarships (D3) 2nd Place: Stephan Barrington 3rd Place: Charlie Kim Honorable Mention: Mason Segura American Academy of Pediatric Dentistry Mason Segura, DDS’17 Clinic Awards – DDS’17 Christopher Chan, Macy Fuhs, Eric Gutierrez, Kelly Kaban, Meryl Liu, Mason Segura, Michael Siy, Jonathan Stuart – DDS’17 (IDP) Haider Anwar, Martha Senar American Academy of Periodontology Macy Fuhs, DDS’17 Delta Dental Student Leadership Award Christopher Chan, DDS’17 American Association of Endodontists Hussam Aloka, DDS’17 Fixed Prosthodontics Award Melissa Seidel, DDS’17 American Association of Oral and Maxillofacial Surgeons Award Christopher Chan, DDS’17 ICOI/Dentsply Pre-doctoral Student Achievement Award Meryl Liu, DDS’17 American Association of Oral Biologists Charlie Kim, DDS’17 International College of Dentists Student Leadership Award Kyim Mung, DDS’17 American Academy of Orofacial Pain Award Christopher Chan, DDS’17 30 American College of Dentists, SoCal Section Kenton Dalen-Gryckiewicz, DDS’17 American Association of Orthodontists Award Melissa Seidel, DDS’17 Volume 28, Number 2 LLUSD ARTICULATOR International College of Dentists Student Humanitarian Award Michael Siy, DDS’17 LLU Center for Dental Research Basic Science Award (D2) Meryl Liu, DDS’17 Pierre Fauchard Academy Award Mason Segura, DDS’17 Pierre Fauchard Academy Foundation Scholarship (D3) Timothy Prewitt, DDS’17 President’s Award Michael Siy, DDS’17 LLU IDP Fixed Prosthodontics Award Omar Alhmoud, DDS’17 (IDP) Prince Award Evan Agnetta, DDS’17 LLU IDP Removable Prosthodontics Award Meerna Zaghloul, DDS’17 (IDP) Service Learning Awards (DDS’17) Osman Cruz, Bianca Esparza, Macy Fuhs, Amanda Manzano, Melissa Seidel National Association of Seventh-day Adventist Dentists Kyim Mung, DDS’17 Oesterling-Wical Removable Prosthodontics Award Eric Williamson, DDS’17 Omicron Kappa Upsilon (OKU) Awards – DDS’17 Evan Agnetta, Christopher Chan, Macy Fuhs, Laila Hadid (IDP), Kelly Kaban, June Kim, Joshua Kim, Meryl Liu, Kyiim Mung, Bryan Otis, Melissa Seidel, Meerna Hanna Zaghloul (IDP) OKU, William S. Kramer Award for Excellence (D3) Meryl Liu, DDS’17 Oral and Facial Surgeons of California Award Isaac Lowe, DDS’17 Southern California Academy of Oral Pathology Award June Kim, DDS’17 Southern California Society of Dentistry for Children Macy Fuhs, DDS’17 Terry Tanaka Student Humanitarian Award (D3) Michael Siy, DDS’17 Western Society of Periodontology Award Bryan Otis, DDS’17 Wil Alexander Whole Person Care Award Michael Siy, DDS’17 Wilfred A. Nation Award Eric Gutierrez, DDS’17 Honors Program Recognition Graduates recognized for Elective Program completion Hussam Aloka, DDS’17 (IDP) Endodontics Meryl Liu, DDS’17 Implant Dentistry Chamandeep Brar, DDS’17 Maasai Dental Clinic Clerkship Isaac Lowe, DDS’17 Oral Maxillofacial Surgery Christopher Chan, DDS’17 Oral Maxillofacial Surgery Amanda Manzano, DDS’17 Dental Education Jim Ervil, DDS’17 Maasai Dental Clinic Clerkship Kyim Mung, DDS’17 Dental Education Macy Fuhs, DDS’17 Pediatric Dentistry Mason Segura, DDS’17 Pediatric Dentistry Emily Johnson, DDS’17 Dental Education Melissa Seidel, DDS’17 Orthodontics & Dentofacial Orthopedics Cara Jones, DDS’17 Esthetic Dentistry Dana Yoon, DDS’17 Dental Anesthesiology Kelly Kaban, DDS’17 Implant Dentistry Meerna Zaghloul, DDS’17 (IDP) Prosthodontics Charlie Kim, DDS’17 Dental Education Jane Zarate, DDS’17 (IDP) Orthodontics & Dentofacial Orthopedics June Kim, DDS’17 Dental Anesthesiology 31 LLUSD ARTICULATOR Summer / Autumn 2017 Bonding and zirconia–A literature review of laboratory studies Montry Suprono, DDS, MSD INTRODUCTION S 32 ince the 1980s, research on dental ceramics has led to the crystals, commonly referred to as yttria-stabilized tetragonal development of high-performance materials with increased zirconia polycrystals (Y-TZP)7-9 (Figure 3). fracture resistance, improved esthetics, and long-term durabilThe superior mechanical properties of zirconia can partially ity. Zirconia, often referred to as zirconium dioxide (ZrO2), was be attributed to its unique ability to transform between phases, discovered in 1789 by M.H. Klaproth.1 Appropriated as a restorknown as transformation toughening.10 Transformation toughenative material, it has been vastly improved to meet the demands ing occurs when the material changes from a tetragonal (t) to a of dentistry, and has gained popularity with dental clinicians monoclinic (m) phase. This t m phase transformation occurs due, among other properties, to its high strength. Although suwhen the zirconia is cooled and undergoes a 3-5% volumetric experior mechanical properties pansion.7,8 Because of the simi(strength, toughness, fatigue larity between this process and resistance)2 have been reThe reported flexural strength what is observed during marported, its ability to achieve tensite formation in quenched of zirconia is almost three times predictable and durable bonds steel,10 Garvie and colleagues between resin cements and coined the term ceramic steel that of lithium disilicate, the the internal surface of ZrO2 to describe zirconia that has strongest silica-based ceramic restorations remains a chalundergone this transformation lenge.3 This review presents toughening process.9 material. the current understanding of The transformation toughseveral oxide surface treatening process in zirconia is ment methods and assesses the especially relevant to the initiation and propagation of cracks quality of the resulting oxide/zirconia bond. due to external stress, such as those experienced when adjusting a crown using a dental rotary instrument (bur) during the try-in Physical properties or placement appointment. The presence of external stress can Zirconia is polymorphic in nature (with five natural and cause a t m phase transformation near the tip of any exist28 artificial isotopes) and has often been described as a ing cracks. The volumetric expansion (3-5%) caused by the phase polycrystalline, high-strength oxide ceramic that contains trace transformation creates compressive stresses at the crack tip and amounts (<1 wt%) of silica or glass3-6 (Figures 1 and 2). It is halts further propagation. In other words, the toughness of zircoa unique material that may exist in three different crystalline nia is attributed to its ability to dissipate the energy associated forms or phases; each phase is dependent on temperature and with the crack propagation by undergoing a phase transformation volumetric changes. The three phases at different temperatures (t m) that generates compression stresses on a crack, preventare 1) Monoclinic (room temperature – 1170oC), 2) tetragonal ing further propagation.7,8,11 This process is known as crack shield(1170oC – 2370oC), and 3) cubic (>2370oC).7,8 For dental purposes, ing. When a crack develops within the material, internal stresses the tetragonal phase possesses optimal physical properties. begin to oppose the crack formation. Because of these remarkable The use of metal oxides, like yttria (Y2O3), has been incorporated properties, zirconia has superior resistance to fracture. to stabilize the material as a metastable matrix of tetragonal Besides crack shielding, zirconia is also known for other excellent mechanical properties that ensure broad application in dentistry. In fact, the reported flexural strength of the material The author thanks Drs. Charles Goodacre and YunHui L. Lin is almost three times that of the strongest silica-based ceramic for editing and reviewing the manuscript. Appreciation is also material, lithium disilicate.12 High rates of long-term survival of due John Wilson, owner of Sunrise Dental Laboratory, and zirconia restorations can be achieved for single and multiple Satoshi Sakamoto, RDT, for their expertise and contribution unit fixed (bridge) restorations if ideal tooth preparation is to this manuscript. Figures 1-4 courtesy of Dr. Charles Goodacre and Satoshi Sakamoto, RDT . Volume 28, Number 2 Figure 1. Two ZrO2 crowns that have been fabricated for the lower left posterior molar teeth LLUSD ARTICULATOR Figure 2. Same ZrO2 crowns cemented onto the molar teeth 33 Figure 3. External (cameo) surfaces of upper anterior crowns Figure 4. Internal (intaglio) surfaces of upper anterior crowns attained.13,14 For these restorations, the choice of cement is not crucial. However, a durable bond between the zirconia ceramic and the underlying tooth structure is needed in applications with compromised retention and resistance forms, such as with veneers, resin-bonded fixed partial dentures, or short clinical crowns. Therefore, the remainder of this review will discuss and evaluate the issues and strategies surrounding the implementation of a strong and durable bond between the internal surface of the ZrO2 restoration, and the resin cement. of its interface with the tooth structure is equally important to clinical success. Strong resin adhesive bonding relies on two main procedures: 1) the establishment of micromechanical interlocking and 2) chemical adhesion to that surface.2,3 Without both of these procedures, a predictable and durable bond cannot be achieved. Researchers have proposed both mechanical and chemical modifications to the zirconia surface as a means of enhancing bonding of the restoration to tooth structure. Micromechanical interlocking from surface roughening methods is the first requirement for successful resin bonding.3 The purpose of this process is to increase the surface area and energy,15 which enhances the wettability of the surface. A more “wet” surface allows the resin cement to flow more readily into the micro retentive spaces, thereby creating a more complete bond. Chemical etching with hydrofluoric (HF) acid is one of the most common methods used to enhance the surface roughness on dental ceramics (Figures 5a and b). The etchant is applied to the surface for a specified amount of time. Next, pressurized air and water is applied to the surface to remove the chemical solution. Then the surface is dried with a steady stream of air, resulting in a matted finish (Figure 5c). This Bonding to dental ceramics A major problem with zirconia, in comparison with other dental ceramic materials like feldspathic, leucite reinforced, and lithium disilicate, is that the internal (intaglio) surface is not easily affected by established adhesive bonding protocols (Figure 4). This is because the ZrO2 surface exhibits exceptional physical and mechanical properties, such as high flexural strength, fracture toughness, and hardness, along with little silica or glass content. Although the independent mechanical properties of zirconia are incredibly important, the stability and durability LLUSD ARTICULATOR Photo credit: Dr. Pooya Soltanzadeh and John Wilson, laboratory technician Photo credit: Dr. Pooya Soltanzadeh and John Wilson, laboratory technician Summer / Autumn 2017 34 Figure 5a. Hydrofluoric acid etch is used to condition the intaglio surface of ceramic restorations. Figure 5b. The facial surface of two ceramic veneer restorations: Left, a silica-based (lithium disilicate) ceramic restoration; Right, an oxidebased (zirconia) ceramic restoration chemical etching process is very effective at achieving, with silicabased dental ceramics, the necessary surface roughness. Chemical adhesion between the ceramic surface and the resin cement is the second requirement of a successful bond. Typically, this process involves a solution that interacts with both the ceramic and resin cement surfaces. Silane coupling agents, also known as “silanes,” are compounds that contain silicon,3 have a dual function, and have been described in detail in the scientific literature.16-19 In general, one end of the molecule is organically functional and can interact with an organic resin matrix (e.g., cement).16 The other end contains alkoxy groups that can react with hydroxylated, silica (glass) containing surfaces (e.g., dental ceramic crown).16 This bifunctional compound forms very strong covalent bonds between the ceramic (inorganic) substrate and the resin cement (organic).17 In general, bonding to any type of dental material begins with the creation of a rough surface, followed by a modification (usually chemical) of that surface. increased bond strength when the surface was treated with APA versus no treatment. During the APA process, aluminum oxide (Al2O3) particles with varying grain sizes (about 25 to 250 µm) are blasted against the surface using a propulsion-pressured device held at a fixed distance, and for a specified duration. The degree of surface roughness depends on the grain size (25 to 250 µm), propulsion pressure (0.05 to 0.45 MPa), distance from the nozzle (5 - 20 mm), angulation,25,26 and application time (5 to 30 seconds). Increased grain size and propulsion pressure were shown to increase surface roughness.27 Importantly, however, an increase in surface roughness does not necessarily translate to improved bond strengths with resin cement.28-30 In fact, others have demonstrated improved bond strengths when the treatment was performed using smaller Al2O3 grain size (50 µm)22,31,32 with lower propulsion pressure (0.05 to 0.28 MPa).33,34 TRADITIONAL SURFACE ROUGHENING METHODS To establish rough surfaces, early researchers and clinicians used traditional methods that had been established to treat the internal (intaglio) surface of metal- and silica-based ceramic restorations.20 However, traditional pretreatment surface methods, such as chemical etching with hydrofluoric (HF) acid and/or the application of a bifunctional liquid (silane coupling agent), were found to be ineffective against the non-polar and chemically inert ZrO2 surface.21-24 Following this realization, researchers and clinicians began to search for alternative methods of achieving rough bonding surfaces. Airborne-particle abrasion Kern and colleagues were the first to report on the effectiveness of airborne-particle abrasion (APA) and the resulting bond strength to the ZrO2 surface.23 The authors reported Tribochemical silica coating Tribochemical silica coating (TSC) is an alternative method that has been used to treat the surface of metal restorations,35-37 as well as repairing fractured porcelain restorations.38,39 It has been adopted and applied to the ZrO2 surface. This method is similar to APA with the exception of the particles being coated with silica.40 It has been described as a combined surface treatment and is thought to have two effects: 1) surface roughening and 2) surface deposition of silica.5,37,41 Rocatec and CoeJet (3M ESPE, St. Paul, MN, USA) are two commercial systems that are currently available. Research has shown that the use of TSC prior to silanization results in significant increase in bond strength.33,42-44 However, using traditional resin cements may result in significant loss of bond strength over long periods of time. Nishigawa and colleagues reported on the deleterious effects of ultrasonic cleaning and the resultant loss in bond strength.45 They reported a decrease in silica content on the ZrO2 surface, which may be a reason why traditional resin cements are not as effective. This Photo credit: Dr. Pooya Soltanzadeh and John Wilson, laboratory technician Volume 28, Number 2 LLUSD ARTICULATOR flaws created along the surface and within the material could lead to delayed failure (e.g., chipping or fracturing of the restoration) due to the slow progression of crack growth.57-59 To avoid these issues, the use of heat to reverse the phase transformation (m t),60-63 or the application of pre-APA64,65 onto the surface of pre-sintered computer-aided design/ computer-aided manufacture (CAD/CAM) restorations prior to the final sintering, have been suggested. Figure 5c. Shown above are the internal (intaglio) surfaces of the same ceramic veneer restorations after conditioning with hydrofluoric acid. Note the whitish (rougher) surface that was obtained only on the silica-based ceramic restoration (left). decrease occurs because the surface of zirconia is inert, acid resistant, and also lacking silica such that an adequate bond cannot be achieved with these surface roughening methods. Nevertheless, when compared to APA, increased bond strengths have been reported with initial TSC followed by silane coupling agent or phosphate monomer application.23,42,46-48 Surface grinding Surface grinding using Al2O3 abrasive wheels or paper21 or coarse diamond rotary instruments (burs)24,49 has also been explored as means of roughening ZrO2 surfaces. Although these techniques are easy and cost-effective to implement in a dental practice, no significant increase in bond strength has been reported when a traditional resin cement is used.22-24,40,50,51 Concerns While micromechanical interlocking via APA, TSC, or surface grinding with a rotary instrument to promote a successful bond is required, two concerns have been raised regarding its application to ZrO2 surfaces: 1) the creation of surface microcracks and 2) a phase transformation from tetragonal to monoclinic (t m) at the surface and subsurface levels.41,52,53 As discussed previously, zirconia is a unique material with the ability to “heal” cracks through the process of transformation toughening. Although APA has been shown to increase the strength by inducing a phase transformation from t m, due to lower temperature and stresses,8,10,54 it has been reported that excessive abrasive surface modifications or grinding may diminish the transformation toughening process, especially if flaws are deep within the material.55,56 The resulting volumetric change may induce large stresses, creating crack formations that may ultimately lead to failure. Furthermore, studies of the long-term performance following APA treatment have reported significantly reduced zirconia strength.57 Therefore, researchers have concluded that initial TRADITIONAL SURFACE MODIFICATION METHODS Concerns with surface roughening methods (summarized above) have led researchers to search for alternative methods of improving micromechanical retention and chemical adhesion while preserving the physical properties of the materials involved. A brief description of some of the derived methods are presented below. As stated before, many of these were adopted from metal- and silica-based dental restorations. Silicoating Silicoating, also known as glass or ceramic coating, is a technique used to achieve a glass matrix on the surface of dental restorations. Earlier protocol began with the application of colloidal silica followed by heat treatment (pyrolysis).66,67 Two things were accomplished with this step: 1) improved ability to achieve micromechanical retention, and 2) enhanced silanization. The colloidal silica deposition forms a glass coating with a thickness of about 0.1 µm68 and helps to promote stronger bonding between the resin cement and ZrO2 surface upon application of a silane coupling agent.61,69 Although a significant increase in bond strength has been reported,24 this method has not gained popularity among practitioners due to the cost and complexity of the procedure. Therefore, a chair-side application (PyrosilPen-Technology, SurA Instruments, Jena, Germany) was developed for use in dentistry.68 Another method of silicoating involves a high-frequency plasma spray to deposit a siloxane coating of <1 µm.69 Once polymerized, siloxane acts like a silane, resulting in a chemical bond between the ZrO2 surface and the resin cement. This technique was shown to produce significantly greater bond strengths compared to untreated or silanized ZrO2, but was significantly weaker than were bonds created using the pyrolytic method.69 Bioglass coating More recently, some bioglass-based methods used to coat the surfaces of implanted medical devices have also been evaluated for potential use in dental applications.70,71 Two methods have been evaluated in the literature so far. The first method begins with a poly vinyl alcohol (PVA) binder that is followed by application of bioglass powder. The second method, similar to 35 LLUSD ARTICULATOR silicoating, uses a slurry consisting of bioglass powder, distilled water, and the PVA binder. The slurry is mixed and applied to the ZrO2 surface using a fine microbrush. After application, the restorations are heated in a furnace up to 1,200oC and held at constant temperature for two hours.71 The modified “silica-containing” surface can be more easily roughened using the methods described previously, and is then followed by application of a silane coupling agent. When compared with other APA methods, bioglass coating resulted in similar bond strengths. However, further laboratory studies are still needed as conflicting results have been reported in the literature.30,71 Vapor-phase deposition Vapor-phase deposition combines chloro-silane gas (SiCl4) with water vapor to form a silica-oxide surface. Thompson and company3 described the process as a “molecular vapor deposition (MVD), an enhancement on conventional vapor deposition, to deposit ultra-thin, uniform, organic molecular coatings on substrates using an in-situ surface plasma treatment.” In other words, this method is used to create an oxyfluoride conversion layer on the ZrO2 surface that is able to enhance reactivity.2 This reactive surface has been shown to be receptive to silane coupling agents.2 Studies have shown bond strengths greater than TSC, and bond strengths comparable to silica-based ceramics.2,72 Furthermore, when compared to commercial primers, higher bond strengths and lower contact angles were reported.73 However, long-term artificial aging (i.e. storage in water or thermocycling) was not conducted with these experiments, so more research is needed to evaluate the longterm effects of bonds created using vapor-phase deposition. Nonetheless, it seems that this method produces a more active surface for adhesive bonding and could be a viable method in the future.73 36 CHEMICAL BONDING After surface roughening or modifications have been completed, establishing chemical adhesion to the ZrO2 surface is the next step in the bonding protocol. In dentistry, this process is usually performed by applying a specific chemical solution (e.g. silane coupling agent) to the ceramic surface. Manufacturers have developed specific chemical solutions that are either incorporated into resin cement systems or used during an additional step of the cementation protocol. Silane coupling agents To achieve a bond between the ceramic substrate and the resin cement, a silane coupling agent is applied. Silanes are typically organofunctional alkoxysilane esters “with three hydrolysable alkoxy groups on the silicon atom.”74 Because the surface of ZrO2 is non-polar, traditional silanes have proven ineffective. Summer / Autumn 2017 Experimentation with different silanes have resulted in varying degrees of bond strengths with different resin cements. Table I itemizes three silane coupling agents that have been evaluated for use on the ZrO2 surface.18 Chemical Name Abbreviation 3-methacryloyloxypropyl-trimethoxysilane MPS 3-acryloyloxypropyl-trimethoxysilane ACPS 3-isocyanatopropyl-triethoxysilane Table I. ICS Improved bonding to Bis-GMA resin cements has been reported when initial TSC was applied to the surface, followed by the application of MPS and ACPS.18 However, with the exception of MPS, significant decrease in bond strengths have been reported in laboratory studies after samples were artificially aged.19,75 These reports proved that the use of silane coupling agents alone does not facilitate the formation of stronger bonds, nor is it hydrolytically stable.76 The surface should therefore be pretreated with a surface roughening or modification method.77,78 Although new silanes79,80 with various chemical compositions have been developed specifically for zirconia, MPS continues to be the most commonly used silane coupling agent.37,81 Nevertheless, new developments of blended silane systems,19 zirconate coupling agents,82 and silane coupling oligomers74 show promising preliminary results. Primers As previously mentioned, a silica-free zirconia surface is difficult to bond. Previous research by Kern and Thompson demonstrated that Bis-GMA containing resin cements was unsuccessfuliy bonded to APA alumina oxide (another oxideceramic) surfaces, but that a phosphate monomer-containing resin cement successfully formed a durable bond.83 Using similar materials and methods, Kern and another colleague tested phosphate monomer-containing resin cements on zirconia surfaces and were able to achieve high long-term bond strength.23 The chemical liquid (monomer) containing 10-methacryloyloxy-decyl dihydrogenphosphate (10-MDP) has been extensively researched and was first developed to bond to metal oxide surfaces.5 A chemical interaction along the ZrO2 surface has been shown to occur with this primer.78,81 The hydrolytically stable bond is formed between the hydroxyl groups found along the surface of the ZrO2 ceramic and the phosphate ester group of the monomer.21,84-87 Secondary ion mass spectrometry (SIMS), performed by Chen and colleagues, confirmed the formation of covalent bonds among the oxygen, phosphorus, and zirconia substrate (Zr-O-P).88 When compared to other phosphate functional monomers, the MDP-containing primer remains the best choice Volume 28, Number 2 when bonding to zirconia.89 An example of a 10-MDP containing resin cement system is shown in Figure 6. Primer + silane The sequential application of silane coupling agent (MPS) and primer (MDP) has also been evaluated and has resulted in varying degrees of surface wettability, and bond strength.90 For now, MDP shows a relevant function in improving the bond of resin to zirconia. However, the use of MPS as the final coat in sequential application seems to impair the bond.90 More studies are needed to understand the interaction between surfaces and both chemical agents using this sequential method. CURRENT METHODS UNDER INVESTIGATION A recent literature review of laboratory (in-vitro) studies was conducted to explore the current trends in bonding to the surface of zirconia.37 The authors presented a succinct table that described the current testing methods, ceramic type, surface treatment method employed, type of resin cement used, and the results achieved. To date, APA and TSC remain the most popular methods for achieving surface roughness, most likely due to the simplicity and cost-effectiveness of the process. Nevertheless, the search to find a simple, non-destructive method to achieve a stronger and more durable bond continues. A brief description of current methods is presented below, along with the benefits and drawbacks of each method. SURFACE ROUGHENING Selective infiltration etching (SIE) Selective infiltration etching (SIE) is a technique that increases surface porosity and establishes a highly reactive, high energy surface.37 The SIE process begins with heat-induced maturation (HIM), which consists of two short thermal cycles on the material that pre-stress the grain boundary regions of the surface so that they can be more easily infiltrated by other materials.84,91 In other words, heat is used to transform the smooth surface into a rougher surface. After HIM, the SIE method is performed by applying a thin layer of glass over the transformed surface.84,91 The process is selective because it affects only the surface grains in contact with the infiltrating glass.84,91 The glass infiltrates the grain boundaries, creating a Figure 6. An MDP containing resin cement system (Panavia V5, Kuraray America, Inc., NY, USA). LLUSD ARTICULATOR surface with inter-grain pores.37,92 A major advantage of SIE is its ability to enhance surface roughness while imposing minimal surface damage. The SIE method was reported to generate increased surface roughness compared to APA.21,93 Furthermore, surfaces subjected to the SIE treatment showed greater bond strength than those treated with APA.75,92 Pretreatment by SIE, followed by the application of an MDP containing primer and resin cement was demonstrated to have the highest bond strength among the techniques studied, even after artificial aging in water.84,91,92 Additionally, increased bond strengths have also been reported with the application of MPS (silane coupling agent) after treatment of the surface with the SIE method.75 However, significant decrease in bond strengths was reported after artificial aging was conducted against the samples that were chemically bonded by silane coupling agents, confirming the fact that these chemicals are not hydrolytically stable.75 Hot chemical etching (HCE) Hot chemical etching (HCE) was traditionally used to etch the surfaces of metal restorations.94,95 In general, an etching solution37 composed of methanol, hydrochloric acid, and ferric chloride is applied to the surface and is heated up to 100oC for a period of time.21 Although few reports have been found in the literature, this technique shows promise as a means of increasing the surface roughness of zirconia. In fact, higher surface roughness has been reported with the HCE method when compared to SIE and APA treatments.21 Recently, lowmelting-point fluoride conditioning agents such as ammonium hydrogen difluoride and potassium hydrogen difluoride have been evaluated and show promising results in achieving micromechanical retention without subsurface damage.96 Laser irradiation Laser irradiation is already a common tool in medicine and dentistry. The most common lasers used for both soft and hard oral tissue are the neodymium-doped yttrium aluminum garnet (Nd:YAG) and the erbium-doped yttrium aluminum garnet (Er:YAG).52 Much attention has been focused on the Nd:YAG for surface roughening procedures against zirconia.97 The amount of surface roughness and resulting bond strength depends on the power (W), energy intensity (mJ), frequency (Hz), and time (s).98 Increased surface roughness and bond strength have been reported using the Nd:YAG laser when compared to APA.99 However, when the surface was evaluated with a scanning electron microscope (SEM), the laser irradiation caused microcracks. Also, using X-ray diffraction (XRD) to detect phase transformation (t m), Usumez and colleagues reported a significantly higher incidence of crack formation.99 Recently, Zanjani and colleagues conducted a study to evaluate the effect of APA and two lasers [carbon dioxide 37 LLUSD ARTICULATOR (CO2) and an erbium, chromium:yttrium-scandium-galliumgarnet (Er,Cr:YSGG)] on the bond strength of resin cement to ZrO2.100 The authors reported higher bond strengths with APA when compared to the two lasers. Continued developments and research in dental lasers remains promising for achieving a rougher surface.101,102 However, more research is needed to evaluate the physical changes of the material that occur with this method. RESIN-BASED CEMENTS As mentioned before, the silica-free composition of the ZrO2 surface makes it difficult to achieve a reliable bond. Conflicting reports regarding which type of resin-based cements produce higher bond strengths are found in the literature.23,24 For example, cements that contain Bis-GMA were shown to be unsuccessful at bonding to the APA surface of zirconia.83 On the other hand, improved bond strengths have been reported with the application of a surface roughening method (APA or TSC) that is accompanied with a resin cement that contains a phosphate monomer.23 These positive results have been attributed to the acidic nature of MDP-containing resin cement that enhances the polysiloxane bonds produced by the silane coupling agents.79 When evaluating another type of primer-containing resinbased cement, Derand and Derand reported higher bond strengths with an autopolymerizing resin cement containing 4-META/TBB/PMMA than with an MDP-containing resin cement.24 It is believed that the anhydride group in 4-META bonds with both untreated and TSC surfaces.3 However, there has been no evidence to demonstrate that this chemical bond is significantly stronger than the bond of MDP to zirconia. This was confirmed by two other studies that evaluated and compared the bond strengths of 4-META and MDP-containing resin cements.103,104 Although mixed results have been reported, due to their stability in a wet environment, MDP-containing resin cements have been the subject of ongoing research and development efforts.3,23,85,104 38 DISCUSSION Today, the increasing demands of patients and practitioners continue to drive the research and development of biomaterials such as zirconia. In fact, market research groups have predicted a significant increase with certain biomaterials by the year 2020.106 Consequently, considerable research efforts have been put forth into understanding the properties and characteristics of these materials. A benefit of performing laboratory research is that more controlled environments for fabricating samples and testing procedures can be achieved. However, laboratory results do not always translate to clinical situations. The inconsistent data Summer / Autumn 2017 obtained from myriad studies have several causes that include missing rigor in testing methods, an absence of standardized methodology, and variables that cannot be standardized.107,108 In 2014, Papia and colleagues published a systematic review of bonding to oxide ceramics.5 Their purpose was to assess the relative bonding strength of existing laboratory methods.5 The authors reported 23 different surface treatment methods published in the literature. Some methods had already been implemented in clinical settings while others were still undergoing laboratory testing. The authors concluded that there is no one universally accepted surface treatment and that the most common methods were APA, surface coating, and primer treatments. In a systematic review of the literature from 1995 to 2011, Özcan and Bernasconi identified 169 different methods used to condition the surface of zirconia prior to cementation.12 The majority of the methods were a combination of air-abrasion protocols (APA or TSC) and adhesive promoters (primers or silane coupling agents). Even when promising laboratory results have been reported, long-term clinical trials are needed to confirm the findings in real world settings. In 2014, 10 publications were evaluated in a review on clinical trials of dental restorations relying on true adhesive bonding (e.g. veneers) to oxide-based ceramic restorations.109 Of the 10 publications, only six involved resinbased cement bonding to zirconia. The author concluded that despite the limited number of clinical trials, there is evidence that demonstrates better bond strength to zirconia when using procedures that employ air-abrasion followed by an application of a phosphate monomer-containing resin cement.78,109 Still, detrimental effects to the material caused by airabrasion methods (or clinical adjustments that are made during the try-in or placement of the dental restoration), cannot be dismissed. As stated before, volumetric changes due to induced stresses, both external and internal, may create crack formations that can ultimately lead to failure of the restoration. Although not described in this review nor fully understood, moisture-induced phase transformation, and the resulting structural degradation phenomenon known as low-temperature degradation (LTD), remains a concern for zirconia-based restorations.8,110-113 Nevertheless, it is of great interest to continue searching for ways to create a more predictable and durable bond to this promising dental material. The purpose of this review has been to survey the most common traditional and current surface pretreatment methods used in bonding with zirconia, and to present the benefits and limitations of various methods. As stated before, the failure to establish an optimal method for pretreating the surface of zirconia41 can largely be attributed to the lack of standardized laboratory testing procedures and reporting.68 Therefore, standard laboratory testing procedures, such as the American National Standards Institute/American Dental Association Volume 28, Number 2 (ANSI/ADA) or the International Organization for Standardization (ISO), are needed to help guide researchers in developing sound protocols and proper reporting of the results. The adoption of such standards will allow for more facile assessment and comparison of the reported outcomes of different studies. Because none of these standards have been established, interpretation and comparison of the data are extremely challenging, and the studies have resulted in a limited number of clinical trials.12 A fairly recent review tried to bridge the findings of laboratory studies to clinical trials.109 The outcomes for the clinical trials were poor, with the majority of failures attributed to de-bonding of the restorations. Moreover, the clinical trials that were reported had short follow-up periods of five years or less.109 At times, what appears to work in the laboratory does not necessarily translate to good clinical outomes. Despite the limited number of clinical publications and short follow-up periods, a recent article reported a 10-year survival rate of 98.2%, and a success rate of 92.0% for non-retentive, zirconia resin-bonded fixed partial dentures (RBFPD) replacing missing incisors. Performing minimal preparation designs, a total of 108 restorations were placed using a bonding protocol that consisted of APA with small Al2O3 particle size (50 µm), low propulsion pressure (0.1-0.25 MPa), and cementing with MDP-containing resin-based cement systems. Out of the 108 restorations placed, only six (5.6%) of them debonded. The authors concluded that anterior zirconia RBFPD provides good clinical longevity.114 Although this is encouraging, more clinical trials with longer follow-up periods (>10 years) remain necessary. CONCLUSION Because of its remarkable mechanical properties, zirconia is a promising candidate for use in dentistry. However, the formation of high quality bonds between the resin cement and the ZrO2 surface remains a subject of exploration. Contemporary developments in surface modification methods, such as SIE and HCE, as well as materials that enhance chemical bonding, have shown promising preliminary results. However, clinical trials, short and long term, are necessary to further understand the physical properties and to evaluate bonding protocols. It should not be forgotten that in order to gain acceptance with dental practitioners, both materials and methods should be simple and cost-effective. To date, the combination of physical and chemical conditioning methods seems to produce good bond strengths. However, the many challenges and concerns that have been identified in this review, for the time being, limit the use of zirconia as an all-purpose type of restorative dental material. This author believes that zirconia dental restorations are best used on teeth preparations that have adequate resistance and retention forms. For now, zirconia is not advised for restorations that must rely exclusively on bonding (e.g. veneers, LLUSD ARTICULATOR onlays, and resin-bonded fixed partial dentures). 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Resin adhesion strengths to zirconia ceramics after primer treatment with silane coupling monomer or oligomer. Dent Mater J 2017. [Epub ahead of print]. 75. Aboushelib MN, Mirmohamadi H, Matinlinna JP, Kukk E, Ounsi HF, Salameh Z. Innovations in bonding to zirconia-based materials. Part II: focusing on chemical interactions. Dent Mater 2009;25:989-993. 76. Chen L, Suh BI, Kim J, Tay FR. Evaluation of silica-coating techniques for zirconia bonding. Am J Dent 2011;24:79-84. 77. Behr M, Proff P, Kolbeck C, Langrieger S, Kunze J, Handel G, Rosentritt M. The bond strength of the resin-to-zirconia interface using different bonding concepts. J Mech Behav Biomed Mater 2011;4:2-8. 78. Inokoshi M, De Munck J, Minakuchi S, Van Meerbeek B. Meta-analysis of bonding effectiveness to zirconia ceramics. J Dent Res 2014;93:329-334. 79. Tanaka R, Fujishima A, Shibata Y, Manabe A, Miyazaki T. Cooperation of phosphate monomer and silica modification on zirconia. J Dent Res 2008;87:666-670. 80. Takeuchi K, Fujishima A, Manabe A, Kuriyama S, Hotta Y, Tamaki Y, Miyazaki T. Combination treatment of tribochemcial treatment and phosphoric acid ester monomer of zirconia ceramics enhances the bonding durability of resin-based luting cements. Dent Mater J 2010;29:316-323. 81. Yoshida K, Tsuo Y, Atsuta M. Bonding of dual-cured resin cement to zirconia ceramic using phosphate acid ester monomer and zirconate coupler. J Biomed Mater Res B Appl Biomater 2006;77:28-33. 82. Anusavice KJ, Shen C, Rawls HR. Phillips Science of Dental Materials. Ed 12, St. Louis, Elsevier Saunders, 2013. 83. Kern M, Thompson VP. Bonding to glass infiltrated alumina ceramic: adhesive methods and their durability. J Prosthet Dent 1995;73:240-249. 84. Aboushelib MN, Matinlinna JP, Salameh Z, Ounsi H. Innovations in bonding to zirconia-based materials: part I. Dent Mater 2008;24:1268-1272. 85. de Souza GMD, Thompson VP, Braga RR. Effect of metal primers on microtensile bond strength between zirconia and resin cements. J Prosthet Dent 2011;105:296-303. 86. Sanli S, Comlekoglu MD, Comlekoglu E, Sonugelen M, Pamir T, Darvell BW. Influence of surface treatment on the resin-bonding of zirconia. Dent Mater 2015;31:657-668. 87. de Oyagüe RC, Monticelli F, Toledano M, Osorio E, Ferrari M, Osorio R. Influence of surface treatments and resin cement selection on bonding to densely-sintered zirconium-oxide ceramic. Dent Mater 2009;25:172-179. 88. Chen L, Suh BI, Brown D, Chen X. Bonding of primed zirconia ceramics: evidence of chemical bonding and improved bond strengths. Am J Dent 2012;25:103-108. 89. Arai M, Takagaki T, Takahashi A, Tagami J. The role of functional phosphoric acid ester monomers in the surface treatment of yttriastabilized tetragonal zirconia polycrystals. Dent Mater J 2017;36:190194. 90. Chuang S-F, Kang L-L, Liu Y-C, Lin J-C, Wang C-C, Chen H-M, Tai C-K. Effects of silane- and MDP-based primers application orders on zirconia-resin adhesion – a ToF-SIMS study. Dent Mater 2017;33:923-933. 91. Aboushelib MN, Kleverlaan CJ, Feilzer AJ. Selective infiltration-etching technique for a strong and durable bond of resin cements to zirconia-based materials. J Prosthet Dent 2007;98:379-388. 92. Aboushelib MN. Evaluation of zirconia/resin bond strength and interface quality using a new technique. J Adhes Dent 2011;13:255-260. 93. Jiang T, Chen C, Lv P. Selective infiltrated etching to surface treat zirconia using a modified glass agent. J Adhes Dent 2014;16:553-557. 94. Livaditis GJ. A chemical etching system for creating micromechanical retention in resin-bonded retainers. J Prosthet Dent 1986;56:181-188. 95. Ferrari M, Cagidiaco MC, Borracchini A, Bertelli E. Evaluation of a chemical etching solution for nickel-chromium-beryllium and chromium-cobalt alloys. J Prosthet Dent 1989;62:516-521. 96. Ruyter EI, Vajeeston N, Knarvang T, Kvam K. A novel etching technique for surface treatment of zirconia ceramics to improve adhesion of resin-based luting cements. Acta Biomater Odontol Scand 2017;3:36-46. 97. Paranhos MP, Burnett LH Jr, Magne P. Effect of Nd:YAG laser and CO2 laser treatment on the resin bond strength to zirconia ceramic. Quintessence Int 2011;42:79-89. LLUSD ARTICULATOR 98. Erdem A, Akar GC, Erdem A, Kose T. Effects of different surface treatments on bond strength between resin cements and zirconia ceramics. Oper Dent 2014;39:E118-127. 99. Usumez A, Hamdemirci N, Koroglu BY, Simsek I, Parlar O, Sari T. Bond strength of resin cement to zirconia ceramic with different surface treatments. Lasers Med Sci 2013;28:259-266. 100.Zanjani VA, Ahmadi H, Nateghifard A, Ghasemi A, Torabzadeh H, Tabrizi MA, Alikhani F, Razi R, Nateghifard A. Effect of different laser surface treatment on microshear bond strength between zirconia ceramic and resin cement. J Investig Clin Dent 2015;6:294-300. 101.Mahmoodi N, Hooshmand T, Heidari S, Khoshro K. Effect of sandblasting, silica coating, and laser treatment on the microtensile bond strength of a dental zirconia ceramic to resin cements. Lasers Med Sci 2016;31:205-211. 102.Prieto MV, Gomes ALC, Martin JM, Lorenzo AA, Mato VS, Martinez AA. The effect of femtosecond laser treatment on the effectiveness of resinzirconia adhesive: an in vitro study. J Lasers Med Sci 2016;7:214-219. 103.Ernst C-P, Cohnen U, Stender E, Willershausen B. In vitro retentive strength of zirconium oxide ceramic crowns using different luting agents. J Prosthet Dent 2005;93:551-558. 104.Lee HJ, Ryu JJ, Shin SW, Suh KW. Effect of surface treatment methods on the shear bond strength of resin cement to zirconia ceramic. J Korean Acad Prosthodont 2007;45:743-752. 105.Wegner SM, Kern M. Long-term resin bond strength to zirconia ceramic. J Adhes Dent 2000;2:139-147. 106.Montazerian M, Zanotto ED. Bioactive and inert dental glass ceramics. J Biomed Mater Res A 2017;105:619-639. 107.Anusavice KJ, Kakar K, Ferree N. Which mechanical and physical testing methods are relevant for predicting the clinical performance of ceramicbased dental prostheses? Clin Oral Implants Res 2007;18:218-231. 108.Scherrer SS, Cesar PF, Swain MV. Direct comparison of the bond strength results of the different test methods: a critical literature review. Dent Mater 2010;26(2):e78-93. 109.Kern M. Bonding to oxide ceramics – laboratory testing versus clinical outcome. Dent Mater 2015;31:8-14. 110.Amaral M, Valandro LF, Bottino MA, Souza RO. Low-temperature degradation of a Y-TZP ceramic after surface treatments. J Biomed Mater Res B Appl Biomater 2013;101:1387-1392. 111.Kim HT, Han JS, Yang JH, Lee JB, Kim SH. The effect of low temperature aging on the mechanical property & phase stability of Y-TZP ceramics. J Adv Prosthodont 2009;1:113-117. 112.Kim J-W, Covel NS, Guess PC, Rekow ED, Zhang Y. Concerns of hydrothermal degradation in CAD/CAM zirconia. J Dent Res 2010;89:91-95. 113.Piconi C, Burger W, Richter HG, Cittadini A, Maccauro G, Covacci V, Bruzzese N, Ricci GA, Marmo E. Y-TZP ceramics for artificial joint replacements. Biomaterials 1998;19:1489-1494. 114.Kern M, Passia N, Sasse M, Yazigi C. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors. J Dent 2017;65:51-55. Montry S. Suprono, DDS, MSD, is assistant professor, Center for Dental Research, Advanced Specialty Education Program in Prosthodontics, and the Division of General Dentistry 41 LLUSD ARTICULATOR Summer / Autumn 2017 Bonding and zirconia—the quiz Circle the letters of the correct answers. 1. Zirconia is a a. high-strength silica-based ceramic material. b. low-strength silica-based ceramic material. c. high-strength oxide-based ceramic material. d. low-strength oxide based ceramic material 2. In which of the following crystalline forms can zirconia exist? a. Monoclinic b. Tetragonal c. Cubic d. All of the above 3. Zirconia is a unique material that is able to transform between phases. This transformation is called a. crack shielding. b. transformation toughening. c. transformation shielding. d. crack propagation. 4. In order to obtain strong adhesive bonds, what principles must be achieved? a. Micromechanical interlocking b. Color stabillity c. Chemical adhesion d. Both a and c 5. A surface roughening procedure in which aluminum oxide particles are blasted against the surface is called a. airborne-particle abrasion. b. surface chemical conditioning. c. surface grinding. d. tribochemical silica coating. Name 42 6. Which of the following is not a current surface treatment method? a. Laser irradiation b. Selective infiltration etching c. Silicoating d. Hot chemical etching 7. Silane coupling agents a. are bifunctional compounds. b. contain silicon. c. enable strong bonds between ceramic and resin. d. all of the above. 8. Who was the first to discover zirconia? a. G. V. Black b. M. H. Klaproth c. N. B. Jörgensen d. R. L. Hanau 9. Which of the following chemical solutions demonstrate hydrolytic stability? a. MPS b. ICS c. MDP d. ACPS 10. Which of the following methods initially begins with heatinduced maturation (HIM) followed by a layer of glass that infiltrates into the transformed surface? a. Hot chemical etching (HCE) b. Tribochemical silica coating (TSC) c. Selective infiltration etching (SIE) d. Airborne-particle abrasion (APA) DDS/DH Lic.# Date Mailing address / Street Phone City / State Zip code After answering the questions and completing this form, mail the entire sheet (or copy) to: Loma Linda University Continuing Dental Education, 11245 Anderson Street, Suite 120, Loma Linda, CA 92354, or you may fax a completed form to (909) 558-4858. For questions please call: (909) 558-4685 Cost $25.00 Please circle: MASTERCARD VISA DISCOVER Credit Card No: Expiration date CVS No: Note: Loma Linda University School of Dentistry is authorized to confer 2 hours of California continuing dental education credit for this home study course. Volume 28, Number 2 LLUSD ARTICULATOR Dental Unit Waterline Testing and Sterilization Assurance Service Order Form Date ______________ Dr. Name (Last) ____________________________________________ (First) _____________________________________________________ Name office ________________________________________________________________________________________________________ Address ___________________________________________ City _________________________________ State ________ Zip ___________ Phone ( ) _________________ Fax ( ) _____________________ E-mail ____________________________________________________ Sterilization Assurance Service Dental Unit Waterline Testing Customer ID# (for current customers) ______________________________ Sterilizer Type/Model/Serial #: __________________________________ (Supplies for each sterilizer must be kept separate for identification purposes.) Customer ID# (for current customers) ____________________________ Price / Kits Amount $84/3 tests $ __________ o Steam_______ o Chemical Vapor_______ o Dry Heat________ $144/6 tests $ __________ Basic (1) One test strip and one control strip per test (2) Return envelopes (3) Monthly report (4) Failure notification via phone $210/10 tests $ __________ $420/20 tests $ __________ Price Quantity Amount $89/12 tests __________ $__________ $119/24 tests __________ $__________ $169/52 tests __________ $__________ Optional: Certificate of participation $12/ea $__________ For more than 20 tests: $21_____ tests Optional: Certificate $12/each $ __________ $ __________ • A foam box, ice packs, sample vials, and instructions included. • Use APHA Standard Methods 9215 to test DUWLs samples. • Full dilutions provide accurate Heterotrophic bacteria counts. Shipping & handling Basic Plus (1) One test strip and one control strip per test (2) Return envelopes (3) Weekly report (4) Failure notification via phone Price $229/52 tests Quantity __________ Amount Priority Mail - starting $15.00/box FedEx 2-day - $36/3-12 tests; $45/13-40 tests Check enclosed $___________ (made payable to SAS-LLU) $__________ Charge: Total $___________ o Intensive (1) Two test strips and one control strip per test (2) Prepaid return envelopes (3) Certificate of Participation (4) Report on each test (5) Failure notification via phone Price Quantity Amount $128/12 tests __________ $__________ $298/52 tests __________ $__________ Class V Integrator for Steam Sterilizer (New) Price Quantity Amount $32/100 tests __________ $__________ $220/1000 tests __________ $__________ o Name on card _______________________________________ Card number ________________________________________ Exp. Date _____/_____ CCV# _________ Invoice# __________ Mail to: Dental Waterline Testing & Sterilization Assurance Service Chan Shun Pavilion, Suite A-1005 11175 Campus Street, Loma Linda, CA 92350 Tel: (909) 558-8176, (909) 558-8069 Fax: (909) 558-0307 E-mail: sas@llu.edu http://dentistry.llu.edu/research/faculty-research/projects/research-services 43 LLUSD ARTICULATOR Summer / Autumn 2017 Falling in L-O-V-E with dentistry by Genesis Gonzalez, media relations specialist, Office of Public Relations 44 hile growing up, Kylin Hamann spent summers in China W Kylin has come to view dentistry as more than a profession: living with various host families and studying Mandarin. it’s a relationship with each patient built on trust and love. During her sophomore year in high school she lived in Sichuan “People truly are affected by their health and how they perceive province where she immersed herself in its culture, people, and their smile,” says Kylin. “It is my goal to care for the person in language. Kylin enjoys using Mandarin to communicate with her a way that goes beyond the teeth.” With every appointment, Chinese patients on the School of Dentistry’s main clinic floor as she takes the time to get to know her patients and to help them well as at The Blessing Center in Redlands, California. understand what is involved in the procedures they need. For Kylin Hamann, a fourth-year dental student at the School of Dentistry, compassion and care for others began at an early age. At that student-run free dental clinic for the underserved, Her commitment to provide compassionate care for every Kylin provides dental services each Tuesday to patients of patient traces back to an early age. Kylin always admired the all ages and backgrounds. “It’s a blessing to work alongside ability of her mother—Beth Hamann, DDS’85—to balance work dedicated classmates who are passionate about serving others as a dentist while raising six children. “Her love for dentistry through dentistry,” says the class of 2018 Loma Linda University is evident, but more than that her passion for connecting with School of Dentistry student. people and building meaningful relationships is beautiful.” Volume 28, Number 2 As Kylin matured, her mother would share stories from her education LLUSD ARTICULATOR “It’s an honor to attempt to follow in that legacy of love and clinical excellence that Loma Linda University School of Dentistry seems to cultivate.” opportunity to connect with faculty members and build relationships that inspire her at Loma Linda University’s professionally and School of Dentistry where one faculty member made a lasting personally. One of those who has played an integral role in her impression. In Dr. Hamann’s first week as a dental student in mentoring is Kwang “Peter” Chung, DDS’76, MA’81. “He will 1981, a young professor walked up to the blackboard and wrote never compromise or settle when it comes to providing excellent the word L-O-V-E. He told the class that if they were here for any care,” she says. “It’s an honor to attempt to follow in that legacy other reason than to love patients, they should leave. This single of love and clinical excellence that Loma Linda University School indelible moment inspired Beth Hamann in a way that over the of Dentistry seems to cultivate.” years nourished a similar inclination in her daughter. As a fourth-year student, Kylin was selected to participate Although Kylin had the option to attend several dental in the School of Dentistry’s implant dentistry honors program schools, she was drawn to the special place her mother always for which she attends classes taught by graduate implant and told her about — Loma Linda University School of Dentistry. “I prosthodontic faculty members. The unique program offers wanted to find people like the young professor who inspired my her the opportunity to shadow and assist in various implant mom so deeply.” surgeries. “I get to learn from the best,” she said. Kylin arrived at the Loma Linda University campus not knowing For the past three summers, Kylin has provided dental care anyone and was a little nervous at first, as most students are. to families and children in Nicaragua as part of the School of During her initial visit to the Blessing Center, she was welcomed Dentistry’s Service Learning trips during which she has come to immediately by Mark Carpenter, DDS’80, who made her feel part know the children she’s treated and has been able to watch their of the team. She remembers how he took the time to get to know progress. She sees value in returning consistently to the same her and inquired about her interests. “You seem like you’re a community and hopes to go back in the future. Also on her to-do service-oriented person,” he remarked. “I’d love for you to come list are dental mission trips to China. back and be a part of the group.” That evening Kylin called her Looking for balance in her life, Kylin will run the Chicago mother to share how her day had gone and described how warmly Marathon this October. She often starts her days at 4 a.m. with she was received by her supervising clinician. a run in the dark. “School can overtake your life and it’s hard “This professor is so amazing, he made me feel so very welcome,” Kylin exclaimed. Dr. Hamann was pleased to hear to balance everything at times,” she says. “Training for the marathon gives me incentive to find the time.” such positive news and very curious to know the dentist’s name. Kylin graduated in 2014 with her bachelor’s degree, a dual When Kylin told her it was Dr. Carpenter, her mother’s reaction major in biochemistry and Chinese, from Calvin College in Grand was joyful surprise: “That’s the person I’ve been telling you Rapids, Michigan. Following graduation next year from Loma about your whole life!” Linda University, she will return home to Phoenix, Arizona, to Beyond her work at the Blessing Center, Kylin spends most of her time with classes and lab assignments. She relishes every partner professionally with her mother and her fiancé, Eric Chen, DDS’14, at the family’s dental practice. 45 LLUSD ARTICULATOR Summer / Autumn 2017 Graduate Endodontic Program celebrates 50 years LU School of Dentistry’s Advanced Specialty Education Program in Endodontics celebrated its first 50 years of specialty training on August 26-27, 2017. It was the first endodontic graduate program in California and the second such program on the West coast, following one at the University of Washington, Seattle. The LLUSD program opened in 1967 with Ronald E. Buell, DDS, its first director, assisted by the famous Navy endodontist, Ed Nutting, DDS, who would drive once a week from San Diego to mentor the School’s postgraduate endodontic students. Subsequent program directors have been Raleigh Cummings, DDS’66, MS’70, Distinguished Emeritus Professor Leif K. Bakland, DDS’63, and Mahmoud Torabinejad, DMD, MSD, PhD, Buell Professor of Endodontics To date more than 150 graduates have completed the program—students from many countries that include Canada, Egypt, Ireland, Italy, Kuwait, Singapore, Taiwan, and Thailand. The 50-year celebration, held in San Bernardino’s newly refurbished DoubleTree Hilton, began with a welcome reception on Saturday evening followed by a full day’s program on Sunday. After breakfast, George Bogen, DDS, a well-known endodontic clinician from Los Angeles, presented the celebration lecture on the MTA Revolution that focused on the important endodontic innovation by Dr. Torabinejad—MTA root canal material. Another highlight of the day was the festive anniversary lunch with welcome greetings from both LLUH President Richard Hart, MD, DrHS, who congratulated the endodontic program for reaching the historic marker of 50 years, and LLUSD Interim Dean Joseph Caruso, DDS, MS. The after-lunch program recognized events and individuals who had important roles in the history of the graduate program. C. John Munce, DDS’78, served as master of ceremonies and presented an impressive pictorial history of the program’s first half century. Approximately one third of all endo alumni attended the celebration, including two from the first class: Norwood Clancy, DDS, MS’69, and Dominic Niccoli, DDS, MS’69. To commemorate the event, all participant received sweat shirt blankets featuring the program’s golden anniversary logo. L 46 Tory Silvestrin, DDS, MSD’15 (Endo), MSHPE, welcomes the assembly. Adjacent page photos Figure 1. Steven Morrow, DDS’60, MS’85 (Microbiology), standing with Dr. Bogen, the keynote speaker; Figure 2. Debbie Catino, endodontic clinic manager, with Dr. Silvestrin, received an honorary plaque for more than 25 years of service to the Department of Endodontics. Endodontics faculty members who also received 25-year service plaques: Lee Ingersoll, DDS’70, MS’74; Charles Holman, DDS’63; David Wolfe, DDS, MS’84; Sean Noorvash, DDS; Dr. Torabinejad, Dr. Morrow, and Dr. Bakland. Figure 3. Drs. Hart and Torabinejad. Figure 4. Dr. Bakland welcomes alumni from far and near (left to right): Nooshin Noghreian, DDS, MS’01 (California); Debra Meadows, DDS, MS’93 (California); Elisabetta Cotti, DDS, MS’90 (Italy); Jantien Herweijer, DDS, PG’85 (The Netherlands). Figure 5. Endodontics alumni catch up: John Pratte, DDS, PG’95; Reed Cummings, DDS’91, MS’97; Ken Tittle DDS, MS’97; Roderick Tataryn, DDS’89, MS’94. Figure 6. Master of Ceremonies John Munce, DDS’78, PG’88 (right), welcomes Dr. Niccoli to the celebration. Dr. Niccoli’s classmates were Norwood Clancy, DDS, MS’69; Raymond Dolph, DDS, MS’69; and Leon Leonard, DDS, MS’69. Figure 7. Elmer Kelln, DDS, emeritus professor, Oral Pathology, was the associate dean when LLUSD established the Advanced Specialty Education Program in Endodontics, working closely with Dr. Buell to acquire approval by the Commission of Dental Accreditation. Figure 8. Robert Handysides, DDS’93, PG’01, newly appointed dean, School of Dentistry; Nishan Odabashian, DDS, MS’03; Erol Apaydin, DDS, MS’02. Figure 9. Wallis Andelin, DDS, MS’02; Kenny Tran, DDS, MSD’12; Luci Denger, retired, served for many years as Department of Endodontics secretary; David Roland, DDS’78, MS’03. Figure 10. Current graduate students pose with a member of the first graduating class: (Back row) Brent Hiebert, DDS’10; Greg Sprague, DDS’05; Arin Alexander, DDS; Jason Fowler, DDS’12; Justin Wu, DDS; (front row) Meghna Patel, DDS; and Dominic Niccoli, DDS, MS’69. Nan and Dr. Clancy enjoy the occasion. Volume 28, Number 2 LLUSD ARTICULATOR 1 2 4 3 5 47 6 9 7 8 10 LLUSD ARTICULATOR Summer / Autumn 2017 LLUSD NEWS Jung-Wei Chen shatters glass ceiling ung-Wei “Anna” Chen, DDS, MS, MS, PhD, program director, Advanced Specialty Education Program in Pediatric Dentistry, was honored with the Outstanding Alumnus Award on June, 1, 2017, from Taipei Medical University (TMU) in Taipei, Taiwan, where she earned her doctor of dental surgery degree in 1996. Dr. Chen’s award, presented at TMU’s annual Academic Achievement awards ceremony, involved two firsts, one of which broke a glass ceiling. TMU’s annual Academic Achievement awards are bestowed in three categories: academic scholarship, professional service, and entrepreneurial success. The 2017 ceremony marked the first occasion during which an alumnus from the University’s School of Dentistry received the Outstanding Alumnus Award in the academic category, and the first time in the history of the University’s award presentations that a female alumnus received that honor. But Dr. Chen’s 2017 travels to southeast Asia had just begun. Between July 26 to August 12, 2017, Dr. Chen spoke at ten different venues/conferences—nine in Taiwan, and one all-day keynote presentation at Sir Run Run Shaw Hospital in the town of Hangzhou, China. Dr. Chen was transported to her presentations at Sir Run Run Shaw Hospital by a new high-speed rail system on which the hospital now has its own station (see sign below). J 48 Dr. Chen’s lectures in Taiwan included continuing education courses at her alma mater, Taipei Medical University, during which she participated in a ribbon cutting ceremony for the University’s new History Museum. She also was keynote speaker on her birthday (June 12) for the annual meetings of the pediatric section of the Southeast Asia chapter of the International Association of Dental Research (IADR-SEA). Dr. Chen also presented the keynote address on August 6 at the Taiwan Association of Pediatric Dentistry’s 92nd Academic Conference on the New Era of Pediatric dental restoration at Taipei General Veteran hospital, Taipei, Taiwan. Topics Dr. Chen covered during her whirlwind speaking tour included the presurgical nasal alveolar molding (PNAM) appliance and dental treatment considerations for cleft lip and Dr. Chen enjoys her award with Taipei Medical University President Yuen Yen, MD, PhD. palate patients and their care; esthetic restoration with zirconia crowns for primary teeth and evidence that supports its use; and pediatric oral sedation patient selection, safety, medication review, and step-by-step clinical procedures. Dr. Chen returned to southeast Asia again in October, first to Suzhou, China (October 19-20), just a few miles west of Shanghai, for the 22nd National Conference of the Chinese Pediatric Society. It was the first year oral medicine was included as a subgroup at this annual meeting of Chinese pediatriciains, and Dr. Chen was the only international (non-Chinese) speaker to present a didactic on Pediatric Oral Dental Trauma. On October 21, Dr. Chen lectured at the ZheJiang University Children’s Hospital, just fifty miles south, southwest in Hangzhou, the capital of China’s Zhejiang province. Her presentations included Cleft Lip and Palate Treatment: from PNAM Appliance to Dental Care; and Pediatric Dentist Residency Training in America: How to Develop a Pediatric Dentistry Residency Curriculum. Finally (October 22), she traveled to Taichung, Taiwan, to deliver a keynote CE lecture on Zirconia Crown Preparation and Comparison and Clinical Cases of Oral Sedation at China Medical University’s Cancer Research Center. Part of a colorful poster used to announce Dr. Chen’s multiple lectures hosted by the Taiwan Association of Pediatric Dentistry Volume 28, Number 2 LLUSD ARTICULATOR Murray Jacobs named president of WSOMS M urray Jacobs, DDS, assistant professor, Department of Oral and Maxillofacial Surgery, was named president of the Western Society of Oral & Maxillofacial Surgeons (WSOMS) during the Society’s annual meetings held July 3-6, 2017, at Park City, Utah The WSOMS covers nine states and “is a voluntary partnership of dental professionals working together to improve the quality of oral and maxillofacial surgery services in the community.” Dr. Murray Jacobs Jeffrey Anderson awarded Dentsply Sirona Student Research Award J effrey Anderson, LLU School of Dentistry class of 2018 dental student, was presented the American Association of Dental Research (AADR) Dentsply Sirona Student Research Award March 3, 2017, during LLUSD’s annual Student Award Ceremony, by Sirona executive institutional specialist Kyle Morton. The annual event took place in the Damazo Amphitheater at the Centennial Complex during Loma Linda University’s 2017 One Homecoming. Jeffrey received a crystal engraved award and will represent the School of Dentistry at the 47th Annual meeting & Exhibition of the AADR and 42nd Annual meeting of the California Association of Dental Research, March 21-24, 2018, in Fort Lauderdale, Florida. Jeffrey was nominated by his mentor Jung-Wei “Anna” Chen, DDS, MS, MS, PhD, program director, Advanced Specialty Education Program in Pediatric Dentistry, for his outstanding research skills and collaboration spirit. With his research team members (and 2018 classmates)—Ross Emerick, Ashlee Sumilat, and Elisabeth Mauro—Jeffrey presented on “Esthetic outcomes following the use of PNAM prior to cleft lip/ palate surgery: a multivariate analysis of cross-sectional data.” He will present the research again during the upcoming 2018 AADR/CADR meeting in Fort Lauderdale, Florida. 49 Sirona representative Kyle Morton (left) with Jeffrey Anderson. LLUSD ARTICULATOR Summer / Autumn 2017 LLUSD NEWS Parnell Taylor’s tinnitus cohort study research article by L. Parnell Taylor, DDS, associate professor and clinical director, Division of General Dentistry, “The effect of specially designed and managed occlusal devices on patient symptoms of tinnitus: A cohort study,” was published online November 30, 2017, in the Journal of Craniomandibular & Sleep Practice. A Dr. Taylor and his co-authors, private practitioners Wayne O. Sletten, DDS, MSD, and Thomas D. Dumont, DDS, demonstrated the treatment efficacy of bioesthetic maxillary anterior guided orthoses (BMAGOs) on tinnitus. Dr. Parnell Taylor Christina Chi represents LLUSD at research conference C 50 hristina Chi (DDS Class of 2018) represented LLUSD at the 53rd Annual Colgate Dental Students’ Conference on Research, October 1-3, 2017, in Gaithersburg, Maryland. Her research presentation was entitled, “Tooth color change monitoring with different shade assessment tools: An in vitro study.” The American Dental Association Foundation (ADAF) hosts the Colgate Dental Students’ Conference on Research each year at the Dr. Anthony Volpe Research Center (VRC) in Gaithersburg, Maryland, to introduce American and Canadian dental students to the possibilities that dental research careers include. At the three-day event, Christina was able to interact with academic/industry professionals and scientists from the VRC, American Dental Association, National Institute of Standards and Technology (NIST), and the National Institute of Dental and Craniofacial Research (NIDCR) at the National Institutes of Health (NIH). She was impressed by “the amount and depth of research being conducted every day on a bigger stage,” as she “attended lectures given by a wide variety of professionals, ranging from the president of the ADA Foundation to postdoctoral fellows.” Christina was able to tour research centers at the NIST and NIH campus, and participated in poster presentations and panel discussions. “It’s not every day,” Christina says enthusiastically, “that you get a chance to eat dinner next to Dr. Laurence Chow, inventor of calcium phosphate bone cements, and casually chat with NIDCR director Dr. Martha Somerman.” For Christina “The best part of this conference was meeting fellow dental student representatives from each dental school Christina Chi poses in front of the National Institute of Dental and Craniofacial Research. across North America and simply discussing dentistry, dental education, and dental research over a meal.” Christina very much appreciates her research team members/classmates—Arfassa Gullo, Emily Hwang, Minna Chun, and Darlene Teddy—and her mentors—So Ran Kwon, DDS, PhD, MS, professor, Dental Education Services, and director, Student Research, and Udo Oyoyo, MPH, assistant professor, Dental Education Services—for giving her the opportunity to represent Loma Linda University School of Dentistry. The conference was sponsored by the ADA Foundation and Colgate-Palmolive Company as a way to invest in the future of oral health care by encouraging promising young researchers to remain engaged in research throughout their careers. Volume 28, Number 2 LLUSD ARTICULATOR Dwight Rice, et al survey CBCT image storage n article by Dwight D. Rice, DDS, associate professor, A Radiology and Imaging Sciences, Kenneth Abramovitch, DDS, MS, professor, Radiology and Imaging Sciences, and Gregory W. Olson, DDS’96, MS’11, associate professor, Orthodontics and Dentofacial Orthopedics, “Saving, Transferring and Long-term Storage of CBCT Volumes: A User Survey,” was published in the July 2017 Journal of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, Volume 124, Issue 1, July 2017, Page e36. The authors’ survey revealed low consensus on the management of the data sets and their subsequent usage. Dr. Dwight Rice Dr. Kenneth Abramovitch Standardization of post-capture data management could greatly facilitate patient care and IT performance, they suggest. 51 LLUSD & LLUSM authors collaborate ead author Dwight Rice, DDS’96, associate professor, L Dr. Gregory Olson Dr. Susan Roche Dr. Heidi Christensen Dr. Edwin Christiansen Radiology and Imaging Sciences, and four fellow LLUSD faculty members—Kenneth Abramovitch, DDS, MS, professor, Radiology and Imaging Sciences; Susan Roche, DDS’93, MS, associate professor, Department of OMFS; Heidi Christensen, DDS’83, MS, associate professor, Division of General Dentistry; and Edwin Christiansen, DDS’75A, PhD, professor, Radiology and Imaging Sciences—co-authored with two LLU physicians— C.A. Cora, MD, assistant professor, School of Medicine, and K. Torralba, MD, physician, Internal Medicine Rheumatology—an article entitled, “Undiagnosed, chronic temporomandibular joint pain: making a case for FDG-PET/CT,” published in the July 2017 issue of the International Journal of Rheumatic Disease. LLUSD ARTICULATOR Summer / Autumn 2017 LLUSD NEWS OMFS faculty members, and Italian clinicians published in Chinese journal n article by Alan Herford, DDS’94, MD, chair, Department of Oral and Maxillofacial Surgery, and Meagan Miller, DDS’15, instructor, Oral and Maxillofacial Surgery, entitled “The use of virtual surgical planning and navigation in the treatment of orbital trauma,” was published in the Chinese Journal of Traumatology — available January 2017 at: http://dx.doi. org/10.1016/j.cjtee.2016.11.002 A The paper reports a case describing the use of virtual surgical planning and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant. Dr. Alan Herford Dr. Meagan Miller Drs. Floriana Lauritano and Gabriele Cervino of the University of Messina, Italy, and Drs. Fabrizio Signorino and Carlo Maiorana of the University of Milan, Italy, are also coauthors of the article. Alumnus Brent Hiebert has faculty co-authors L 52 LUSD alumnus Brent M. Hiebert, DDS’10, MSD, and faculty members Kenneth Abramovitch, DDS, MS, professor, Radiology and Imaging Sciences; Dwight Rice, DDS’96, associate professor, Radiology and Imaging Sciences; and Mahmoud Torabinejad, DMD, MSD, PhD, professor, Department of Endodontics, coauthored an article entitled “Prevalence of Second Mesiobuccal Canals in Maxillary First Molars Detected Using Cone-beam Computed Tomography, Direct Occlusal Access, and Coronal Plane Grinding,” in the July 20, 2017, Journal of Endodontics. Dr. Brent Hiebert Dr. Kenneth Abramovitch Dr. Dwight Rice Dr. Mahmoud Torabinejad A review of CBCT volumes found the presence of an MB2 canal 69% of the time. Accessing the tooth led to an MB2 detection of 78%. When a CBCT scan was viewed, this brought the access detection rate up to 87%. Coronal plane root grinding had an MB2 canal detection rate of 92%. Differences between each method were statistically significant. Volume 28, Number 2 LLUSD ARTICULATOR Nadim Baba and fellows publish Dr. Nadim Baba Dr. Hamad AlRumaih Dr. Aziz AlHelal adim Baba, DMD, MSD, professor, Advanced Specialty Education Program in Prosthodontics; N Hamad AlRumaih, BDS, MSD’15, and 2016 fellow of the Advanced Education Program in Implant Dentistry; and Abdulaziz AlHelal, BDS, MS’16, and 2017 Fellow of the Advanced Education Program in Implant Dentistry, collaborated on an article, “An Alternative Technique for the Fabrication of a MetalReinforced Interim Implant-supported Fixed Prosthesis: A Clinical Report,” published in the April 2017 issue of the Journal of Prosthodontics, pp. 211-215. 53 The article presents a technique for the fabrication of a metal-reinforced interim implant-supported fixed prosthesis for patients to wear while an existing prosthesis is being repaired. Rami Jekki’s new role ami Jekki, DDS’06 (IDP), MS’15, has been appointed associate program R director for the Advanced Specialty Education Program in Prosthodontics. Dr. Jekki is an experienced clinician, having practiced dentistry for a combined eight years in Iraq and Jordan before completing LLUSD’s International Dentist Program in 2006. Since then he has been a full time primary attending member of the School’s clinical faculty. Dr. Rami Jekki LLUSD ARTICULATOR Summer / Autumn 2017 LLUSD NEWS Intrusion of permanent teeth reviewed by Samah Omar et al n article by Samah Omar, assistant professor, Advanced A Specialty Education Program in Pediatric Dentistry, and coauthors William F. Freccia, DDS, MS; Bonnie Retamozo, DDS’05, MSD’09, assistant professor, Department of Endodontics; and Leif K. Bakland, DDS’63, distinguished emeritus professor, Department of Endodontics, has been published in the May 2017 Journal of the California Dental Association titled, "Traumatically Intruded Permanent Teeth: Three Case Reports and a Review of Current Recommendations," 45:5, pages 235-243. This review evaluates the current information about management of traumatically intruded permanent teeth. As more data accumulates, uncertainties with respect to both treatment recommendations and long-term outcomes can be expected to be elucidated. Dr. Samah Omar ( foreground) and two of her co-authors (L-R): Dr. Bonnie Retamozo and Dr. Leif Bakland Sarah Bukhari wins research competition and publishes S arah Bukhari, BDS, 2017 recipient of a certificate from the Advanced Specialty Education Program in Prosthodontics, tied for first place in research competition held at the 82nd Annual Meeting of the Pacific Coast Society for Prosthodontics, June 28-July 1, for her presentation, “An In-Vitro Investigation Comparing Methods to Minimize Residual Excess Cement for Cement-Retained Implant Supported Fixed Partial Dentures.” 54 Led by Dr. Bukhari, an article by five LLUSD authors, “Three-dimensional printing in contemporary fixed prosthodontics: A technique article,” was published in the September 2017 issue of The Journal of Prosthetic Dentistry. This technique article provides an example of the use of 3D printing to create a definitive cast. Dr. Bukhari’s coauthors were Brian J. Goodacre, DDS, MSD, assistant professor; Abdulaziz AlHelal, BDS, MS, assistant professor; Mathew T. Kattadiyil, BDS, MS; professor and program director, Advanced Specialty Education Program in Prosthodontics; and Paul M. Richardson, CDT, Dental Lab Services. Dr. Sarah Bukhari Volume 28, Number 2 LLUSD ARTICULATOR 2018 LLU/AAID Implant MaxiCourse ® 55 Over 500 participants have completed the LLU School of Dentistry and AAID For more than 30 years, the Advanced Education Program in Implant Dentistry through the Continuing Dental Education Division has provided part-time didactic and clinical training in implant dentistry to general practitioners and specialists. The 2018 LLU/AAID MaxiCourse® offers 300 hours of lectures, hands-on workshop sessions, live surgical demonstrations, online lectures and clinical experiences placing dental implants on participants’ patients. The LLU/ AAID MaxiCourse® brings the experience of renowned instructors and clinicians from Loma Linda University and around the world. The 10-month sessions (two days per month) also help prepare the participant to take the written portion of the AAID Associate Fellow Membership Examination. The didactic portion of the course includes information for beginners, intermediate and advanced clinicians in implant dentistry wishing to expand their knowledge in this field. The program is designed to take the participants through a systematic learning approach of implant dentistry. Starting with basic concepts, diagnosis, treatment planning, dental implant surgery and implant prosthodontics, the attendees have the opportunity to develop sequential treatment plans on their own patients and participate in performing surgeries with the assistance of experienced faculty and residents of the Advanced Education Program in Implant Dentistry. The attendees also experience hands-on workshops where procedures such as cone-beam imaging analysis, simulated patient-based dental implant surgery on life-like mannequins, and guided-bone regeneration procedures on cadavers and pig jaws complete the understanding of basic and advanced dental surgical procedures. Dates: March 8 - December 7, 2018 Tuition: $15,000 MaxiCourse program. To register for LLU/AAID MaxiCourse contact Loma Linda University School of Dentistry Continuing Dental Education office at (909) 651-5673 or visit us online at dentistry.llu.edu LLUSD ARTICULATOR Summer / Autumn 2017 FOND FAREWELLS Milford Anholm 56 LLUSD’s Distinguished Alumnus of 2010, Milford Anholm, DDS, MS ’62, who died July 24, 2017, was the first Seventh-day Adventist with a dental specialty (orthodontics) to serve as a missionary. Born February 12, 1923, in Hemet, California, Dr. Anholm attended Loma Linda Academy despite daunting odds: his mother died when he was six years old; his father died when he was 15. On a rigorous work schedule Dr. Milford Anholm and budget, he completed predental studies at Pacific Union College and then dentistry at University of the Pacific in 1946. After practicing dentistry for almost 20 years in Corvallis, Oregon, he established a flourishing orthodontic practice (196572) in a Bangkok, Thailand, mission clinic. Sometimes he joined medical/dental teams to do “bush” dentistry, which required elephant transportation in remote areas. In 1989 Dr. Anholm began a five-year stint as the only orthodontist in Harare, Zimbabwe (a country of 12 million). In a land where graft may be “king,” Dr. Anholm arranged for direct transfer of the clinic’s profits to benefit mission schools and hospitals selected after his inspection. When he joined LLUSD’s faculty, Dr. Anholm undertook multiple trips to supervise students on mission trips. They went to the Philippines, Brazil, the South Pacific, Belize, and Peru. He participated in short-term mission trips around the globe: Micronesia, Russia, Honduras, Cameroon, ultimately reaching his goal to visit 100 countries. He applauded the current practice of dental teams that take air-driven turbines, air compressors, and other equipment—all in a suitcase. “You need to present American dentistry as first class,” he declared “You don’t go there and do ugly dentistry.” Honoring his impact on the profession, the orthodontic alumni and Orthodontic Department named their current clinic the J. Milford Anholm Graduate Orthodontic Clinic. Preceded in death by his wife of 61 years, Betty Louise, Dr. Anholm is mourned by his two sons—James, LLUSM’76, of Redlands, California, and John (wife Anne, MD), of Snohomish, Washington—and one granddaughter. Anholm’s first academic appointment with LLUSD was in 1972 and he remained on faculty in Orthodontics and Dentofacial Orthopedics in various capacities until August 1, 2013. Ernest Annofsky The son of missionaries who had fled China in the ’40s, Ernest Garret Annofsky, DDS’71, was born in San Francisco, California, on April 23, 1946. He grew up the son of a minister who pastored a Chinese church in the Bay area. After completing dentistry with LLUSD’s class of ’71, Dr. Annofsky practiced at various sites in California. He also obtained a pilot’s license and spent numerous weekends flying his plane to Mexico, where he provided Dr. Ernest Annofsky dental service in remote areas. Upon retirement in 1993, Dr. Annofsky moved to Evergreen, Colorado. There he joined his wife, Norma Delaney, in her self-empowerment business and coauthored Breath Around the World with her. The couple conducted conferences in the United States as well as in Canada, Austria, Germany, and Spain. Their conference presentations are available in English, Portuguese, and Spanish. Dying peacefully in Evergreen on August 1, 2017, Dr. Annofsky leaves to mourn his wife, Norma Delaney, of Evergreen, and his older sister, who lives in Virginia. Susan Bennet Susan Louise Bennett, BS’77 (DH), will be sorely missed in her community of Bellingham, Washington. She died July 22, 2017, after falling into a crevasse during a descent from Forbidden Peaks in the North Cascade Mountains. Ms. Bennett was born September 11, 1955, in Pomona, California. She spent her childhood and youth in nearby Corona, before entering LLUSD’s dental hygiene class of ’77. Upon graduation, Ms. Susan Bennet she joined Galbraith Mountain Pediatric Dentistry in Bellingham, Washington, where she worked as a pediatric dental hygienist. Active in children’s dental advocacy, she also participated in local mountaineering and soccer communities, serving on the Bellingham Mountaineers board and volunteering at the Whatcom Family YMCA. Some of her most significant community contributions were made in mountaineering classes, where she taught on site the skills of mountaineering: belaying, knots, rope work, Prusik ascents, and rappelling. A mountaineering student has called her “fit,” “strong,” “smart,” and “confident.” Among Ms. Bennett’s survivors are her husband of 37 years, Craig Convery, of Bellingham; and two sisters: Lisa Bennett of Lynwood, Washington, and Jean Maddy of Kingman, Arizona. Contributions in Ms. Bennett’s memory may be made to either the Whatcom Family YMCA children’s activities or the Bellingham Mountaineers. Volume 28, Number 2 LLUSD ARTICULATOR FOND FAREWELLS Paul LaVerne Coe Born in Stockton, New York, on August 9, 1931, Paul LaVern Coe, DDS’66, completed military service during the Korean War in an Austrian dental clinic. Expertise gained there plus predental courses at Andrews University, Berrien Springs, Michigan, prompted his career choice. It proved to be a fortunate match. He frequently characterized his career positively: “I never had a day I dreaded going to work.” Dr. Coe practiced dentistry in Delta, Colorado, for 44 years. During that time Dr. Paul Coe he was active in his local church, and added reading, camping, and backpacking to his pursuits. He made more than 30 climbs on Colorado’s 14,000foot peaks. Predeceased by his first wife, Nancy, of 48 years, Dr. Coe died in Eckert, Colorado, on August 23, 2017. His mourners include his wife Bonnie, RN, of Delta; his sons—David of Paonia, Colorado; Sanford (wife Marivic) of San Antonio, Texas; and Allan (wife Michelle) of Canon City, Colorado—his stepdaughters—Katee (husband John) McCollum of Montrose, Colorado, and Laura Clark of Delta; his stepsons—Robert (wife Patricia) Wheeling of Thornton, Colorado; and Donald (wife Tracy) Denham of Colorado Springs, Colorado—his 14 grandchildren and five great grandchildren. Gerald Robert Douglass A life-time NASDAD and Dean’s Circle member, Gerald Robert Douglass, DDS’64, was active in civic and charitable organizations until his death on September 21, 2017, in Riverside, California. Born in Massachusetts on February 25, 1938, Dr. Douglass completed predentistry studies at Columbia Union College (now Washington Adventist University), Takoma Park, Maryland, before joining LLUSD’s class of 1964. Upon dental school graduation, he Dr. Gerald Douglass began practicing in Riverside, where he continued until retirement in 2002. In an active retirement, he was serving in an administrative position for his dental group at the time of his death. Mourning Dr. Douglass’ death are his wife of 41 years, Carol; his daughters—Christiana (husband James) Clubb of Tennessee; Shelly Benedict of Glendale, California; Chrisann (husband Victor) Burull of Riverside; and Andrea (husband Guy) Chrest, of Oak Hills, California—and nine grandchildren. 57 Melvin England The son of missionary parents, Mel England, DDS’58, was born in San Juan, Puerto Rico, on March 29, 1933. He would live in the Dominican Republic, Cuba, Panama, and Colombia before completing pre-dental studies at Andrews University prior to entering LLUSD’S class of ’58. He pursued a practice in Centerville, Ohio, for 49½ years. Active in the Dayton Dental Society, National Association of Seventh-day Adventists, LLUSD’s Alumni Association and Century Club, Dr. Melvin England Dr. England was also a founding member of the Centerville Seventh-day Adventist Church, where he served in numerous roles. In his youth Dr. England began putting together model airplanes. Advancing to become a licensed pilot at the age of 16, he would join the Dayton Pilots’ Club and the Experimental Aircraft Organization. He introduced many children to their first small aircraft flights. When he died on June 7, 2017, in Centerville, he left to mourn his wife Nancy of 62 years, his four children—Debra (husband John) Gustin of Roseville, California; Randall (wife Silvia) of Englewood, Florida; Jeffrey (wife Lori) of Dewey, Arizona; and Jennifer (husband Michael) Karasek of Elkhart, Indiana—his seven grandchildren and four great-grandchildren. The family has suggested that memorial gifts may be made to the worthy student fund at Spring Valley Academy of Centerville. Willis Mason Fox A 22-year LLUSD faculty member in restorative dentistry, Willis Mason Fox, DDS’59, battled health setbacks to pursue his professional career. Born in Nashville, Tennessee, June 19, 1931, Dr. Fox grew up, admittedly focused on baseball even at Emmanuel Missionary College, where he qualified for entering LLUSD’s class of ’59. At the end of five years’ practice in Cologne, British Columbia, a viral infection of his heart muscle halted his practice for two years. Returning to active life, he Dr. Willis Fox taught geometry and biology at Glendale Adventist Academy, in California. Resuming dental practice, he introduced fluoride rinse in the Ventura County Schools and provided Ventura County jail inmates with dental care until a fungus infection on his hands forced termination of his dental practice. He found considerable satisfaction in his subsequent LLUSD teaching role, 1975-1997. An avid birder, Dr. Fox made annual trips to Morro Bay, California, for bird sightings; he also presided over family trips to Lake Mojave. When he died July 22, 1917, he left to mourn his wife of 61 years, Friedab(NP); and his daughters—Pamela Sue (husband Merlin) Hirschkorn of Alberta, Canada; and Cheryl Denise (husband George) White of Littleton, Colorado—three grandchildren, and three great grandchildren. LLUSD ARTICULATOR Summer / Autumn 2017 FOND FAREWELLS Fredrick Quentin Holweger A member of LLUSD’s first graduating class, Fredrick Q. Holweger, DDS’57, was born December 19, 1929, in South Dakota, where he grew up on a farm. He pursued predental studies at Union College, Lincoln, Nebraska, before entering LLUSD’s class of ’57. After dental graduation, he completed three years of military service in El Paso, Texas. His family, friends, and patients knew he loved dentistry, which he practiced energetically for 55 years in Chatsworth, Georgia. His major off-duty pursuits were Dr. Fredrick Holweger connected to activities at his church Dr. Holweger’s principal entertainment was road trips. He often undertook cross-country trips to attend LLUSD alumni events. When he retired in 2008, he moved to Chattanooga, Tennessee, where he died on August 13, 2017. His survivors include his wife of 64 years, Beverly; his son Jeff (wife Jeri) of Greer, South Carolina; his daughters—Jerri (husband Mike) Manlove of Chattanooga, Tennessee; and Holly (husband Greg) Fowler of Grovetown, Georgia—his eight grandchildren and nine great grandchildren. Memorial gifts in Dr. Holweger’s memory can be sent to the worthy student fund at Georgia-Cumberland Academy in Calhoun, Georgia. Jack Jennings 58 Remembered for his life of service and gratitude, Jack T. Jennings, DDS’58, died August 16, 2017, at his home in Stockton, California. Born in Baytown, Texas, November 14, 1929, he graduated from La Sierra University, Riverside, California, with a bachelor’s degree and a license in medical technology. An army recruit during the Korean War for two years, he then entered LLUSD’s class of 1958. After practicing dentistry in Canada, Stockton, California, and Galt, Dr. Jack Jennings California, Dr. Jennings completed oral and maxillofacial surgery training at Oakland’s Highland General Hospital, 1971-75, and a residency fellowship at University of California San Francisco Medical Center, 1983-84. He practiced oral surgery in Stockton and Tracy, California, until retirement. Active in professional organizations, dental education, civic and artistic projects, and his local Seventh-day Adventist church, Dr. Jennings also pursued travel, horses, gardening, and service to those in need. He is survived by his wife of 37 years, Walsie of Stockton; his daughter, Cynthia Ketcherside of Stockton; a granddaughter Hannah Ketcherside of Stockton; and two grandsons, Christopher and Michael Jennings of Laguna Beach, California. James Walden Jacobson Born in a farmhouse in Hagerman, New Mexico, on January 1, 1935, James (“Jim”/”Jake”/“Jimmy”) Walden Jacobson, DDS’62, moved with his family to a dairy farm in Modesto, California, when he was 10 years old. While pursuing predental studies at Pacific Union College, Angwin, California, Dr. Jacobson contracted polio, and because of a resultant delay in his education, he met and married the love of his life, Beverly McBride. Dr. James Jacobson Continuing his education at LLUSD, he graduated with the class of ’62 and opened a dental office in Westminster, California, where he practiced for 46 years. Retiring in 2008, he moved to Desert Hills, Arizona, where he died September 10, 2017. Dr. Jacobson is remembered for serving in the youth program at his church for 27 years, becoming an influential figure in the lives of many teens. He will be forever remembered by his wife of 58 years, Beverly of Desert Hills; his daughters—Tina (husband John) Stacy of Phoenix; and Shelli (husband Scott) Foster of Lafayette, New Jersey—his five grandchildren, and a host of friends. David Lawrence Kelly David Lawrence Kelly, DDS’80, was born June 3, 1949, in San Bernardino, California. After marrying his high school sweetheart, he interspersed work with school for several years, completing pre-dental studies at La Sierra University, Riverside, California. Graduating with LLUSD’s class of ’80, he practiced dentistry in Riverside for two years before opening an office in Arcadia, California, where he practiced until retirement. Among his recreational pursuits Dr. Dr. David Kelly Kelly established a family tradition of water skiing vacations at Lake Havasu, Arizona. Suffering complications from a kidney transplant, Dr. Kelly died December 1, 2016. Mourning his death are his wife of nearly 49 years, Jean, of San Dimas, California; his son, Jess, of northern California; his brother, Michael, of Moreno Valley, California; and his sister, Kathy Repan, of Couer d’Alene, Idaho. Volume 28, Number 2 LLUSD ARTICULATOR FOND FAREWELLS Sam Kennedy Active until the day he suffered a fatal cardiopulmonary arrest, Sam Kennedy, DDS’77, was pursuing general and hospital dentistry in Eureka, California. A native of Kansas City, Missouri, where he was born on September 25, 1949, Dr. Kennedy spent summers on a family ranch. During World War II, he looked with pride upon his mother’s work in the manufacture of B-25 airplanes and developed an affinity for all things aeronautical. He attempted to join the Air Force, but when health screenings Dr. Sam Kennedy prevented his enlistment, he took predentistry at the University of NebraskaLincoln, Lincoln, Nebraska, and entered LLUSD’s class of ’77. Dr. Kennedy spent 20 years at the site of his first dental practice in Temecula, California, before relocating to Eureka, California, where he was at the time of his death on July 17, 2017. Learning of his death when an appointment was cancelled, one of his patients said, “He was a good dentist—good conversation during appointments.” Another commented, “Very thorough; explained in detail what needed to be done.” Predeceased by two sisters who died very young, Dr. Kennedy’s survivors include his son Jared and daughter Kathleen. George Kuniyoshi To LLUSD’S first dental class, George Kuniyoshi, DDS’57, brought the unique experience of having spent his eleventh, twelfth, and thirteenth years in a Japanese internment camp at Granada, Colorado. His parents had immigrated from Japan before he was born January 21, 1930, in Merced, California. At 13 he returned with his parents to Merced, attending Grant Union High School in Sacramento before entering Pacific Union College. Graduating with LLUSD’s first class, Dr. George Kuniyoshi Dr. Kuniyoshi served as an army dentist, achieving the rank of captain. Following his military service, he opened an office in Sacramento, where he practiced for 35 years. He became a very active member of Sacramento Japanese Church, serving at various times as deacon, treasurer, and Sabbath School teacher, and participating in the church choir, men’s quartet, Pathfinder leadership, gym nights—and even mowing the church lawn. Dr. Kuniyoshi enjoyed golfing, gardening, reading, and, with the arrival of his grandchild, babysitting. He had moved in retirement to Upland, California, where he died on October 29, 2017. Mourning his death are his wife of 61 years, Mildred of Upland; and his daughters—Diane Loo, LLUSM, ‘84 (husband Ivan Loo, MA, LLUSR ’87) of Upland; and Keri Medina, DNS (husband Ernest Medina, DrPH, LLU’93) of Loma Linda—and one grandchild. 59 James Pettey Growing up in Riverside, California, after his birth in San Francisco, California, on March 11, 1946, James Pettey, DDS‘75A, attended Ramona High School, Riverside City College (RCC), and La Sierra University before entering LLUSD. Upon graduating at LLUSD he would establish a practice in Riverside, becoming very active in the community and in the Tri-County Dental Society. A pilot, Dr. Pettey also participated in volunteer flights to Nicaragua to Dr. James Pettey provide dental care with his colleagues. Introduced to Redlands Sunrise Rotary, he made several Rotary-related trips to various countries. In 1979 the Petteys moved to Redlands. There Dr. Pettey became a Webelo den leader, a coach for Junior All American Football, copresident (with his wife) of Music Boosters, and a trip sponsor for the RCC band when his son played trumpet in the group. Dr. Pettey’s plans to practice five more years were cut short when his battle with leukemia ended. He died on November 9, 2017, at his home in Calimesa, California. Mourning his death are his wife of 52 years, Jean; his three sons—James of Oklahoma City, Oklahoma; Donald (wife Kate) of Manitou Springs, Colorado; and Douglas (wife Kelly) of Yucaipa, CA—and four granddaughters. Vernon Prewitt Those who knew Vernon Prewitt, DDS’59, cite the moral compass he maintained for life, which began in Wallula, Washington, on July 24, 1931. After predental studies at then Walla Walla College, College Place, Washington, Dr. Prewitt entered LLUSD’s class of ’59. His first practice was established in Alaska. Later he would open offices in Kilroy, California, Spokane, Washington, and Portland, Oregon. In Portland Dr. Prewitt became involved in dental care at the prison. In another pursuit he combined his enthusiasm Dr. Vernon Prewitt for travel with trips overseas to provide dental care in remote areas. Active in his church he also gave extensive support to NASDAD, serving as its president for more than one term. Still devoted to his dental career, Dr. Prewitt semi-retired at 81 in Scottsdale, Arizona, where he taught at the local dental hygiene school. Predeceased by his wife Gladys, he was in Scottsdale when he died on June 27, 2017. Dr. Prewitt’s survivors include his daughters—Shirley (husband Alan Scott) Wall, BS’77 (DH), Scottsdale, Arizona; and Barbara (husband Martin) Karge of Portland, Oregon—his son Edward (wife Tracy) of Minnesota, and 17 grandchildren. LLUSD ARTICULATOR Summer / Autumn 2017 FOND FAREWELLS Keith Tall Just months after joining LLUSD classmates (March 2017) to celebrate the fiftieth anniversary of their graduation, Keith Tall, DDS’67, died July 13, 2017, in Vancouver, Washington. Born in Birch River, Manitoba, Canada, September 23, 1940, Dr. Tall prepared for dental school at Canadian Union College, LaCombe, Alberta, Canada, and Walla Walla College, College Place, Washington. After dental graduation Dr. Tall established a dental practice in Tracy, Dr. Keith Tall California, where he practiced for 17 years. Then in a 29-year return to Canada, he lived in Langley, British Columbia, where he was active in overseeing his five-acre property, acting as school board chairman, and traveling with Fraser Valley Adventist Academy’s gymnastic team, serving as its emcee. He gained a reputation for being a notably outgoing person with a sense of humor. Mourning their loss are Dr. Tall’s wife of 50 years, Marilyn (DH’66) of Vancouver, Washington; his children—Christine (husband Michael) Sharon, DH’93, of Walla Walla, Washington; Laura (husband Jason) Liu, of Irvine, California; and Brian (wife Priscilla, DDS’08), LLUSAH’01, of Beaumont, California—and six grandchildren. Eugene Voth 60 Born February 14, 1937, in Shafter, California, Eugene Voth, DDS’63, MS’68, worked in Scappoose, Oregon, as a youth on the family farm as well as at a sawmill, as an electrician’s apprentice, and as a tile mason before completing predental studies at Pacific Union College. Groomed for a teaching career during his dental education at LLUSD, Dr. Voth completed a dental degree and master’s in dental materials in 1963, and a second master’s at Indiana University. Dr. Eugene Voth He would serve in LLUSD’s restorative dentistry for six years. After completing orthodontics at LLUSD in 1968, he spent four years overseeing establishment of an orthodontic department at the Medical College of Georgia in Augusta. Dr. Voth then opened an orthodontic practice in Asheville, North Carolina. He practiced there until a serious accident in 1992 forced his retirement. He remained an active benefactor of the Warrensville, North Carolina, Adventist Church; he also enjoyed outdoor activities: gardening, hiking, and shooting. On November 21, 2017, Dr. Voth died in Asheville, North Carolina, leaving to mourn his wife of 30 years, Lori; his children—Bradford Voth, Kent Wolff Jr. and Mary Lorena Wade, MD (husband Robert Wade, MD)—and four grandchildren, all of Asheville, North Carolina. Rik Vanooteghem Born February 23, 1957, In Kortrijk, Belgium, and educated in his home country, Rik Vanooteghem, DDS, MS’84, practiced dentistry there until coming to the United States for graduate studies. Awarded a master’s degree (1984) in LLUSD’s Advanced Specialty Education Program in Periodontics, he joined the dental faculty at University of the Pacific, San Francisco, and soon opened a practice in Sunnyvale, California. He loved the practice of dentistry but was also fond of traveling. His friends hailed Dr. Rik Vanooteghem him as a gentleman, scholar, and family man, commenting, “There’s nothing he would not do for friends and family.” His battle with ALS ended when Dr. Vanooteghem died February 15, 2017, in San Jose, California. Survivors include his wife of 26 years, Kathy of San Jose; four children—Bonnie (husband Ryan) Johnston of Chico, California; Kyle (wife Caitlin) Cameron of Benicia, California; Tara (husband Luke) Liggett of Avella, Pennsylvania; and Tessa Vanooteghem of San Mateo, California—and five grandchildren. The family has suggested that gifts in Dr. Vanooteghem’s memory may be made to his favorite charity, Angel Flight, which arranges charitable flights to connect needy people with health care. William Warmkessel William F. Warmkessel, DDS’64, MPH ’76, was born September 5, 1932, in Allentown, Pennsylvania. Army service during the Korean War introduced him to laboratory work. He continued laboratory work even while pursuing dentistry in the class of ’64. Dental practice would take him to Napa, California (1964-69), then Truckee, California (‘70s and ‘80s), and finally to Naples, Idaho, where he retired in his 70s. A master’s in public health enhanced Dr. Willliam Warmkessel Dr. Warmkessel’s commitment to health education. He staged both smoking cessation clinics and cooking classes in his communities, and enjoyed hiking and exploring nature. When he died in Naples on April 6, 2017, Dr. Warmkessel left to mourn his three sons—Ethan (wife Laura) of Reno, Nevada; Jonathan (wife Deborah) of New Cumberland, Pennsylvania; and Keith of Sarasota, Florida—and four grandchildren. RDAEF Expanded Duties Program This comprehensive Board‐approved RDAEF program provides 410 hours of instruction for RDAs and 318 hours of instruction for existing RDAEFs. It combines didactic, hands‐on laboratory and live patient clinical experiences that satisfy the California Dental Board's requirements for new and existing RDAEFs who wish to expand their licensure in preparation for earning certification in the new extended functions. This RDAEF Expanded Course will be taught as a series of three individual courses (modules) that must be successfully completed in a designated sequence within an established time frame before taking the new State Board Examination. Modules can be paid individually and sessions will be offered on Sundays and evenings to better accommodate working adults. To successfully complete the program and be eligible to sit for the new State Board Examination, participants are required to pass all three modules with a minimum 75% pass rate. Module 1 Fee: $4,700 | CDE Credits: 104 June 3, 2018 - Aug. 26, 2018 (19 class sessions) June 3, 5, 7, 17, 19, 21, 24, 2018 / July 10, 12, 22, 24, 26 / Aug. 5, 7, 9, 19, 21, 23, 26, 2018 Module 2 Fee: $6,300 | CDE Credits: 128 Sept.4, 2018 - Dec. 16, 2018 (24 class sessions) Sept. 4, 6, 9, 18, 20, 23 / Oct. 2, 4, 7, 16, 18, 21, 30 / Nov. 1, 4, 13, 15, 18, 27, 29 / Dec. 2, 11, 13, 16, 2018 Module 3 Fee for Licensed RDAEFs: $6,000 | CDE Credits: 104 Fee for RDAs: $7,000 | CDE Credits: 180 Jan. 6, 2019 - May 5, 2019 (30 class sessions) Jan. 6, 8, 10, 20, 22, 24, 2019 / Feb. 3, 5, 7, 17, 19, 21, 24, 26, 28 / March 10, 12, 14, 24, 26, 28 / April 7, 9, 11, 23, 25, 28, 30 / May 2, 5, 2019 All three modules can be paid with payments, with balance due 10 days before the end of each module. Class times: Sundays: 8:00 AM to 5:00 PM (with a one hour lunch period) // Tuesdays & Thursdays: 5:30 PM to 9:30 PM Financial Aid: Loma Linda University Continuing Dental Education is now offering funding available to qualified individuals through the Sallie Mae Smart Option Student Loan® program. These are low interest student loans in which you can choose between 3 repayment options. Apply online and it only takes approximately 15 minutes to get a credit result. The site is NOW LIVE & ready to go! Please visit the Sallie Mae website more information. For more information contact: LLUSD Continuing Education 11245 Anderson Street, Suite 120, Loma Linda, CA 92350 Ph: (909) 558-4685 · F: (909) 558-0835 · dentistry.llu.edu/RDAEF Upcoming CE Courses Tisk Tisk Tisk, You’re High Caries Risk Sunday, January 21, 2018 Oral Surgery Challenges and Solutions for the General Practitioner Sunday, January 28, 2018 Managing Restorative Materials: The Path to Beautiful Dentistry Sunday, February 4, 2018 Are Your Patients Getting Comfortably Numb? An Update and Review of Local Anesthesia Techniques and Pharmacology Sunday, March 18, 2018 The Science & Technology Behind Treating Sleep Apnea: A Roadmap to Lower Stress, Higher Income, and Healthier Patients! Sunday, April 8, 2018 Hot Topics in Infection Control and the California Dental Practice Act Sunday, April 15, 2018 Recreating Nature Using Direct Composite Resin Sunday, April 22, 2018 The Bottom Line on Bleaching 2018 Sunday, June 3, 2018 RDAEF Expanded Duties Program June 3, 2018 - May 5, 2019 For more information or to register contact LLUSD Continuing Education 11245 Anderson Street, Suite 120 Loma Linda, CA 92350 Ph: (909) 558-4685 | F: (909) 558-0835 | dentistry.llu.edu NONPROFIT ORG U.S. POSTAGE PAID SAN BERNARDINO, CA PERMIT NO. 1272 Loma Linda University 11145 Anderson St. Loma Linda, CA 92350 ALUMNI STUDENT CONVENTION homecoming ONE Thursday, March 1, 2018 Poster research presentations Friday, March 2, 2018 Missions Emphasis Breakfast Centennial Complex 4th floor // 9am-4pm Wong Kerlee // 7am-8am Maximizing Your Practice Value with Data Mining Methods Interdisciplinary Healthcare Updates Centennial Complex Room 3111 // 10am-12pm Poster research presentations Top Ten Lessons I Have Learned In Orthodontics Centennial Complex 4th floor // 9am-2pm Centennial Complex Damazo Amphitheater // 8am-5pm Critical Issues in Dental Practice Management Whole Notes Conference - Bridge the Gap: Clinical Communication Symposium Loma Linda University Drayson Center // 8am-5pm Centennial Complex // 8am-4pm • Practice Management Statistics: Key Performance Indicators • Becoming an Associate or a Practice Owner Wong Kerlee // 1pm-4pm All- School All-Alumni Reception Wong Kerlee // 4pm-6pm Saturday, March 3, 2018 Sabbath Services Lunch Haystacks Class Reunions Sunday, March 4, 2018 Dental Trauma Can Be More Than a Chipped Tooth School of Dentistry // 8:00am – 5:00pm For more information on the 2018 One Homecoming, contact Loma Linda University School of Dentistry Continuing Dental Education office at (909) 558-4685 or visit us online at dentistry.llu.edu/alumni/one-homecoming-convention