In this Instructable I will show you step by step how to make a drying tower to hold rectangle drying racks.
First you will need a 4'x8' sheet of 1/8 inch thick plywood.
Next its time to cut your side wall support braces.
1. Cut two boards that are 38" long and sqare at the ends.
2. Cut two more boards that are 30 5/8" at there longest point. Next you need to cut the top of the boards off at a 20 degree angle.
3. Cut two boards that are 41 1/4" then cut off a 20 degree piece from one end, then cut of a second 20 degree piece perpendicular to the first cut.
4. Cut the last two boards 42 3/4" inches long and cut off a 20 degree piece from the top.
Next you are going to need to lay out your boards as shown in the first image so that you can mark around them. The forth picture shows what the measurements should be and what the wall will look like when you cut it. Now that you have your board marked cut out your wall you will need two of them.
Next you will need to screw the support beams to the side of the wall. These supports should be on the out side and face away from each other.
You now need to cut two boards that are 24" long and screw them to the top and bottom of the back.
Now cut two more boards that are 22" long and screw them to the front. You will need to screw them from the side.
You now need to cut a piece for the roof from a piece of PVC roofing cut it 4 feet long. We used tin snips to cut the roofing.
Next you need to cut a second piece of the PVC roofing for the front. Cut it 32" long.
Now you need to screw the roof and the front on.
Next cut out a piece for the floor it should be 24"x38 3/4"
Then cut out a piece for the door it should be 24"x42 3/4"
You will need to to cut 4 pieces of a 1"x4" board 35" long.
Then cut the boards in half.
And drill a hole in both ends of the board 3 1/2" from each end.
Next you need to add legs to your drying tower if you place each of the legs in a pail of water then bugs cant crawl into your tower.
Cut 4 legs that are 12" long and cut from a 1"x4"
Then mark out a square and draw a line at a 45 degree angle.
Drill two holes one on each side of the diagnle line.
You now need to cut four boards to screw around the edges of the door that was cut out earlyer.
The boards need to be cut from a 1"x4"
The first two should be 18 15/16"
The second two should be 42 5/8"
Now screw the boards to the door.
You can add a latch to the middle of the 42 5/8" board.
You will need to to miter out a section of the door so that you can screw the hinge on flush to mount the door to the tower.
Start with a 2'x18" piece of galvanized or other sheet metal and paint it flat black on both sides.
You now need to bend one end of the metal at 30-7/8".
You now need to cut 5 more boards.
Drill two holes in either end of the 1"x2"s it doesn't matter were you drill the holes but make them around 3"s in.
Now screw thought the black side of the metal and into the 1"x4" boards you should screw them in at about 4". they should be flush with the metal, do this to both sides. Now black your 1"x2" boards to the top of the metal and screw them thought the holes and in to the black side of the metal.
Now screw a 20"x30-7/8" board to the 1"x4" boards.
Now you need to use whats left of your roofing and screw it to the top of the solar heater. We cut a piece off the front to make up for what we needed to cover the heater. Then we cut it to the correct width.
You should have two pieces of roof left you will use them and some wood to cover the front back up later.
You now need to cut two boards to screw to the front. You can see the dimensions in the picture below. Now screw these boards so that they are flush to the bottom and side of the tower.
Now screw the two pieces of plastic to the front.
You now need to fill all the cracks and gaps with clauking and Great Stuff(foam in a can).
DO NOT seal the cracks on the top of the roof this is were all the moist air leaves from.
I would not use "Great Stuff" to do the sealing. I would use the strips that are made for sealing and supporting the material on roofing. On the front, put the lower part under the top part. That way any rain stays on the outside.
Use cheesecloth to cover the drying frames. It is used in cheese making.
Can you dry anything else than just apples in it? I am looking for a dryer that would dry apples, few other fruits, and herbs.
Ya you can dry anything with this thing, but I wouldnt try drying meat in it unless its a really hot day or the meat might spoil before it drys, but I dont think that will happen, but better to play it safe.
haha I am a huge fan of jerkys, but I would not try to dry meat. =D Thanks for replying and posting the instruction!
Sure thing glad someone can learn from it.
Dear Mindstormmaster1 I would like to know What kind of temps that it reached and held. It is a great design, I would love to try to build one. I was wondering if the material you used to cover the top and side. Does it give of any fumes that you know of when heated?
I believe it reached in the low 90s mid 80s and stayed there most of the day. The "top and side" material was designed to roof houses so I would think that it wouldnt give off any fumes. Everything we dried didnt taste plasticy or anything so ya I think its safe. If you do build one please let me know and send me pictures. Also if you need help with anything let me know I would be more then glad to help in any way I can.
This is a really nice instructable, you clearly put a lot of thought into the design. Thank you for sharing this with the rest of us. I'm thinking of building this but I am also going to send it on to some friends and family who do a lot of drying too.
Nice instructable. I was thinking of building something on these lines (but much smaller). I was not planning for a solar collector/heater of this kind but was thinking of using metal for the lower 1 foot of the tower walls to act as heater/collector. I was going to add a solar powered fan to force the circulation. That may help with a smaller tower as there is less of a chimney effect. My browser shows some odd characters in the Bill of materials. You may want to take a look at the formatting of that. What are you using for the trays - the mesh bottom part? Do you think some kind of down facing strip near the top vent will help prevent water from getting in in case it rains? Have you tried a dryer working on convection alone (without a transparent roof/front)?
This is a nice set up, but in a pinch, you can also set up your drying racks in an old car in the sun with a couple windows cracked.


text:
Q: How do I append to a hyperlink created by a form submission using jQuery? I have a group of drop-downs in a form. Each drop down adds a variable to a URL ie:(?year=2010&position=C) with year and position being different drop-downs.
On submission of this form I am looking to append an additional variable that is not included in the form. ie(&location=/123/abc)
I am looking to accomplish this using jQuery. I am currently appending links on a page, but have no idea how to append to the href created by the form submission. Any assistance would be greatly appreciated.
This is the beginning of the form
<form id="SimpleForm" name="SimpleForm" action="/club/app" method="post">

This is the submission button
<input type="submit" value="Go">

A: 2 ways I can see:
1) create a hidden control called location with the value you require
2) Use jquery to manually construct the querystring and post the form.
I suspect the former will be the easier approach for you.

A: add a hidden input field for each pair you wanna add:
$("#SimpleForm").submit(function(e){
    // for each key/value pair:
    $(this)
        .append($("<input />").attr({"type":"hidden", "name":"keyA"}).val("value 1"))
        .append($("<input />").attr({"type":"hidden", "name":"keyB"}).val("value 2"));

    alert($(this).html());
});

see a working demo: http://jsfiddle.net/roberkules/6gHhR/

A: Would a jquery post work?
You can set the URL cause the action will be on the end of the url.
http://api.jquery.com/jQuery.post/
or found this article about changing the action wiht jquery.
http://groups.google.com/group/jquery-en/browse_thread/thread/1277764ec2bdc711?pli=1

redpajama_set_name: RedPajamaStackExchange


text:
Knife, 1904
Silver and moss agathe
Oscar Graf
The Guild of Handicraft
Alongside William Morris and John Ruskin, Charles Robert Ashbee was one of the most prominent figures of the Arts and Crafts Movement—especially in its later days—and created a body of work that spanned wooden furniture, drawing, metal tableware, jewelry, and decorative paneling. Founding the Guild of Handicraft in 1888, he secured his place within the movement; the guild's two decades epitomized its reverence for medieval- and renaissance-style craftsmanship, especially apparent in simple enamel and gilded metal objects. The guild continued to operate through 1907, but reached its apex around the turn of the century under Ashbee's tutelage, and his work in that decade remains his best known.
Other works by Charles Robert Ashbee
Charles Robert Ashbee silver salt bowl with spoon Guild of Handicraft ca. 1903/04, ca. 1903
Kunsthandel Kolhammer
Muffin dish with dedication, England, early 20th C.
Biscuit box, 1906
Charles Robert Ashbee, Guild Of Handicraft
Porringer bowl and spoon, England, 1900s

redpajama_set_name: RedPajamaCommonCrawl


Spiritual Sciences are proving the existence of the natural laws of the universe. We should pay attention. Read the link above.
Your Daily Affirmation: "You are the Embodiment of GOD. It's your Birthright." " I AM an Embodiment of GOD. It is my Birthright."


text:
<?php
/**
 * Created by PhpStorm.
 * User: David Cocom
 * Date: 03/02/2016
 * Time: 04:24 PM
 */
use kartik\tabs\TabsX;
?>

<?php

$items = [
    [
        'label'=>'Servicio Social y Practicas Profesionales',
        'content'=>$this->render('community'),
        'active'=>true,
    ],
    [
        'label'=>'Voluntariado Ambiental',
        'content'=>$this->render('volunteer'),
    ],
];
// Above
?>

¿QUIERES FORMAR PARTE DEL CAMBIO?

                    ¡Únete a nuestro equipo de trabajo como parte de la Comunidad Ambiental o Voluntariado!

            <?=TabsX::widget([
                'items'=>$items,
                'position'=>TabsX::POS_ABOVE,
                'align'=>TabsX::ALIGN_CENTER,
                'encodeLabels'=>false
            ]);?>

redpajama_set_name: RedPajamaGithub


text:
layout: post
title: The Joy of Mapmaking with Bob Ross
description: "Bob Ross tribute map created using Mapbox Studio, Sketch, and Portland open data"
modified: 2015-11-01
category: articles
tags: [mapbox, studio, noun project, sketch, react, firebase]
comments: true
share: true
---

Yesterday I lead a fun session at Wherecamp PDX.  I'd been working on a Halloween costume of the late great Bob Ross so I embraced it and in the classic format of his PBS show [Joy of Painting](https://en.wikipedia.org/wiki/The_Joy_of_Painting) I took people through creating and publishing a map in just a half hour.

There. It's just that easy.

Is that Bob Ross at #WhereCampPDX ? pic.twitter.com/Q9J1nf4fpX
— Justin C. Houk (@GEOpdx) November 1, 2015

The joy of mapping with Bob Ross! (And QGis, Mapbox Studio, React JS, and...) #WhereCampPDX pic.twitter.com/zdVCfWItfa
— WhereCamp PDX! (@WhereCampPDX) October 31, 2015

Check out the interactive final product below complete with happy trees, clouds, squirrels, and a heatmap of furry travels as they forage and build giant acorn stashes.  I used some of my favorite tools including the new Mapbox Studio, Sketch, The Noun Project, and QGIS.  We then published the map as a simple web app using React and Firebase.  I did not create the data however.  Can you guess what I used?  [civicapps.org](http://civicapps.org) was my friend this time.

I hope you enjoy and read on for some of my workflow details.

View fullscreen in new tab

# The Blank Canvas

In Mapbox Studio your blank canvas will often be one of the pre-styled global street maps lovingly extracted from OpenStreetMap by the Mapbox team.  I chose the light basemap to focus the viewer on the data I was going to layer on top.  I then made the background color a little warmer and toggled off the display of any unnecessary layers including buildings and most labeling.  Studio has a nice feature where you can click any feature on the map and jump right into editing its style.  This is expected in graphic design software, but a global basemap?  This is a pretty big leap forward.

# Icon Design

All of my icons I found at [The Noun Project](https://thenounproject.com/).  Seriously they have icons for everything.  You can use any of them for free if you give credit.

* [Tree](https://thenounproject.com/icon/88105/) created by Matthew Hawdon
* [Squirrel](https://thenounproject.com/icon/16683/) created by Andy Beksa
* [Acorn](https://thenounproject.com/icon/1685/) created by Proletkult Graphic, GB
* [Cloud](https://thenounproject.com/icon/3765/) created by James Fenton
* [Rain](https://thenounproject.com/icon/96901/) created by Lloyd Humphries, DK

I was able to import each icon in SVG format directly into [Sketch](https://www.sketchapp.com/), my vector editing tool of choice next to [Inkscape](https://inkscape.org/en/).  Sketch is not a full-blown vector editor but I'm able to adjust color and size as well as duplicate and mash them up into new icons.  The final product is then exported as a new SVG and imported into Studio.  Some nice features are available for choosing what zoom levels the icons should appear at and how they should scale in size as you zoom in and out.  Very slick.

Exporting from Sketch

Importing into Studio

# Data

I found all of the data I needed at Portland's [civicapps.org](http://civicapps.org).  To load it into Mapbox Studio I only needed to convert it to the WGS84 reference system (longitude/latitude decimal degrees) from the local Oregon State Plane system.  Quantum GIS easily did this by loading the dataset and saving as GeoJSON WGS84.

# The Polish

To finish the map off I added some linework for squirrel paths.  These styled semi-transparent, maybe only 20% opacity, so that where multiple paths overlapped there would be more intense color, signifying you know higher density squirrel traffic ;)

I also added in some clouds that vary in size based on their size attribute. The clouds also appear and disappear as you zoom in and out giving a more interactive feel.  Completely for show but an interesting touch I think that takes interactive maps to another level.

# The App

But wait we're not done yet.  Once the map style is published we've just gotten started.  The map style is now available via the Mapbox style API and can be consumed by any mapping library that support the style and vector tiles spec.  For this example I used the [Mapbox GL Javascript library](https://www.mapbox.com/mapbox-gl-js/) and wrapped it into a simple [React app](https://github.com/twelch/react-mapbox-gl-js) that I put together.  It's not production-ready code but if React is your framework of choice it lets you get a map up and running in the browser quickly and get a feel for how it will work on a variety of devices.  Nice!

With just a few more steps you can then publish this little app prototype on the web using the [Firebase static hosting service](https://www.firebase.com/docs/hosting/).  The interactive map above is my published map that I put into an iframe.

There's much more you can do with the GL JS library including interacting with map features, filtering and restyling layers on-the-fly, tilting and rotating the map, and more.  I'm currently working on a production-ready starter project using the GL JS library, React, and webpack.  Keep an eye on the Github repository for more.

# Wrap

So that's it, I hope you enjoyed getting a glimpse into one possible workflow.  I have high hopes for this software stack and look forward to publishing some production apps in the coming months.  Until next time.


Sahitya Akademi Awards was returned by many writers in recent days. Young 17-year-old Kannada writer Ria Vithasha who had written five novels returned her Sahitya Akedemi Awards for killing the experienced Kannada writer MM Kalburgi on 30th August.
Vithasha writes her works by her pen name Muddu Thirthahalli and she was awarded this year for her book of short essays Ondu Chandrana Tundu. Her novel Kaada Haadiya Hoogalu was adopted for the award-winning movie on the same name. She is the student in Government PU College in Thirthahalli, Shimoga district.
She knew MM Kalburgi form her childhood and she had read all his writings. 'I cried a lot when he was killed and wanted to return my award but my parents told me to have patience and wait. Now so much time has elapsed and still there is nothing being done so like the other writers have done, I have returned my award,' she said in Hindi.
The 78-years-old MM Kalburgi has been shot dead in his residency in Dharwad district, Karnataka on 30 August 2015. His Marga series, research articles is very popular among the readers. Marga1 is hold on for various controversies but his Marga4 had gained him Sahitya Akedani Award.
Two unidentified men came by the motor cycle, one entered his house introducing himself as writer student to his wife. He entered writer's room and shot him twice while other one stands out and escaped immediately. Kalburgi earlier criticized the idol worship and traditions in his speech. He was threatened several times before for allegedly hurting the sentiments of Hindus. Some Hindu activists filed complaint earlier about his criticism that hurts the Hindu sentiments.
Former Union Minister and congress MP Shashi Tharoor on Thursday stated Awards should not be dishonored in the function at Thiruvanathapuram. The report quoted his statement that 'Personally, I regret the fact that a section of writers have returned the Akademi awards. Award is a recognition of intellectual, literary, creative or academic merits. It is not a political act'.
'Sahitya Akademi is actually an independent institution, and the concerns we have are political ones. For writers, I think there is no need to confuse these two. One should oppose the present climate ... one should stand up for freedom ... but one should not dishonour the award,' he said.
Sahitya Akedami Award was initially started by the government of India on 1954. It aimed at encouraging the writers, journals and literacy works. Though it was set by the government it functions as the independent autonomous organization. It gives 24 Awards to the literacy works in all the languages in India it has recognized.


With templates and checklists to make your blogging experience simpler. Say to me if one of these scenes seems known to you: You are sitting in front of an empty page to make a new blogsit. They often find themselves writing their designs from scratch because they just don't seem to work. Once you've posted a contribution, hurry around and fix all the little things you might have been missing - the "read more" tags you skipped, the picture you slipped, you forget to size, and the "further reading" proposals you didn't turn into links as you planned.
Posting and posting seems to take longer than you thought. When you are like most blogsgers, at least some of these things probably happens every single weeks. But the good thing is that there are a few simple ways to fix all these problems: templates and check lists. The world' s largest blog uses templates and check lists.
We' ve posted a lot of templates and check lists in the past - such as our first year ( or any year ) rating templates for your blogs - and I will link to some of them in this article. When you are afraid that using a pattern or check list could suffocate your creativeness, consider this: Maybe you could be more imaginative if you had enough structures so that you could concentrate on your contribution instead of everything else.
Styles are great ways to help you create a specific item of work. This is a great place to create a style for your favorite blogs: This is a great way to create brand image on your blog: This is a form for answering certain kinds of e-mail requests. When you need to answer prospective guests poster, prospective advertiser, or even reader who ask frequent question, it can really help to use a submission instead of typing a new response from the ground up.
It can involve things like submitting it to yourself, making sure the link works, and rechecking that you are submitting it to the right one. This is a checkinglist for the introduction of a new product: It could be a pretty long checkup, and one you don't use very often. Just don't let it stop you from making it.
This is a check list for modifying and posting your own video podcasts. For example, the creation of a check list now could considerably facilitate the handover in the near term. I' ll guide you through two very useful resource you can make for yourself: a submission form for posting your own blogs and a posting check list.
This is how a very basic blogs posting submission could look like: However, to make your design useful, you may want to make it more detail. Your pattern could look like this, for example: Ideally, your design should look different. You might, for example, want to have part or all of the tutorial before the features picture, or you might want to make brief contributions that have only one or two keys and a very brief deduction.
Do you have an attempt to come up with your own submission for your contributions? Submissions and check lists are vivid and can be optimized and perfect over the years. There are several variants of the templates that you can use for different kinds of postings. Or you could select another blogger's contribution and divide it into an order that will be used as the foundation for a submission.
As soon as you begin with check lists, you will find that they make your lives so much simpler. There is no longer time to take a look at a check list than to call up the mind "check list" in your mind. Indeed, you will probably find that it is faster to use the check list because you will not struggle to recall everything.
A lot of web sites use check lists for frequent, repetitive administration work. One of the great things you can choose for your first check list is to create a posting for your website. Here is what your check list might look like: Naturally, you can have various different assignments that you would like to add to your check list. Maybe you will immediately release the article and then plan a teetze about it.
Checklists may vary over the years. This kind of checkbox makes it much simpler to work with a wizard if you decide to do such a task in the near term. Just give them the checkbox and ask them to work through it for each contribution instead of relying on them to keep a long record of what you gave them on the telephone.
In addition to the creation of your own templates and check lists, you can also use ready-made templates. At any time, you can customize or change them to fit your blogs. Templates and check lists (among many other resources) can be found in our (FREE) Ultimate Guide to Start à la Blogs Course. Register or login to directly consult the check lists below.
Templates and check lists (among many other resources) available in our (paid) 31 day blog course to help us set up a better blog course. Register or log in to directly consult the check lists below. Submissions and check lists require some lead times in order to be created or adapted exactly to your needs. I would be happy to learn how you use templates and/or check lists.
Are you using any on your blogs?


Dremel Grinding Wheels. Huge selection of sizes, shapes, and materials. Grinding wheels are primarily for use on metals, but can be used on other harder materials..
Tormek Grinder, Japanese Water Stone Wheels for Japanese Water Stone Wheels for The coarse side of the grader reverses the stone to normal fast grinding.
sond stone grinding wheels; This ring test for checking grinding wheels has been around about as long asto radiate around the wheel which produces the ringing sound.


text:
arrow_rightarrow_righticon_excelicon_pficon_ppticon_wordmagnifier
info@congresscare.com
Home » Programma
21 januari 2022 21 jan
vrijdag 21 jan
23e Nationale Longkanker Symposium 2022
Welcome + Quiz
Combo IO-CT in NSCLC in stage IV
Martin Reck
Martin Reck, MD, PhD, is head of the Department of Thoracic Oncology and head of the Clinical Trial Department in the Department of Thoracic Oncology at the Lung Clinic Grosshansdorf, Germany.
He is also Principal Investigator in the Airway Research Center North (ARCN), which is a member of the German Centre for Lung Research (DZL).
Dr Reck has been a Principal Investigator (PI) in various clinical trials since 1993. His main interests are new medical treatments of thoracic malignancies as well as translational research related to predictive markers. A particular focus of his work has been attributed to the clinical development of antiangiogenic compounds. Recently he also has been deeply involved in several key trials with immunotherapies including ipilimumab, PD-1 and PDL-1 antibodies and other agents. As part of this activity he has been the principal investigator of the Keynote 24 trial investigating monotherapy with Pembrolizumab against platinum based chemotherapy in untreated patients with advanced PDL-1 expressing NSCLC (TPS =/> 50%), IMpower 150 trial and the CheckMate 9LA trial, which evaluated the combination of Nivolumab and Ipilimumab together with a short chemotherapy. Furthermore he has served on various Global Trial Steering Committees.
Besides the European Society of Medical Oncology (ESMO) Dr Reck is member of the International Association for the study of Lung Cancer (IASLC), the American society of Medical Oncology (ASCO), the German Working Group for Lung Cancer, the German Cancer Society (DKG) and the German Society of Pulmonology (DGP).
He has published papers in numerous peer-reviewed journals and is member of the editorial board of Journal of Thoracic Oncology, Annals of Oncology and Lung Cancer.
The implementation of immunotherapies has significantly improved our opportunities to treat non oncogenic driven advanced non-small cell lung cancer (NSCLC). I will discuss the most recent data for the novel opportunity to use double immunotherapy combinations as first-line treatment.
Therapeutic options after first-line triple therapy
Prof. Fabrice Barlesi, General Director, Gustave Roussy, France
Le Pr Fabrice Barlesi est Directeur Général au sein de l'institut Gustave Roussy. C'est un des acteurs majeurs de la recherche sur les thérapies innovantes contre le cancer. Il a cofondé le cluster français de l'immunologie Marseille Immunopôle dont la mission est de rassembler les expertises en immunologie de la métropole d'Aix-Marseille. Le Pr Barlesi est auteur et co-auteur de près de 400 publications parues dans des revues internationales ou des ouvrages spécialisés. En 2018, la Société européenne d'oncologie médicale (ESMO) et l'Association internationale pour l'étude du cancer du poumon (IASLC) lui ont décerné le prestigieux prix Heine H. Hansen. Fabrice Barlesi figure dans la liste des chercheurs les plus influents au monde (Highly cited researchers de Web of Science Group).
IO therapy beyond PD-(L)1
Prof. John B. Haanen
John Haanen finished his MD at Leiden University cum laude in 1988. From 1988 till 1991 he performed his PhD studies at the Division of Immunohematology & Blood Bank of Leiden University Medical Center and at DNAX, Research Institute, Palo Alto, California, US and defended his PhD thesis on human CD4+ helper T cells reactive against mycobacteria. He trained in internal medicine in hospitals in Leiden and The Hague. In 1996 he was registered as consultant internist. From 1997-1999 he did a post-doctoral fellowship at the Division of Immunology of the Netherlands Cancer Institute (NKI), Amsterdam. From 1999-2001 he trained in medical oncology and was appointed a permanent position as consultant medical
oncologist and research group leader at NKI. His research has been focused on development of innovative immunotherapies in close collaboration with prof. Ton Schumacher. In 2008 he was appointed professor of translational immunotherapy of cancer at Leiden University Medical Center. From 2009 till 2018 he headed the Division of Medical Oncology at NKI. In 2018 he was appointed CSO Immunotherapy, one of the major research themes at NKI. His current research is on development of cellular therapies for solid tumors, neoadjuvant immunotherapies, and biomarker research. His clinical specialty is in melanoma and other skin cancers, kidney cancer and management of immune-related adverse events. He coauthored over 300 peer-reviewed articles, serves at the editorial board of ESMO Open, Cancer Treatment Reviews and Kidney Cancer. He is currently Editor-in-Chief of ESMO IOTECH. John Haanen was scientific co-chair of ESMO IO Congress from 2016-2019, and Scientific Chair of the ESMO 2020 Congress.
Neo-adjuvant therapies in resectable stages
Prof. Dr. Martin Schuler, Director Department Of Medical Oncology, University Hospital Essen
Martin Schuler, MD, is director of the Department of Medical Oncology and vice director for translational research of the West German Cancer Center in Essen, Germany, which is the comprehensive cancer center of the University Hospital Essen and one of 13 Oncology Centers of Excellence designated by the German Cancer Aid. Professor Schuler also heads the partner site Essen/Düsseldorf of the German Cancer Consortium (DKTK). He holds a full professorship of medicine at Medical Faculty of the University Duisburg-Essen. Professor Schuler received his medical degree from Johannes Gutenberg University of Mainz, Germany, and completed his residency and fellowships in internal medicine, hematology/medical oncology, and pulmonary medicine at the University Medical Center in Mainz. He also completed a postdoctoral fellowship with Dr. Douglas R. Green at the Division of Cellular Immunology at La Jolla Institute for Allergy and Immunology in San Diego, California.
Professor Schuler is board certified in internal medicine, hematology/medical oncology, pulmonary medicine, and palliative medicine. He is a member of several professional associations, including the German Society of Hematology and Oncology, the German Society of Pulmonary Medicine, the American Society of Clinical Oncology, and the International Association for the Study of Lung Cancer. Professor Schuler sits on the editorial boards of several scientific journals, including Oncogene, the Journal of Cancer Research and Clinical Oncology, and Oncology Research and Treatment. He has authored or co-authored more than 100 original articles published in peer-reviewed journals such as Cancer Cell, Science, Nature, the New England Journal of Medicine, Lancet Oncology and the Journal of Clinical Oncology. Professor Schuler has received several awards including the AIO Scientific Award of the German Cancer Society and the Pulmedica Award of the German Society for Pulmonary and Respiratory Research.
IO strategies in stage III NSCLC
Willemijn Theelen
Medical Crossfire 1: IO monotherapy in PD-L1 >50% is first choice Chemo-IO in PD-L1 >50% is the	first choice
Michel vd Heuvel & Fabrice Barlesi
Vaccines for lung cancer
Prof. Dr. Joachim Aerts, Head of the Department, Professor of Pulmonary Medicine, Erasmus University Medical Center Rotterdam
Joachim Aerts is head of the department of Pulmonary Medicine at the Erasmus University Medical Center Rotterdam since 2018. His main research focus is on fundamental, translational and clinical research in immuno oncology, with a strong focus on lung cancer and mesothelioma. As PI and as co-investigator, prof. Aerts is involved in many studies both human and animal.
Prof. Aerts is leader of the core network on mesothelioma and board member of the European Reference Network on Rare Respiratory Diseases (ERN-Lung) and elected member of the board of directors of the International Association for the Study of Lung Cancer (IASLC). He is a frequent invited speaker on international conferences, and he is scientific committee member of multiple national and international societies, such as the NVALT, EORTC, ASCO, ESMO, ETOP, AACR, ERS and ATS. Prof. Aerts is co-author of >200 articles in international peer reviewed scientific journals.
Vera Bonta Award
MPM treatment in the IO era
Sjaak Burgers
EGFR, ALK and KRAS
Pasi Janne
How to find these drivers in tumor tissue and ctDNA
Michel van den Heuvel
How to discuss the results in a molecular tumor board
Sanjay Popat
Antibody-drug conjugates in 2022
Egbert Smit
Medical Crossfire 2 MET exon 14 skipping mutations: Chemo is first choice Targeted agents is first choice
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Independent schools offer a rounded education in and outside of the classroom. Outdoor schools such as Forest School, Beach School and Farm School are usually held weekly for Pre-Prep pupils, to help develop a child's sense of wellbeing through regular activities in their local environment. They encourage a child's desire to be active; and makes them confident, engaged and develop communication skills when sharing their new discoveries with others. Learning about the great outdoors is vital when our lives are becoming ever more remote from it, with consequences for our understanding of plants and wildlife and for the value that's placed on them. Educating children about the natural world is intrinsic to its survival and deepens their relationship with it for years to come.
Beyond a cherished valley known as the Gulch, lies the mysterious Dinosaur Bowl, home to Snor. Here, beside the Hobbit Hut, Radagast guards magical Tongswood: it's a beautiful ancient woodland adored by both kids and teachers. Opportunities and challenges are provided; the desire to discover and explore is palpable when rambling through the woods and across the grounds – a truly enriching experience for staff and children alike.
Our Top 20 Things to do in the Pre-Prep include going down a mud slide, building a den and creating natural art. Among other skills, children are taught how to use flint to start a fire, a skill that relies not only on perseverance, at times, but bravery and determination too.
Outdoor learning is integral to the Nursery and Pre-Prep curriculum; alongside the outdoor forest there's also Paradise Farm. At the farm, the children collect and count eggs, muck out pig arcs and hold the animals.
By the end of their time in the Pre-Prep the children will have had a go at completing the 20 challenges. Curiosity, imagination and empathy, some of Saint Ronan's core values, go hand in hand with the challenges.
At the Priory, the grounds provide food for thought, mental space and ways of living sympathetically with the environment.
On the farm, girls care for the animals – chickens, micro-pigs and an endangered variety of sheep. And parents are involved too: one mum came in at 10pm each night during the summer to train chicks to stay on their perch! Whether gathering apples from the orchard for the pigs, or selling eggs to buy chicken feed, these are lifelong habits.
The head of science has led this farm organically, and in doing so has taught girls life lessons. When a neighbour complained about the cockerel crowing, he built a shed using physics to muffle the sound. Solar panels on the chicken coop power the electric door which keeps the chicks safe from foxes.
The orchard has trees which are more than 100 years old, most of which are native species, including historic varieties like the wild service tree with autumn fruits. The girls press apples for delicious juice. The nuns who lived on this site originally were self-sufficient, and now the produce is grown by St Augustine's girls.
Pre-Prep pupils have been visiting a half-acre area of woodland called The Copse for several years. It was first planted nearly 200 years ago, and it's now a mature piece of woodland boasting a wide variety of trees. Using the traditional Forest School approach to learning, pupils gain extensive knowledge of the natural environment through regular sessions which develop their emotional intelligence, self-awareness and communication skills.
The Copse has a large grass area and clearing with a circle of logs where the girls sit. It provides an ideal, safe environment for Forest School sessions (waterproof clothing is provided as sessions continue in most weathers!) Some of the activities include mud painting, den making, creating art using natural materials, imaginative play, nature trails, finding insects and worms, bark rubbing, flora and fauna identification and making dreys for squirrels.
Beach School is loved by all and appreciated every season: from blustery autumn mornings to fresh spring visits and sumptuous summer days, its dunes never fail to delight.
The essence of outdoor learning is captured in every moment. Exciting discoveries, learning about tides and weather, all while breathing in fresh sea air, it's a perfect way of engaging pupils away from the classroom. "After all, they're only children once," says Headmistress Louise Salmond Smith.
Alongside Beach School, Prebendal takes every opportunity to broaden horizons, and its location in the heart of Chichester means pupils can walk to all manner of attractions right on their doorstep. The school has also invested in an outdoor classroom and amphitheatre so alfresco learning on school grounds is easily accessible for all year groups.
At Moulsford, one of the boys' favourite activities is Forest School, with all pupils having the opportunity to explore and learn outdoors (including an overnight camp for the Year Eight boys) during their time here. Pre-Prep boys visit Forest School weekly.
The woods at the two Forest School sites are about more than just fun. It's an incredibly important and valued part of Pre-Prep life and the space, time and surroundings enable the boys to immerse themselves in open-ended learning opportunities. Lighting fires, roasting marshmallows, den building, knot tying, wood cutting, whittling, making bows and arrows and drinking hot chocolate are all delights they'll enjoy. Or just kicking back and enjoying the view with Bosun the Forest School dog. The boys learn to climb trees safely and manage their own risk on the rope swing or rope bridge.
At Forest School, pupils build their skills in cooperation, communication, problem solving, assessed risk taking and leadership. The activities they pursue foster self-confidence, resilience and perseverance. They're able to see the awe and wonder of the changing seasons and thrive in a safe, well-organised outdoor space, without the constraints of time.


In this post I am specifically talking about overdentures, not fixed implant bridges.
Most commonly, a lower denture is supported with two to four implants underneath it. The more implants you have the more stable the denture is.
If I gave you a stool with two legs, could your sit on it? Yes you could! It would take some balance on your part, but you could sit on it. An overdenture with two implants, works like that. The denture is held in very strongly, but it can still move in the back.
In a two-implant overdenture, the implants are purposely placed in the front part of the jaw.
If you added a third leg to the stool, would that make it more stable?
Of course! Especially if the three legs were equally spaced away form each other.
The average denture has fourteen teeth on it. So the more implants, the better. Four implants are the best option for stability. It is a four-legged stool. The implants make the overdenture even more stable when a bar connects all the implants. This "splints" them together and creates strength in numbers.
Even two or three implants and be splinted together with a bar for added stability.
Five or more implants in the lower jaw is usually strong enough to replace the denture all together! Meaning the teeth would no longer come out. They can be fixed in place.
The upper jaw generally requires six implants to have a non-removable fixed bridge.
The basic theme is: the more stability you want, then the more implants are needed. Also, the more bone you have missing, requires more implants to be stable over time and avoid bone loss on the new implants.
This concept is sometimes confusing. Please comment below if you have a question!
Hello Dr. Amin, I hope you can help me with my problem. I have read all the comments and your answers. I did not see anyone with my problem. I had all my lower teeth removed 4 months ago, and 2 implants placed. While waiting for that to heal so that it can be uncovered I have developed a terrible nasal problem. Both sides of my nose are stopped and I can not breath out of either side. I would think I might have a sinus infection or an allergy, but no fever just can not breathe through my nose. I would not have considered my implants as being a problem but my chin is swollen to about twice the normal size, and directly under my chin in the upper throat area. All of the swelling is on the outside. Do you think I have two problems and could I possibly be allergic to the implants. You are so very knowledgeable concerning dental issues I thought you might have an opinion.
Something is NOT right. The upper and the lower are likely separate issues. Allergy doesn't really exist and would show differently. Take a new xray 3D scan and see the DDS ASAP.
Hello Dr Amin.. hope you can help me make the right the decision.. I am 70 years old and have worn full dentures, upper and lower, for 50 years with little or no issues other than the normal occasional sore spots. I recently saw an oral surgeon about having the All on 4 for my lower denture at the suggestion of the person that has made my dentures for many years. He has concerns that I may have issues as I age keeping my lower denture in place. The oral surgeon that I saw did the 3 D scan to ensure I had enough bone to do the implants, and he said I did. We have got as far as doing the implant mapping (GPS) placement but then I got cold feet and have the surgery on hold. Now I am trying to decide if I should move forward or take my chances that I will be able to wear my lower denture 15/20 years down the road. I saw your video on the All on 4 and your recommendation on doing 5 or 6 implants. My question is should I move forward to do the implants and if so, do you think doing 4 implant would be alright at my age? Also do implants help slow bone loss? Thank you so much for your time.
The lower jaw is very predictable when performed by a skilled provider or team. It sounds like the surgeon and dentist are giving you good information. The concept of the all on 4 really means that you'll be having a fixed, nonremovable situation rather than a removable overdenture like this post is talking about. Be sure that you are clear what you are getting. On the lower jaw the fifth implant is insurance in case 1 fails and also helps have higher stability to put same day teeth on. As you get older this process will become more difficult as your tissue becomes thinner and you may have a lot of problems with your regular denture which decreases quality of life. 70 years old is a young!! I do this procedure on patients in the early 90s sometimes!
My dentures won't stay in when I try to eat. I had them since January 2017. My top dentures stay in but I'm so afraid to eat because they might fall out I feel. How can you help me with this problem?
Hi. 2 vs. 4 implants for a prosthetic implant. 4 will cost $4,000 more. Is it worth it?! Should I try it with 2 first and add 2 more later if I have problems? Or bite the bullet and just get 4?
Hopefully you are talking about a lower situation. Yes 4…you won't regret it.
A two legged stool requires that you balance it use it as a seat. A 4 legged stool stands on its own.
Dentist says I have no more bone to put to many implants only the bone can accommodate only 2 implants what shall I do?
I had dentures put in 4/14/17 and had a lot of teeth pulled.
Dentures but had to pay on payment plan for bone grafts.
Fitting -and was told Sept Perm fitting.
Last visit the person I saw said something about dental implants ?
My bottoms aren't sucking in ( loose ) uppers better , but not real secure ?
They say it takes 6 months for gums to heal , and I have low platelets so it wasn't pretty that oral surgery day , only surgery I've had and I'm not sure if I made a wise decision ?
My teeth were receding , brittle and loose ..actually falling out!
I'm really grateful but didnt realize the other complications.
PS: how much are dental implants for dentures?
Why have bone grafting if you are only having dentures? That does not make any sense. Most of the time I will do a bone leveling procedure typically eliminating the need for bone grafting for someone that does not have teeth. Bone grafting on the upper jaw can often be bypassed by the use of zygomatic dental implants if your upper jaw is very thin and or your sinuses are hollow. cost can be variable. More importantly find someone that has the skill, judgment and experience to make sure that you have this done right the first time and do not have to have redo implants!
How long is the process for lower ov erdenture. How quickly an the denture be affixed?
Could you recommend a good inplant dentist in the Vancouver, WA/Portland, Or area. What are your thoughts with mini inplants for dentures? Can you combine regular and mini inplants for a stronger hold on someone with less bone?
Mini implants are considered temporary. They are bendable and break quite commonly.
So, are you able to combine the implant types if you only have limit bone areas suitable for regular implants?
I have 3 teeth together on my lower jaw that i need pulled. How many implants do I need. I am super scared of dentists and have been putting it off knowing I have to have the teeth out then when healed go back and have holes drilled.
The number of implants you will need is partially dependent on what teeth are opposing the teeth that are being removed. Also depends on how hard or soft her bone is and how much bone you have. Sometimes you can do more implants and sometimes you can do less… A really good implant dentist can help to determine this.
Why not have IV sedation for all of your appointments including dental cleanings?
Hi I have a denture held by 2 implants at the front. I have very little bone at the lower rear right. Is it possible to have additional implants to help reduce the movement of the denture or is it possible to have several implants and to do away with the denture altogether??
Yes, definitely! Typically three additional implants totaling five can support and lower full fixed implant bridge like a Solid zirconia Prettau.
There is not enough detail here for me to answer this. Almost always having more than less implants is the best. The foundational support allows things to last much longer and prevent bone loss that occurs around implants from too heavy of a bite on too few implants.
I cant use metals due to Lyme disease, allergic to them, what materials do you use for holding dentures in place?
Hmm….you should still be able to have medical grade titanium.
Hi doctor, Is it possible to get a implant for the lower jaw wisdom teeth? I accidentally bit some hard metal and my lower jaw wisdom teeth has been crushed and there is immense pain also. What would I do doc..? Please help….
we do not place implants for wisdom teeth. This is unnecessary.
I have full upper and lower dentures, w 4 implants securing the lower. I have always been displeased w my appearance following this very expensive undertaking, but figured i just had to live w it. Over the past 2 years, i suppose my jaw has shrunk and now my upper teeth are barely visible when talking, smiling, etc. Consulted a dentist for a replacement upper denture and he said both upper and lower would have to be done. Included in his estimate for bottom denture is an "inner bar" and 4 locators. I do not have any type of bar for my present denture, and why is it necessary to replace the 4 locators (at the cost of $825 each?
Hi Sandra, I would need to see you and evaluate your situation. Yes I can do implants in almost any situation with or without teeth. ?
i've had a full upper denture since i was 23 years old and i am now 32. i originally had two metal implants where the teeth to the left and right of my front four teeth once lived. after about 5 years, one of the implants came loose, and i started to wear the denture 24/7 as it was the only thing keeping my implant in place. eventually, i grew tired of having to constantly worry about it, so i just pulled it out and put it in a sealed container. its now been several years since then and the implant hole never closed in on itself and i still wear my denture almost always, only removing it to clean it/my mouth. just recently i noticed my natural gums on that side of my mouth now have a splotchy dark color to them. I'm very worried and i don't know what to do, as i have no effective means to pay for treatment. is it possible that this might be cancer? thank you very much for your time if you decide to respond to this.
Hey Ryan…you need to see someone. This does not sound good. Especially if bone is exposed. If there is gum over it then you are likely ok.
You didn't have enough implants to hold the denture.
Because the upper jaw tends to be so soft you will need several implants in order to hold the denture more stable. Without enough implants they will fail after just a few years. Sometimes a well-made full upper denture will hold just as well. This is not the case for lower dentures.
What is the procedure called when a dentist wants to draw your blood and add some jell to your blood to aid in healing for extractions for your teeth? The dentist im seeing is not very good explaining things. All I know is, its 550.00 and he is going to draw my blood and add some kind of jell to my blood before extracting all my teeth for full dentures. I can't find nothing on line to explain it.
see link —-this technique is very helpful if it is actually done correctly. It is typically not this costly.
i have upper dentures and 8 teeth on the bottom in the front. is it possible to get a full bottom dentire over the existing teeth instead of a partial?
Two months ago I had the last of my top teeth removed. As soon as they were removed I was given my upper dentures. I gag every time I put them in. If I try to get through it, I restart throwing up, and have to take them out. I love my dentist, and he has filed them down, and I still gag. He told me in the beginning it may take a while, because I gag easy. What can I do. I go back in a few days. What on average will it cost to have the post in on the top. Then I guess he can use my same denture I just got?
Based on your description, I doubt an overdenture would work for your strong gag reflex. Some people never adapt to an upper full denture. You should consider a fixed dental implants on your upper jaw rather than a snap in overdenture. They are much smaller and last much longer.
Have you tried seeking treatment in a dental school? They may be able to help if all your looking for is basic treatment.
I need to secure my upper dentures. Any suggestions.
More than a year ago, I had implants for a lower denture completed at Edward Hines Jr. Veterans Hospital near Chicago. Since then I have been back multiple times for the prime reason that when the dentist puts the denture in, it stays in for an hour or so. Then it comes out. I have given up wearing the denture(s) because when it would come loose while I was eating, I would end up chewing on my lower denture, usually when dining out. The VA put only two implanted posts. Attempting to find a dentist or oral surgeon to get at least a second opinion here in Chicago is almost nil. Can you recommend someone in my part of the country? Thanks.
The retention of an overdenture can be very complex and I would suggest you see a highly skilled dentist who specializes in implant dentistry to correct your situation.
I think your suggestions are out of reach for most patients. If 2 implants are placed in theion incisor position, more patients in need of a stable lower overdenture would be served.
Thank you for your comments. There are many many patients who have only two implants and they are very unhappy with the results. two is bare minimum for those that have Minimal bone loss. For the average person that has more moderate bone loss, two implants does not provide a lot of support.
Three implants is a great compromise.
There is no way for me to be able to tell you if the dentures will bother you. You need to be examined.
Consider a fixed bridge like a prettau rather than an overdenture.
Just wanted to thank you for all you do. I have never seen a dentist take time like this to talk to people are educate. I have learned more from you than any dentist I have ever seen. When they speak to me in the dentalese I understand it from reading here, to a degree.
Thank you again for all the help you give to others.
Thank you. I enjoy helping others.
I have been told that I need my lower teeth removed. I asked about an over denture with 2 implants. One dentist stated that I need a bone graph and would not be able to have more than 2 implants due to lack of bone. I consulted with another dentist that stated that no bone graph was required. The first dentist stated that they would remove the lower teeth and do the bone graph giving me a temporary denture. Then when everything healed they would go on with the implants etc. (I think that's what she said). The second dentist stated that when he removes the lower teeth that he would do the implants, however, the denture would not have the posts put on them until everything healed (approx. 3 months). The second dentist stated that there was enough bone where he wanted to put the implants and that is why the bone graph was unnecessary. I guess the reason why the first dentist stated that a bone graph was necessary is because of some abscesses (Don't know if I spelled that correctly.) So, now I am very concerned and do not know what the best thing is to do. I want to do the right thing for sure. I am 64 years old and healthy as far as I know, although, I have been told by other dentist that I have bone loss in the past. What should I do?
Before I answer your question, I would strongly suggest you have four implants rather than 2. You will be much happier this way. 2 implants are the absolute minimum and only help to keep your denture from falling out.
They don't prevent the denture from rocking. If the 2 dental implants aren't precisely placed, you won't be able to add a third or fourth implant later on. A highly experienced implant dentist will plan your case so that you can receive future implants in the most ideal locations.
It is uncommon for me to have to bone graft in this area. Occasionally, and under special circumstances it is necessary but most (95% ) of the time it can be avoided by leveling the bone down a bit. This is called a bone leveling alveoloplasty and I have another post that you can read and get all the details about it.
This will help you tremendously. I have many patients even into their 90s that have dental implants in the lower jaw with a simultaneous bone leveling and extraction procedure. That means everything is done in a single surgical visit. I do this extremely routinely with very high success.
Let me know how it all works out and please reference your original post in detail.
In my previous post, I stated that 2 dentists recommended 2 implants with a lower over denture. They stated that due to loss of bone, I supposedly am unable to support more than that. You recommended 4 implants as 2 doesn't prevent movement. (That makes a lot of sense to me) What about a bar between 2 implants would that work any better? I was also the one that was told that a bone graph was necessary because of the abscesses I have I guess. So are you saying that although there are abscesses that I guess causes bone loss a bone graph is still not necessary to support more than 2 implants? You stated that a bone leveling procedure may be done. How do I find a dentist that does that alveoloplasty procedure. What are they called? (I think I am probably limited also due to my insurance.) I live in Florida.
Two dental implants with a bar may be the same cost as four dental implants with locator abutments. without seeing you, there is no way that I can be sure that the bone graft could be avoided. Those with extensive dental implant surgical experience will bypass or eliminate the existing bad socket and use the better bone below your lower front teeth area to place implants.
The dental implants will gain support in better bone that aware the abscess was.
Choosing for dental implant provider should never be an insurance question. These are body parts that you are replacing and dental insurance really doesn't do much of anything for this procedure.
I asked how to find a dentist that would be the best at implants and familiar with the bone leveling procedure in case that is what decided. You said the decision should NOT be based on insurance. Ok, I understand that but how did I find someone that specializes in implants and bone leveling? I live in Florida.
My wife is a diabetic and lost all four of her posts that held her dentures in is there anything you can do???
I am guessing these are all on her upper jaw?
Please copy and paste your original question when you reply so that I can follow the question and answer you better.
also, when did they fail? Did they fail 1 month after they were placed? Or did they fail after the denture already being connected and if so for how long?
and was going to get a bridge. Now the dentist thinks he should just get an upper denture, because he says the other top teeth are loose. He told my husband that he needed to get 2 implant posts on each side of his top jaw to hold it in place. I'm concerned, we've had a terrible time with this dentist. Other than switching dentist, how many posts, and where should they be for the upper denture?
If you don't want a failure, I would suggest that you have 6-8 implants placed on the upper jaw spread out as far as possible from each other. I also need to be connected with a fixed bridge or a bar in order for them to be stable. The upper jaw has such soft bone that trying to use individual implants or less implants to replace all the upper teeth almost always result in bone loss and short and long term failure.
If he lost all of his natural teeth, he can most certainly lose all the implant even easier. Implants are not better or stronger than the natural teeth.
Consider something more substantial like a fixed implant bridge such as the Prettau dental implant bridge.
I HAD DENTURES MADE AND THEY ARE NICE BUT I PAID 30,000.00 PLUS DOLLARS FOR THEM AND THEY PUT (2) TITANIUM POSTS IN THE BOTTOM AND NONE OF THEM IN THE TOP.
HOW MUCH DO YOU CHARGE TO ADD (2) TO THE BOTTOM OF MY MOUTH AND DENTURE AND (6) IN MY UPPER AS THEY PUT NONE THERE.
THAT LASED (2) DAYS AS YOU STATE IN YOUR ARTICLE THEY (LOWERS) SEEMED TIGHT AT FIRST UNTIL I ATE AND OUT THEY CAME – THE UPPERS CAME OUT WITH DENTURE CREAM AND THEY PUT THE IN WITH NOTHING – ALL I FELT WAS A BOWLING BAWL IN MY MOUTH I COULD NOT EVEN TALK – WITH THE BULK AND LARGE SIZE OF THE UPPER THEY FILLED MY MOUTH – THE BOTTOMS LOOKED AND FELT GOOD BUT NEED THOSE EXTRA (2) TO MAKE (4).
I SPENT 275,000.00 SO WITH THE 30K TO 40 KEY FOR THE SO CALLED IMPLANTED I AM ABOUT OB FUNDS WISE.
COULD YOU EMAIIL ME AN ESTIMATE CLOSE TO PLUS OR MINUS A THOUSAND.
THANK YOU – I TAKE A WHOL LOT OF COLONZAPAM AND ZANAX FOR AGORAPHOBIA AND HAVE SINCE I WAS (14) YEARS OLD – THAT IS WHY THE WORK NEVER HELD AND THEY ALL KEEP SAYING YOU WANT YOUR TEETH – THEY ONLY WANTED THE MONEY.
$30,000 for dentures??? WHAT?? That is crazy!!
Please call my office after we return from the holiday vacation on January 4, 2016. If you're local my office or able to travel regularly your entire mouth can be easily rehabilitated with dental implants. Most of my patients are intravenously sedated for implants and bone graft procedure so you'll be very comfortable.
Full mouth reconstruction determined is utilized to restore a debilitated mouth back to as close to original as possible. It may involve all types of dental procedures such as extractions, bone grafting, many crowns, temporaries, fillings, gum treatment, root canals, etc.
To properly diagnose and treatment plan a full mouth reconstruction, I would suggest a 3-D scan, 3-D models or molds of your teeth, full series of regular x-rays and a full set of photographs. Typically I sit down with a patient for about an hour to review what is involved in the entire process that may take anywhere from 2 weeks to 2 years to finish. I hope this helps answer your question.
The number of dental implants you will need will depend on a tremendous number of factors. The post that you are reading on has got to do with dentures but some of the concepts that I mention pertained to you also. The upper jaw always needs more implants in the lower jaw just based on bone density. Cosmetics are going to play a big factor in the choices of how many implants also. Sometimes in the front of the mouth less implants you have the better.
Ultimately I would suggest that you're treated by a single provider who can make the teeth and do the implants so that cosmetics can be addressed all the way from the surgical phase. Sometimes if you have to dentist that her in charge of your procedure, they do not communicate well and the less than desirable result can happen.
I would also suggest you go through several temporaries in order to shape and mold the teeth or pontic sites. Sometimes I use an ovate shape and definitely use temporaries to make the gumline look natural which is by far the most challenging part of making her teeth look really natural. Front teeth are always complicated so make sure you do your due diligence.
I have to admit that your article is very detailed but I would like to place to you a patient's case in which the patient's upper overdenture placed in four implants two of them in canines and the other two in first molars, at this point I have to mention that a connection with metal bar to all abutments were avoided..! so every single implant operated by itself.
The result of this construction's choise were very bad at all.After a year of use two of the implants broke and the other two loose their joint with bone.
The question is what in your opinion causes this fail, the non connection with metal bar to all abutments or an assumed bruxizm it might were exist.
I would really appreciate to answer me.
It sounds like you are describing a case that is not pictured in this blog post.
Your description describes an upper denture retained by for individual implants that are not connected by a bar.
In the upper jaw, implants should be connected by a bar because the bone is so soft. When they are not connected by a bar, they tend to prematurely fail and get ripped right out of the bone or have substantial bone loss that occurs quickly.
I don't have enough information such as a clinical exam and detailed x-rays to answer your unique situation. Every person and situation is different. These are permanent decisions.
I am 87 years old, have Parkinsons, and have a new heart valve, so time is limited. this is about upper dentures which I have had about one year. There are two dentist where I live one does standard implants only the cost for two implants is $4500.00. The other dentist will do 6 mini implants for about $2800.00. I am tending to use the mini do to cost and my age. A comment would appreciated.
It is my opinion that both of these are bad options.
Two standard implants would help if this was your lower jaw. The upper jaw is very soft and 2 implants would cause a severe rock in your denture.
6 mini implants have limited surface area and often bend and fail because they are so skinny and they are being put into very soft bone. Remember that the upper jaw is very different on the lower jaw.
You would be better off with 4 standard implants connected with a bar on the upper jaw although 6 is much better. I guess you could consider doing 8-10 mini dental implants instead. This way when one or 2 fails you have several backups.
Again both of these are very bad options which I would not suggest to my own family regardless of their age or socioeconomic status. If you don't want complications and to be re-doing all of this in 1-3 years, consider doing it right the first time….. I say this with all due respect…. I'm really trying to help you make a good decision.
I forgot to mention that the mini implants would be stainless steel, would that make any difference in the possibility of the implants bending or breaking?
They have to be titanium or titanium alloy in order for them to be compatible with your body. Stainless steel would not be a good option and I am hoping there is not a dentist and United States that would put stainless steel implants into the bone. I'm guessing there was some sort of miscommunication. Stainless steel would set up an immune system reaction.
Just found this avenue for message! Left message and question on your Face Book page.
Thank you if you have time to read and answer it Dr. Ramsey. Your videos have been most informative and educational! I have read most of them in two days as I have to make some big decisions very soon re my upper jaw! Over denture vs. hit and miss repairs on 40 year crowns with root canals going bad! Nervous and a bit of a coward in Virginia! Thank you Dr. Ramsey!
I did not want to bore Face book friends with my situation,but I have a big problem! First and foremost your videos have been so educational and informative! I have read most of them on Google and because of the good info you have shared I believe I have the courage to do the over dentures on my upper jaw! Now the questions for you!
1. 2 molars on upper left and 1 inciser and 3 molars on upper right are all crowned about 40 years ago and lasted(amazing I Know) Several have have root canals done probably due to the trauma from earlier orthodontics and the filing of the teeth to prepare for crowns!
The crowns are connected to give stability to loose teeth after braces! The front 6 teeth are a removable denture with claps. 2 weeks ago the front right crowned incisor with root canal became very sensitive and it hurt to bite on it. The other teeth on the right also hurt some what. My dentist found an "infection" above that root canal and says it must come out! Also he says it looks like there is infection above the other right molars on the right crowned teeth. This tooth is connected to the other 3 molars which if left attached after removing root will be unsupported only by back 3 crowns and sort of left hanging on. It is in right front so if removed space will look awful! I am a 73 year old female and basically healthy and still enjoy looking attractive!
My dentist has proposed an over denture and 4 implants that will attach to the over denture after removing the 6 remaining crowned teeth in my upper maxilla jaw. I certainly have bone loss after years of having crowns and the removable bridge in front so bone graft will have to be done also. Your videos indicate I have lost vertical space from my bite changing and I am noticing a lot of clicking in my right jaw and even the bone seems to feel like it pops out a bit but always goes back with some wiggling! They gave me an anti-biotic for a week and all the sensitivity and discomfort is gone,but the jaw still clicks. This proposal was daunting and overwhelming for me to hear at first,but thanks for your very informative videos I now can accept this is the best route to take rather than patch work and lots of money wasted!
The BIG BIG fly in the ointment as they say is the cost quoted for the whole procedure which is a down payment on a house! The cost is $34,000.00 which seems extremely high! I live in northern Virginia across the Potomac from DC in a pricey area and the dentist office is here as well so I know all costs are higher. As this is your field of expertise can you advice me if this fee for this work is within line with charges in metropolitan areas? If I were in Burbank I would be consulting you for the dental restoration. Family obligations prevent my traveling to Burbank! Your video interviews are so informative and clear for a novice and I am very grateful for the education. Thank you!
Thank you for your very kind words. I'm happy to help.
It sounds like you be better off removing all the teeth on the upper jaw. $34,000 should be able to get you a fixed Prettau upper reconstruction which is tremendously better than an implant overdenture which has to snap in and out. Over dentures require much more maintenance and need to be replaced, relined and attachments changed on a frequent basis.
Most people don't realize that they're pricing out of body parts. Make sure you have the best work you can possibly afford so that you have no problems in the long run.
These types of procedures are extremity complex and often include realigning your jaw joint to make sure that clicking does not turn into a severe TMJ problem.
I just had a sub dental implant removed from my lower jaw after 17 years and many years of infection. I still have 7 front teeth left, only my back ones are missing. Most dentists consulted or now suggesting that I have all my teeth removed in the front and have four to five impants for a permanent or removable bridge. I feel that this may not be the best solution as I have six of these teeth caped with veneer and lots of money invested.
Is there a better solution where I could keep my natural front teeth?
A subperiosteal dental implant that lasted that long is great. Many subperiosteal did not go beyond 10 years. It sounds like you have deep saddle areas in the back part of your lower jaw. My guess is that your nerve is very high and regular implant will not work there.
In order to have dental implants where your subperiosteal used to be, a nerve repositioning procedure may be required. This is where the nerve is taken out of the bone and moved to the side so that implants of regular length and diameter can be placed without the nerves being in the way. It is a procedure that is more rare but there are some of us that perform this procedure fairly routinely.
I just had a sub dental implant removed from my lower jaw after 17 years and my years of infection. I still have 7 front teeths left, only my back one are missing. Most dentists consulted or now suggesting that I have all my teeth removed in the front and have four to five impant for a permanent or removable bridge. I feel that this may not be the best solution as I have six of these teeth cap with veneer caps and lots of money invested.
I am interested in more info on nerve repositioning procedure, what is the risk of a side effect with lose of facial sensivity. I was told by my prosthodontist that this procedure is very risky and should not be considered, any comments?
Expect to have some numbness for 2-3 months which should go away. I have never had a patient not regain 100% sensation.
I have some information for you on the topic.
Dear Dr Ramsey can 3 implants in lower jaw be enough to support ,12-14 teeth on a fixed denture .
Three implants is not enough. You have to engineer implants in a similar fashion to how God designed your natural teeth. We have may more than three roots per arch.
If you don't design strength, you will not have longevity. This is not an area to skimp on, unless you are looking for problems.
If you are talking about a snap on over denture that you remove then that is a different story.
My mom is 90. Has had upper dentures for a long time no problems. 3 years ago she had to get bottom dentures. They have never been comfortable even after several trips back to the dentist for adjustments. Now the dentist says to make it work she would need new top dentures also because they can't align the upper and lower ones and that is probably the problem. Does that sound right?
Yes…the way the bite comes together is critical for a lower denture. Lower dentures are always a problem if no implants are present. I just placed 4 lower implants on a 90 year old last Tuesday.
Check out the above articles too.
I would like to replace conventional full upper denture with implant supported overdenture. My question is, how many implants do i need to wear upper overdenture with and without full palatal coverage? do 4-implants enough to fabricate full overdenture without palatal extension? does the implant number depend on bone density ?
If your denture currently holds well, a dental implant over denture will not benefit you that much. This is only true on the upper jaw because and upper denture already has a lot of support from the palate. If your main goal is to remove the palate, then a fixed dental implant bridge on 6-8 implants would be far better and achieve your goals.
Over dentures work far better on the lower jaw then on the upper jaw. On the upper jaw, the bone is softer than the lower jaw. Because of this more implants are needed to support teeth. Generally speaking 6 is the magic number for the upper jaw to have long-term stability.
I would suggest you have a Prettau dental implant bridge using a minimum of 6 implants. Over dentures are a lot more maintenance and they upper over dentures break a lot too.
My dad's dentist told him he need to get 6 implant on top and 4 Implant in his mandibular in order to get full upper and Lowe denture!
Do you thing all the 10 implants are necessary for a better and more stable denture , or this dentist just wants to charge us more money with putting more implant?!
If your father's bone is really dense than you can use less number of implants on the lower jaw. The upper jaw typically always has soft bone so requires more dental implants.
The dentist is not trying to take your money. He or she is trying to restore everything back to nature.
The most important thing you want to know is what type of teeth will be used at the end. Will this be a fixed bridge on the upper and lower? Will the teeth be made of porcelain or plastic? Will this be a removable overdenture? This is far more important than the number of implants. Once you know the type of teeth…then determine how many and where the implants should be placed.
You ask a really great question. The upper jaw is very soft for almost all human beings. Because the bone is soft, more dental implants are required. I would suggest a minimum of 6 implants on your upper jaw. Four is very under engineered and will not likely last 10-20 years.
Unless you are greater than 80 years of age, you may want to consider replacement with a fixed Prettau dental implant bridge rather than a removable snap-on overdenture. Fixed Bridges are so much better than removable implant over dentures especially in the upper jaw. An overdenture in your upper jaw will only help with stability and retention of the denture.
It sounds like you don't have a lot of bone to retain a conventional full upper denture. You likely have some bone atrophy within your sinuses also. Over the years your bone will continue to shrink unfortunately.
If your budget permits I would suggest replacement of your full upper arch with a Prettau dental implant bridge. This is a fixed dental implant bridge that you never have to remove. It is typically anchored by 6-8 dental implants. It looks fantastic and is super strong. You can eat and chew whatever you want without the worry of it ever coming out.
Cost is variable depending on so many factors.
Method of temporization during the process.
As of 2014 a full arch replacement can range from $10,000-$50,000 per arch. On the low end would be removable types of teeth and on the high end it would be an upper arch that required extensive bone grafting including sinus bone grafting.
I want complete fixed bride, lower jaw Please send estimate of cost. Thank you.
I would need to see you in person in order to evaluate you. There is no way to properly review cost, risks, benefits and alternatives without a proper 3-D scan, intraoral photographs, clinical examination including skeletal profile.
Replacing your entire mouth with dental implants is extremely complex and care must be taken to precisely diagnose and treatment plan.
It sounds like you're considering something like a Prettau dental implant bridge which is an excellent choice. It generally requires about 5-8 implants in each of the lower and upper jaw. The upper jaw is always more complex and costly. Full mouth treatment can range from as little was $5,000 to as much as $120,000.
If you're local please call my office to schedule an appointment.
In your proffessional opinion is The Baylor School of Dentistry in Dallas, Texas a good place for a patient to go to and have a full set of dentures made. (Posts Included). Are 3M MDI better than Sendax MDI, in your opinion.
The two companies you mention I believe are now fused as one. The manufacturing giant, 3M, purchased IMTEC/Sendax.
What you are speaking of arm mini dental implants. Mini dental implants are not real traditional implants. They are small, bend and break very easily. I would consider them temporary dental implants. Many inexperienced dentists use exclusively mini dental implants as a way to avoid opening your gums to place normal dental implants.
I would suggest you have traditional diameter dental implants which will last you so many years. I just removed four more many dental implants just last week!
Typically a dental school University can be a good place to have procedures if you have more time than money. Often what would take 1 hour and a traditional dental office may take 5-7 hours in a dental school. Total cost reduction is approximately 25% so it is really not that much cheaper. You can definitely have excellent work in a dental school with proper oversight by the instructor dentist. I speak from first-hand experience because I taught in a dental school for many years. Some students are definitely way better than others. Good luck, I'm sure it'll all work out for you just do your due diligence.
I have a perm. Fixed denture on lower. It's great! My problem is the top.
I only had enough bone to put 4 implants in , two on each back side .
After a couple months they had to change the connector ring? It only works for about 6 weeks and then my over denture falls out again.
Is there a way to have a fixed upper? I want it like the lower. It feels real.
I'm very disappointed with my upper. I'm in Dallas.
Four dental implants to support and upper overdenture or fixed bridge is unfortunately under engineered. 4 dental implants on the lower jaw can work very well…. The difference is in the bone. The upper jaw is very soft, while the lower jaw is very hard. This allows me to use less implants in the lower jaw than in the upper.
From what it sounds like, I am guessing you have locator custom abutments. If these abutments were placed in a divergent manner, your dentist needs to correct the attachment by using the divergent attachments rather than the ones that are intended for straight (axial) implants. If you only have 4 implants on your upper jaw, I would suggest connecting them together with a bar to stabilize the bone so that you don't lose your implants within 3-7 years.
Keep in mind that bone can be rebuilt anywhere in your mouth. It is most common to do lateral window sinus bone graft in the upper jaw in order to build bone to have 6 or 8 implants. With proper implant position and location, your teeth will never fall out. Ideally, you can convert your current situation to a fixed monolithic zirconia, Prettau bridge or a porcelain fused to metal fixed restoration that never comes out. You will need some bone grafting in order to do this to add more implants.
I am guessing that you are missing all the teeth on your lower jaw. A two implant over denture will definitely give your lower denture a more secure hold. Yes, the more dental implants you have, the more stable your overdenture on dental implants will be.
It sounds like your dentist is using a traditional, two-stage surgical approach. This means that here she is going to put the implants under the gums for 4-6 months. At the 4-6 month mark, the dentist will expose the implants and connect the abutments. Sometimes it is better to bury the implants under the gum line for healing and sometimes it is okay to leave them exposed in the mouth during the healing process. They can be exposed by traditional surgery, laser and/or other dental instrumentation.
If the implants are in your lower jaw, typically I would let them heal for 2-3 months and then provide you with the lower over denture. 4-6 months is utilized more in the upper jaw than in the lower jaw.
Good luck with everything. Let me know if you need any more help.
Quick question. I have had the o-ring and abutment changed on my implant after only two days of use on the right side of lower denture. Now again, two days later I need them changed on the left side. I have only two implants retaining it. Is this common? It just wont snap securely into place and I can pop it out with my tongue. Once the right side was changed it's been fine…..so far.
The Dental implant abutment attachments should last 1-2 years on average. Have you found a solution to the problem yet?
The sooner the better in general. The longer you wait, the more bone you will lose. Keep in mind that only having to lower implants will only help to retain your lower denture from falling out but doesn't provide a whole lot of stability.
3 or 4 dental implants are going to be more stable if you are considering having a denture on top of implants.
Even if you wait, it will still likely be okay. Just yesterday I treated an 87-year-old woman who has been missing teeth for 50 years. I placed for implants in her lower jaw.
My Dentists wants me to get six implants on the top. I don't see why 4 wouldn't work just as good. I don't have a lot of money to throw around and that would save me some money. Why wouldn't 4 be plenty?
Four implants on the upper is really under-engineered **IF** it is fixed bridge. If you have a problem with just one of them, you will lose the all of the teeth. Is this for an overdenture? If it is, four can work, but you will still need to keep most of the palate.
The implants had to be placed at the trajectory of your bone if it is really small. O-rings are a really old design. Try changing to "locator abutments" or change to a fixed porcelain bridge.
I have a question about whether it is possible to wear a full upper denture(traditional removable) with an implant retained denture on the lower mouth. The prothodontist that is working with my periodontist right now is telling us that the constant pressure of an upper traditional denture against a fixed lower implant denture will more then likely cause the implants to fail within 5, 10 or 15 years. He so far has been very resistant to wanting to do anything apart from a removable overdenture with a four implant base . Right now I only have four remaining teeth, three in the front and one in the back and I'd like to keep them if possible, My periodontist has suggested that if I had the remaining teeth pulled that it might be easier to do a full fixed bridge. In your opinion, is there a significant risk of damaging the implants that retain a fixed denture with an upper denture? I don't want to invest a lot of money in implants and a fixed denture if it will fail in a short period of time. I also don't want to have to lose viable teeth unless it is absolutely necessary.
This was very helpful…thank you for the link and for the explanation. The whole process of trying to understand implants and overdentures at first was pretty overwhelming so your answer helped me to know what questions to ask when I spoke with my new prothodontist.
Dr. I got a full set of dentures about a year and a 2 years ago and my tops are wonderful! My bottoms have been a constant source of sadness for me! I have a very small mouth (my bottom only have 12 teeth) I just cant seem to get comfortable with them no matter what I do! I have been thinking of getting the implants for my bottoms but I am so scared to spend the amount of money it will cost and It NIOT work either! I live on disability because I have crippling arthritis (RA) which is another concern about the implants. I just want someone to tell me that if I get them that I wont have to wear paste anymore and I WONT be getting things stuck under my dentures? Is this possible?? Should I have 4 post put in? 2 in front and 2 in back? I'm so confused I just want to be me again!
Four implants will be far more stable than two. A stool with four legs is more stable than a stool with 2-3 legs. It is definitely worth the money. Keep in mind that if you have the denture over implants you will always get food underneath them. You won't need paste, but unless you get a fixed implant bridge, you will get food under them. You are ok with the RA too, just see someone very skilled in this procedure that understands your medical condition too.
thank you! do you have a recombination for anyone in the memphis tn area?
I don't know anyone personally in that area.
Hi. In processes of getting an over denture w/implants. I have had bone grafts and 4 implants. In the process of having the removable over denture made. What is the parts called that are inserted into the over denture that clicks on to the locator/implant.
The piece that connects the dental implant abutment to the denture is called an attachment. They are made of plastic and will need to replaced about every one to two years on average.
I simply couldn't leave your web site prior to suggesting that I really enjoyed the expertise. Is going to be back often to read new posts?
Yes, I post on a very regular basis and try to help people around the world by providing solid answers for dental implant questions.
Usually extensive bone grafting is not required for the lower jaw to have a non-removable option. The upper jaw usually does.
Err on the side of more than less implants, especially if you choose to "upgrade" your implants to fixed at a later date.
Are you local enough to come in for me to look at you?
Dear Doctor Amin, I am soeaking to a periodontist about a 'permanent denture'- my dentist who is a Prothodontist will do my teeth. My problem is my two sides of my mouth are thin. I want a non-removable denture on the bottom as I am in the beauty business. My Periodontish says he can do 5 or 6 implants around my front to my first molar. This is not a cheap procedure at all. Will this secure this denture?? I have read above what you said. Bone grafts would be a hardship for me. Thank You so much!
I think you should follow up with your dentist. Have them carefully adjust the bite. That is often the source of pain.
An overdenture with only two implants will generally still rock. The denture is held in, but it can still move in the back. Consider adding 1 -2 more implants.
A prosthodontist may or may not be the answer. Just be sure to see any dentist highly experienced to troubleshoot this if you have to go elsewhere.
Hello Doctor, my question pertains to two implants that I have in my lower jaw. I have had the denture for about three months now and have had use of the denture for the last two weeks and it doesn't fit right yet. I have been back to the dentist that made the denture and put in the posts and caps more than seven times. The denture still rocks back to front. The last visit was Tues. the 15th.Also, my lower gums are jammed up into the cap holes and leaves me with aching gums at the end of the day. Is there something wrong here?
It depends on what your goals are. Do you have a problem with your dentures staying in? If so, the full overdenture may be a better option.
The front implants with a fixed bridge will always allow you to have your front teeth in place even when you sleep. You could transition to implants in the back and have a separate bridge in the back left and back right to supplement the front fixed bridge at a later date. The bone preservation of fixed dental implants is ideal.
Can you send your x-rays and photographs to me?
Magnets were used many years ago as attachments for implants and dentures. They do not hold as well as the current line of attachments.
Also, If you needed to take an MRI, the magnets can cause a problem. MRI stands for Magnetic Resonance Imaging.
My preference is the locator or a bar attachment. I have been doing this procedure for the last 11 years with great success.
What about using very powerful magnets to hold the dentures in place? Either located in the abutments or in the denture material or both if polarity is in proper alignment?
Dear Sir, which option do you consider the best to fix to four implants on the top jaw.
or a front bridge with dentures afixed to the back?
Please can you let me know of any pro's and con's to each option.
Dr. Ramsey Amin, could you recommend an implant surgeon for a bar attachment similar to the system you recommend in the Seattle area or Washington State. Thanks Tom C.


While hiking through Castlewood Canyon, we stumbled upon several remnants left over from when the damn burst in 1933 causing a 15-foot wave of water to travel all the way to downtown Denver, resulting in a huge flood. Alex Stanley from ClassTen Photo was with me for this shoot. As we set up our cameras, we heard the howls of hungry coyotes in the distance and even as serene as is this place may seem, the sounds of these animals hunting in the night serve as reminders that we were not alone.
We set up an old camping light to illuminate the forgotten Patrick Lucas homestead, build in 1894, and used Alex's jacket to diffuse the light. Setting our f-stops to 3.5 and using shutter speeds of 30 seconds allowed our cameras to see the vibrant colors of the Milky Way traveling above us. Most people will never get to see this breathtaking image firsthand and I believe that's my job to share these images with the world.


So You're Scared of Getting a Massage?
The good news is that you're not alone in this fear. There are plenty of people who are hesitant to schedule a massage because they're worried about what could happen during the procedure. If you're nervous about scheduling an appointment, the good news is that most of these fears can quickly be put to rest with the help of our professional masseuse.
Here are some of the most common fears that we hear from people who aren't ready to set an appointment up for a massage and why they are the last thing that you should be worried about.
Depending on the type of massage that you're getting, there is a chance that your massage could you leave you sore, but it isn't going to leave you in pain. The way that we ensure there is very little pain is through the procedure that we perform. We will warm the muscles that are going to be worked on up before we start working on the deeper layers of muscle. If there is a point in time during the massage that you do feel some pain, it's your responsibility to make the masseuse aware of the discomfort. In the case that you are sore the following day, it's good to know that the reason this is happening is because of the waste and pressure that is being released from your body. The soreness can quickly be reduced by stretching and drinking water. If you are still noticing discomfort by day three, call our office and we can gain a better idea of where the discomfort is coming from.
The purpose of your massage is to provide you with a little rest and relaxation. If you're nervous about loosening up behind closed doors with a stranger, start off slow. Let your massage therapist know that this is only your first massage and start with a standard back massage, rather than a deep tissue. Then work your way up once you've got a better idea of what you're going to be signing up for, and even then, if ever you are uncomfortable we can both accommodate and stop at any given minute.
Leave your fears at the door and stop into the Skin & Body Spa. Once you've had your massage, you'll see just how great it feels to relieve your muscles of all the stress and pressure that they hold in and then winds up hurting your body more. Trust our massage therapists to provide you with the break that you need.


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