So the TMJ design probably a little more forgiving in that regard, but you still have to deal with it. You still have to deal with what your local environments are and what the contributions are. We get into an actual dental implant at the tooth level and be subject to what goes on in the mouth itself and corrosion is a big scenario, which is why we won’t stick. It’s typically titanium into a ceramic matted piece of the abutment, so we will see that in a moment.

So I said earlier, titanium is really our most successful implant, primarily that’s a biological but also mechanical issue. Excellent fatigue, total life resistance, so it’s got a very high endurance limit, it’s got good stability. But probably the number one reason is you get good bony in growth. So you get a fantastic osseointegration. So it really is our template for our materials so that Ti6Al4V, the aerospace alloy that we see in the thermal stem is the same material that dominates the implants. And so this is just a nice picture to give you – this is an actual biological tooth just to give you perspective of the root structure so that’s just what ties into the bone. This is the part that we see from a cosmetic standpoint. So we all smile, this is the exposed part of our teeth. So this is our enamel, this enamel has been actually worn away.

So, this is what gives you structural anchor into the jaw bone. This is about the same, obviously same scale, so here’s your titanium implant, it’s threaded. So there’s actual contact stresses or fretting stresses to give you a mechanical interlock. One of the biggest challenges is that hopefully became clear when we talked about orthopedics is we don’t put titanium as the bearing material because it’s soft, it’s got very poor wear resistance. So excellent fatigue, excellent corrosion but it’s got poor fretting resistance and poor wear resistance. So it would scratch easily, it would create debris readily. So lot of times what’s done is as you do a surface treatment, you use ion implantation or ion bombardment. You leave the surface in compression and you make it much more resilient to mechanical damage. So you will see it in some orthopedics, but mostly you will see it in dental where you actually have surface implantation techniques and that actually improves the overall wear or the fretting resistance of that material. And again this shows just our implant on X-ray.

So really where we see titanium do well is just how well it fixates. And so the downside of this – and we will see this again when we get to soft tissues is there is always a trade-off. You want good mechanical integrity, you want wear assistance, fatigue resistance, fracture, corrosion, you want this thing to be stable, right? So you want to implant it, you’ve seen this now in Dr. Ritchie’s lectures. There is a good mechanical interlock, right, this thing is hammered in place. So you got good mechanical fixation or you have bone cement, that thing is not going anywhere, unless you get stress shielding or you get osteolysis and you lose the bony support in which case you’re going to retrieve.

The downside on retrieving and you saw this when Mike took out one of the implants there was no bone left. The downside of – if you get good fixation and the device needs to come up for any other reason is that it’s almost impossible to get these devices out without taking the surrounding bone with it. So if you have a recall of a device or you have inflammation or response to something else and you haven’t had enough bony loss, getting this thing out is a real challenge without losing supporting bone. So it’s always a trade-off, but this material really osteintegrates and so the real scenario for using this is you get good bone interfacing, good bony in-growth to the structure and you get a very good biological shield. So that helps prevent the whole corrosion issue. What you don’t want to happen is put this threaded device down below the jawline and actually have a mechanism by which saliva, food, other items work their shelf down and then you literally are setting yourself up for the crevice corrosion issue, right? You’ve got a very small opening, you get oxygen depletion but if you can get osseointegration all the way round you literally get a biological shield. And so you go through a process by which you can build yourself a shield and it’s a biologically stable one. So this is the real reason that this material dominates the market.

I put this in just for completion sake fatigue issues. So about 1 million cycles annually, I think quite honestly that’s probably on the low side. A typical stress is up to 20 megapascals, so again you’re up to the same stress levels we saw in a new design. Critical crack sizes, again that comes back from back calculating up from the stress 20 megapascals and the fracture toughness, you get a very long crack size. So you get something on the order of meters. In other words, this material has got phenomenal fracture toughness, resilience.

Total life approach even after accounting for stress concentrations, so again you get – if we look at a circular fillet you have a stress concentration factor of three. You’ve got a fatigue limit or an endurance limit for titanium on the order of 600 megapascals. So you’ve got a lot of forgiveness in terms of fatigue resistance. So here’s a material, it’s going to do well in terms of fracture. It’s going to do well in terms of fatigue. And this equation here hopefully that’s very familiar. Here’s your DADN meters per cycle is one times 10 to the minus 11, so that’s C. Here’s your delta K, 3.9 so that’s the old DADN is C delta K to the M.

So for titanium, we said before for alloys it’s typically two to four. So there’s titanium sitting at 3.9 and I said that C was one times 10 to the minus 11, and again that’s meters per cycle. So there’s your funky units. It’s delta K which is megapascal root meters raised to the power 3.9, so you would have that inverse multiply by meters per cycle, that’s the units on C. So C does not have any steady units in case you’ve not figured that out yet. C always depends – yeah, C always depends on what the multiplier is on M, on this megapascal root meter, and that’s a little subtlety that will bug you somewhere probably in your homework, okay, such but remember that C — the easiest way to find C is to always just remember this equation and solve for it, and just remember that M is the scaling parameter.

Okay. This is actually a plot that came out of Professor Ritchie’s group, did a lot of work on fatigue issues on titanium. It’s really that this man not only spent a lot of his time doing fatigue and fracture but also aerospace materials, right? So moving out of aerospace and ceramic materials to dental and bones is actually a pretty good transition. So the only thing you need to really see off this plot is that you’ve got an endurance limit for titanium. So here’s your maximum stress versus cycles to failure. You actually get endurance limit at 600 megapascals. So if you’ve got stresses on the order of 20 megapascals, you’re pretty safe against stress concentration, right?

We said total life tells us about initiation plus propagation, what if something already had a flaw in it. Well, again you’ve got a lot of protection with fracture toughness. So here’s predicted lifetime versus an initial crack length and so — but this is meters, so by the time you get out to the 0.1 meter level, you still get a year of life. So all it takes is 0.01 meters and you’re up towards the eight-year mark and so on and so forth. So if we can only do this well in terms of polyethylene we would be golden, right? So in terms of fracture toughness, years of use, very small crack lengths, all it takes is something on the 0.001 meter crack length and you’ve got decades of use. So titanium is a really good material in this capacity.

So you may think well, do we ever have failures then? And the answer is yes, so we don’t have traditional fatigue failures. We don’t have just a typical monotonic fracture failure, but we can have stress cracking, which is environmentally based. So the coupling of corrosion and stress can set you up for failure of that device. Fretting, so again borrowing back from the Morse taper, the study of the micro motion and continue rubbing of titanium, not having good surface properties, taking away that surface oxide sets you up for wear resistance that is actually quite poor, you create wear debris, you create essentially a third-body wear but you also have a mechanism for loosening or osteolysis. So we do see structural failures, but they typically are combination of stress and environments. So this would be where stress corrosion cracking is an issue.

And again just – these are on your hand-out, this should be an example again of the secondary crack or flaw that’s developed due to stress corrosion mechanisms rather than just cyclic mechanisms. So when you start taking away protective oxides and dropping pHs and in those situations the game changes dramatically.

So just let me walk us through how we actually do a tooth replacement? So this is the actual abutment piece. So we’re going to start with the structural peace, which is going to be underlying implanted device for the titanium. It looks very much like just a [peer-out] mechanical fixation. So internal taper for easy fit, try to avoid stress concentrations, it’s actually got a threaded design, smooth external finish and easy removal of the caps. So again you’re going to switch this out and we’ll walk this through the process as we look at this. It’s going to look a lot like orthopedics. So remember the reamer, so you’re going to drill a hole with the reamer appropriate to the dimensions, not nearly as exciting as watching a hip or knee replacement, okay, very small.

But just take the scale, drop it down, actually in my office I have got very tiny drills if you want to see some dental drills, they are pretty — pretty interesting to look at. They are about the size of needles. Come in, you actually drill a hole with a reamer appropriate to the dimensions of your site. So again very much like what we’ve seen in orthopedics. And then that’s going to be the mechanism for which you place your temporary abutment into your device. So you’ve got your mechanical fixation piece. So here’s your titanium. It’s going to be prepared and actually mechanically fixated into the jawline and then we’re going to have a temporary abutment. So again we have titanium, so we’re going to have this little ball that becomes a temporary tooth and the reason for that is going to become obvious as we go along. We need to have this sealed biologically. We need osseointegration, so we need to have good healing around this. Then we will substitute that out.

And I think when you are in surgeries, an example of what one might do in hip replacement as a temporary, there was a case of infection in surgery few weeks ago and Doctor Reese built up a full mask system out of polymethyl methacrylate. So rather than mixing materials and putting in the full implant, you’ve got a temporary system that would come out. So in this case, also you have a temporary system that comes out in about six weeks time or more depending on healing and then you get a full replacement. So if you look at the insertion, so again if you ream out whole hole, here’s your substructures. So here’s the dental sub – substructure that’s threaded, this is going to then be threaded into the jawline. So again you’ve got your bone structure that this is going to be matted too. And so it’s into your prepared socket and then you’re going to have your temporary abutment. So you’ve got mechanical loading or transfer of load to the jawbone. So here is your titanium device. Here’s your temporary abutment. So initially you actually have a little titanium ball that’s actually screwed in and until the whole structure is healed, you get osseointegration and good load bearing capability. So anywhere from 6 to 10 weeks depending on bone growth.

So this little temporary abutment is actually – or this – I will show you about it a bit here. You’re going to have little temporary abutment that’s actually screwed right in. So here is your piece here, you’re actually going to thread that in and so this little piece becomes the temporary, it’s the holding ground until you get full osseointegration of the substructure. So once you’ve got that in place and you’ve got your healed tissue, this would be a top-down view, you’ve actually got a full biological shield. If you try to put the dental replacement on beforehand and you are fully healed, you essentially set yourself up for crevice corrosion, right? Now you’re going to have a material mismatch. If you don’t have good healing around, any type of food or contaminant can actually become a pathway now down towards the crevice. So usually it’s waited until you’ve got absolute full healing, absolute osseointegration, which can be confirmed on X-ray.

So there’s your soft tissue topside looking – before the insertion of the permanent abutment. And then these actually look very much like the human tooth. So these are matched, they can be resin or all ceramic, probably all ceramic is the more common design, but again a lot of resins technology is improving that situation. They can be blended to the exact same color as adjacent teeth. And so now you’ve got an all-ceramic crown and use a dental adhesive. So again it’s that polymethyl methacrylate adhesive and then that’s placed into the abutment below. Now you’ve got your permanent abutment with your integrated crowns, so in cross-section you’ve got your titanium below osseointegration. You’ve got a biological seal and then you’ve got a ceramic crown. And so now you’ve got a tooth that looks like it’s always been there.

And so your net results rather than being without a tooth is you end up with something that looks like it’s always been there. So there’s a lot of work, structural work that’s going on in the field of dentistry and we tend to I think — from an engineering standpoint, we may look at as dentistry is not quite the same caliber as orthopedics in terms of engineering, and it’s absolutely the same caliber if not more. So there’s a lot of mechanical design that goes on into these devices.

So again in the end you have something that’s aesthetically matched with good structural support. And then if you look post-op what this would look like, so here’s your basic radiograph. You would see into the bones your threaded titanium, your abutment attachment and then from the side it looks exactly like an actual tooth. So rest assured if you lose a tooth, it can be recovered.

Okay. So I thought I just saw the same here, because I think in terms of regulatory issues, your first instinct might think class II because it doesn’t seem to be a safety critical application. But because of the osseointegration and because of what’s involved there is actually for this sub part here the underlying structure to the abutment where you’ve got thread titanium you actually have a class II regulation on it. So it requires the PMA or 510(k) and basically you have all the same specifications as our safety critical thermal stems or heart valves. So all these basic specifications, device manufacturing, sterilization, mechanical, bio and clinical studies are in place. So it’s a pretty robust industry in terms of what’s expected mechanically and structurally.

And then just — again just a quick note to finish on the TMJ Concepts. TMJ Concepts are again – actually this is the name of the business TMJ Concepts and it’s right here in Ventura, California and probably the most important thing for us to look at inside view is how similar this device actually is to a hip or knee design. So you’ve got titanium, you’ve got a metal bearing, you’ve got something again that looks a lot like what we see in orthopedics. So the same types of design issues, we have to think about contact stresses, we have to think about fatigue loading. We have to think about wear debris, we have to think about corrosion. So there’s a lot of similarity in terms of what we do with dental work with what we’ve done with orthopedics.

And again here’s just another example that – so nice cast resin of our teeth choppers, and just inside view you can actually see these devices. So I will – I know we are short on times but if anyone wants to come up at the end, you can just take a look. But I think it just gives you a good example of how complex these devices can be and how similar they are in terms of dealing with stresses and design issues that we have in orthopedics. So again just a good appreciation of crossover in our fields. Okay. Let’s stop with that and if anyone wants to come up and take a look, you can check out the devices.

We’re going to stop there and we’re going to open up for questions initially related to dentistry and they we’ll go right on to sex. Anyone in the very back of the room have any questions.

Audience: would it be wise then before deciding to remove the <inaudible> to perhaps go and have a test. I believe there is a place in Chelsea hospital.

DR BRIAN CLEMENT: I can’t address where it is but I’m going to ask my friends here because they probably know a lot more than I do about location but let me say this to you.  First find a very well-seasoned woman or man who is an alternative dentist for far more than ten or twenty years.  You don’t want a newbie. You don’t want a new guy or gal coming along because this is a god way to make some money. I’m not saying all the new ones  are shady but I’m  saying the ones  that have been doing this thirty years ago lets  applaud them and support them . They obviously love what they do or they wouldn’t be doing   for thirty years.

Secondly, those people should be very well equipped to say to you that they even do testing for very little money for example 120 pounds, where they tell you what composite works better in your body. How many of you have had that done? That’s a common test. It’s not that much money.

Audience: not in this day and age. All they do is root fill and take them out

DR BRIAN CLEMENT: we’re talking about private pay. We’re obviously not   going to go down the road of government control and insanity. This is all private pay stuff.

Audience: do understand that I was asking if the test is necessary

DR BRIAN CLEMENT: it is absolutely necessary in 100% of the cases. I would avoid being tested for that because it’s futile. I don’t know if you have the device here, it was outlawed  in America because they didn’t like  what it was causing for people  to  understand  how dangerous these filling were but there  is  a device where they touch the filling and it’s  at a scale from one to ten.

If you have more than one it’s very frightening but you don’t have to have it out today. If you have a    ten they better not let you leave the office. Any of you get alternative dentistry here?

Audience: yes

DR BRIAN CLEMENT: had they use that device on you?

Audience: I don’t know

DR BRIAN CLEMENT:  this was a device that was available. I was fortunate because I had nothing above a three so they took the threes out first, the twos out second and then they did psychic healing on me. All my fillings fell put within six months. I had to go to a real dentist after that and get it all done.

Audience: isn’t it called Gavianni?

DR BRIAN CLEMENT: thank you, I forgot. Its Gavianni testing. Have you seen it done?

audience: I  went to an alternative dentist , I paid  for it and then  at the end they said the machine broke down so I didn’t do it .

DR BRIAN CLEMENT: bottom line is, that’s why I revisit by saying many times when you see the world holistic or alternative it means counts. It’s become for the slackers, the lackers, the not so bright, the losers, and the people who couldn’t make often call themselves that. Also caution yourself with the best. Even our mainstream journals of medico recently reported that if you get sick do not go to the most reputable, well known hospital with the guys with the greatest credential because in 100% of those hospitals they have higher mortality rate.

They’re really sign get into the car, drive half way between here and Manchester, knock on the door of a doctor who didn’t go to   Oxford and say please can you treat me. They didn’t say this in writing but what it means is you fatality rate is much less if you see that doctor. Poisoning because he took out within a matter of two or three visits probably about eighteen fillings.

Here are the signs of being in the hands of a good dentist. Let’s imagine that you won’t due to you diligence but you’re wise enough to know that this might hurt you. If you go into a dentist and they don’t you a dam you know you’re in the wrong hands. It’s a big rubber thing that all you see out j of that is your tooth. When the dentist is looking down at you’re in the chair like this, this rubber dam literally covers your entire face of it captures the mercury. It captures any of the garbage coming out of you and all they are able to do is drill because that’s pop through the rubber and they’ll drill the tooth. If they’re not using that you’re not in the right hands.

The second sign that you’re not in the right hands is if they’re not putting oxygen on you. The vipers when they’re drilling, the mercury vipers go up, you inhale them it goes directly to your brain. The fatter your brain is the more it stays up there.

Audience: is the oxygen over your face over your nose?

Be: it can’t be in your face so over the nose. You don’t have to be crats with these people. just sit back and say ” could  you tell me what the procedure is like?” and  if they say nothing about a  dam and nothing about oxygen say ” thank you , I can’t quite see you now ” and go off to the next  one.

The third thing they have to have is if they have brains. This one isn’t a pre requisite because they may want to commit suicide themselves but they may want to have a filter in that room. The wise ones have a filter and   also have the window cracked open in snow storms in January.

Audience: would you recommend Gruella?

DR BRIAN CLEMENT: not that I recommend it, you’re going to eat the box of that thing. If you go to a dentist don’t say this is the inquisition. What you say to the dentist is “when you take my fillings out how are you going to do it?” if they don’t say at least two of these three things you now you’re in the wrong hands.  Be polite as a brattish can be, get up and walk out and that’s the end of the show.

What else should you do to prepare to take dentistry? Before you go to the dentist, at least one day before I want you to start to do two things. Stop eating a lot of solid foods. Unless you’re   a diabetic, unless you’re already amnestic or bulimic we’re going to preclude all of you but if you’re just a normal, relatively healthy person we want you to pretty much to go on a fast or close to a fast. We want you to start a day before.

Let’s imaging on Wednesday you’re going to the dentist, on Tuesday you’re not going to eat solid food. if it’s hard for you to fog on  a  juice fast , green juices , wheat grass,  high chlorophyll fast then  at least eat only solids  that day with copies  and large amounts of  water or juice.  that’s when you start to upload a minimum  and we’ll use chlorella because it’s easy to do 30 , 15  in the am and 15 in the pm of these little  chlorella tablets because when we want to take mercury out of people’s body or uranium  or any heavy metal we use chlorella .

When we went to Russia after chinoble we use chlorella to take uranium of out of people’s body. When I get people who have dental problems or mercury toxic poisoning we use chlorella to do that because algae’s do that and chlorella is the least expensive and most effective way to do that. Solange is helpful but chlorella is by far the best way to do that.

If you can do info red sauna. You should do an infrared sauna as often as you can period. I do a sauna 7 days per week, 365 days per year.  Am I toxic? Yes. Not because of my lifestyle because I live on the planet you live on. Every single day I make sure that I spend   a minimum of twenty minutes to thirty minutes in a very hot sauna as I did today at the hotel where I am .infrared is far better. The latest thing we found on that is that infrared I takes 86% more toxins out of your cells than a normal sauna.

For instance you go on a normal sauna and they take your perspiration and they test heavy metals, chemicals etc.  and they get a certain level. When they put you in an infrared the same amount of time when you come out you have 86% more toxins coming out.

Thirdly you should take copies amounts of water. On a daily basis always no matter what for every one pound of body weight you must consume a minimum of a half a pound of pure fluid. If you weigh 200 pounds you need how many ounces of water or juice combinations that day? 100 ounces.

Audiences: litres?

DR BRIAN CLEMENT: how many ounces are in a litre? Remember I am an American. They gave us a metric system. We went completely bunkers we had to get rid of it. For six month we said “let’s get back to the English system”. I’m sure the internet or your cell phone hades that you press a button and it compounds out.

Lastly zeolites are something I use on planes. I never get on a plane without zeolites. I open up my mouth, put my tongue up here and spray zeolite underneath the tongue. Zeolite collects all kinds of waste toxins and even biology out of the body. We give it to people who have cancers, bacteria’s, viruses etc.

Everything is advertising in marketing today even the alternative field and more than I would like to admit but that’s what it is. Find the well season thirty year old, if you have a friend that went to them hear the other signs.

audience: this is the whole problem isn’t  is trying to find  someone  reputable to do this  because  w heave gone to the reputable  people  in dentistry and it doesn’t  always work out . Who do you go to?

DR BRIAN CLEMENT: let’s practise what you just said. If you consider the work of somebody who puts malgum fillings and does root canal reputable you’re probably in the wrong lecture today. Main stream has one objective, money. it is not people , health , it’s not current and clear research that is abundantly evident  and if ii van  come here and teach you this tonight and I’m not a dentist , this is available.

there’s  thousands of people  I’m  sure with the internet today that would say I’ve  got cancer after I did a root canal. what we have to do is we have to look at  a doctor, even an alternative doctor the same  way we  would  buying a piece of  clothing. You have to like the person. I know people who  are really good doctors  who I wouldn’t goo to because I don’t resonate   with these people and especially a dentist.

you’re opening up a mouth , this guy or gal is drilling in your mouth and even if they’re not doing chemical treatments  with you, you ‘ve got to like that person.  Don’t be shy to shop these things. I’m very proud of you that you are very civil enough    to have a social medicine system here. In our country, poor Obama has been put through the colds because he’s trying to help people over there but bottom line is don’t get stuck in the social thing. You’re going to have save your money because this is life threatening.

These aren’t bad people. When I was younger and dumber it was a lot easier for me because I used to be angry at the doctors. Then I finally realize that these poor doctors were victims too. they went  to school, they wanted to help people, they have all the right intent then they are given a shit  load of bad information and they literally have one thing  that they’re doing  with ought knowing that they’re doing it which is writing prescription all the time and so they have the right intent.