Cover / Editorial / Content / Passive micro-volume management of sodium hypochlorite in endodontic treatment / A new paradigm in surgical training / Endodontics made more efficient with the ScanX Swift / X-Runner all-tissue ablative laser scanning handpiece / LVI Core I three-day course is designed for doctors and their teams to learn together / Submission Guidelines / Imprint
Cover
01 - 01 viewEditorial
03 - 03 viewContent
04 - 04 viewPassive micro-volume management of sodium hypochlorite in endodontic treatment
06 - 09 viewA new paradigm in surgical training
10 - 14 viewEndodontics made more efficient with the ScanX Swift
15 - 16 viewX-Runner all-tissue ablative laser scanning handpiece
18 - 18 viewLVI Core I three-day course is designed for doctors and their teams to learn together
20 - 20 viewSubmission Guidelines
21 - 21 viewImprint
22 - 22 viewArray
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[1] =>
roots
issn 2161-6558
the international C.E. magazine of
1
2014
_C.E. article
Passive micro-volume
management of sodium
hypochlorite in
endodontic
treatment
_education
A new paradigm
in surgical training
_industry
Endodontics made
more efficient with the
ScanX Swift
North America Edition • Vol. 5 • Issue 1/2014
endodontics
[2] =>
[3] =>
editorial _ roots
I
Expanding our
horizons
How is your new year shaping up so far? If you are like me, you have been traveling to some of the major
dental industry meetings, including the Yankee Dental Congress in Boston and the Midwinter Meeting in
Chicago. Perhaps you picked up this copy of roots at one of these meetings.
This issue contains some interesting articles, including a study by Dr. Les Kalman on the use of sodium
hypochlorite in endodontic irrigation and a report by Dr. L. Stephen Buchanan on some new technology
that enhances the educational experience for those who are learning about endodontic surgery. You can
also read about tools that Dr. Howard Golan uses to make digital imaging in his practice more efficient.
Every issue of roots also contains a C.E. component. By reading the article by Dr. Kalman, then taking a
short online quiz about this article at www.DTStudyClub.com, you will gain one ADA CERP-certified C.E.
credit. Keep in mind that because roots is a quarterly magazine, you can actually chisel four C.E. credits per
year out of your already busy life without the lost revenue and time away from your practice.
To learn more about how you can take advantage of this C.E. opportunity, visit www.DTStudyClub.
com. You need only register at the Dental Tribune Study Club website to access these C.E. materials free of
charge. You may take the C.E. quiz after registering on the DT Study Club website.
I know that taking time away from your practice to pursue C.E. credits is costly in terms of lost revenue
and time, and that is another reason roots is such a valuable publication. I hope you will enjoy this issue
and that you will take advantage of the C.E. opportunity.
For those of you attending the late winter and spring meetings in Chicago, Atlanta and other places, be
sure to say hello to me in person. As always, I welcome your comments and feedback.
Fred Weinstein, DMD, MRCD(C),
FICD, FACD
Sincerely,
Fred Weinstein, DMD, MRCD(C), FICD, FACD
Editor in Chief
roots
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[4] =>
I content_ roots
page 10
page 06
I C.E. article
06 Passive micro-volume management of sodium
hypochlorite in endodontic treatment
_Les Kalman, B.Sc (Hon), DDS
I education
_L Stephen Buchanan, DDS, FICD, FACD
I industry
_Howard Golan, DDS
X-Runner all-tissue ablative laser scanning
handpiece
I industry education
20 Three-day course is designed for doctors and
their teams to learn together
page 15
04 I roots
1_ 2014
21
22
_submissions
_imprint
roots
North America Edition • Vol. 5 • Issue 1/2014
the international C.E. magazine of
1
15 Endodontics made more efficient with the
ScanX Swift
18
I about the publisher
issn 2161-6558
10 A new paradigm in surgical traning
page 10
endodontics
2014
_C.E. article
Mineral trioxide aggregate
revisited: A cement for all
seasons
_technique
The rationale and use of
electronic apex locators
_education
New endo program is
established at University
of Tennessee
I on the cover
A fully segmented CT volume in preparation for
3-D printing. (Image/Provided by L. Stephen Buchanan,
DDS, FICD, FACD)
page 18
page 20
[5] =>
[6] =>
I C.E. article_ irrigation
Passive micro-volume
management of
sodium hypochlorite in
endodontic treatment
Author_Les Kalman, B.Sc (Hon), DDS
_c.e. credit
_Abstract
This article qualifies for C.E.
credit. To take the C.E. quiz, log
on to www.dtstudyclub.com.
Click on ‘C.E. articles’ and
search for this edition (Roots
C.E. Magazine — 1/2014). If
you are not registered with the
site, you will be asked to do so
before taking the quiz. You may
also access the quiz by using
the QR code below.
The passive utilization and micro-volume management of sodium hypochlorite as an endodontic
irrigant has been illustrated with a laboratory demonstration and several clinical cases. By limiting the
volume and pressure of sodium hypochlorite, the injurious effects can be minimized while still benefiting
from the ideal disinfecting characteristics. Further
studies are required to understand the behavior of
fluids, especially sodium hypochlorite, within the
context of permeability, fluid mechanics and multiphase fluid flow through porous media.
_Introduction
Endodontic treatment addresses the re-
moval of the tooth’s internal pulp and microorganisms,1 primarily due to infection and
necrosis. Once proper diagnosis and prognosis
has been established, the patient has the option
of maintaining the tooth’s form and function
while the vitality becomes lost. Current endodontic treatment consists of utilizing rotary
files to remove the pulpal tissue and shape the
internal dentin chamber of the tooth. Chemicals,
in the form of gels and liquids, are then implemented to disinfect the canal(s) and eliminate
bacteria.2 The chemicals are then dried and the
canal space filled with either gutta-percha or
resin to create a hermetic seal.
The chemicals employed to clean and disinfect the
intracanal space are vast and include file lubricants
such as Prolube (DENTSPLY) and irrigants such as
Fig. 1_DENTSPLY Vortex rotary
file with sodium hypochlorite.
(Photos/Provided by Les Kalman,
B.Sc (Hon), DDS)
Fig. 2_DENTSPLY Profile rotary file
with dyed sodium hypochlorite.
06 I roots
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Fig. 1
Fig. 2
[7] =>
C.E. article_ irrigation
I
Fig. 3_Micro-volume delivery of
sodium hypochlorite with rotary file.
Fig. 4_Sodium hypochlorite in block
with rotary file.
Fig. 3
QMix (DENTSPLY). During clinical endodontics, the
canal is filled with a cocktail of chemicals, as file
lubricants and irrigants become a mixture.
Chlorhexidine gluconate (CHX) is an uncommonly
used irrigant3 with several desirable properties. It
provides antimicrobial activity against certain aerobic and anaerobic bacteria, exhibits no significant
changes in bacterial resistance in the oral microbial
environment and has no injurious effect to the skin
or mucosa.4 In fact, CHX has a role as an oral rinse at
the 0.12 percent concentration.4
Sodium hypochlorite (NaOCl) still remains the
most commonly used chemical,2,3 because of its
availability, cost and effectiveness.2,5 Sodium hypochlorite is effective against broad-spectrum bacteria and has the ability to dissolve both vital and
necrotic tissue.6 However, this irrigant is equally
damaging to the patient and has a history of injurious effects.5 Typically the NaOCl is delivered into the
canal space with a syringe dose of 2-10 ml that is expelled under pressure. The ability of NaOCl to escape
either through poorly sealed isolation or other means
can cause serious injury to the patient.5
Injury from NaOCl is well established in the
literature3,5,6 and has been attributed to three main
errors: poor handling, injection beyond the apical
foramen and allergy.6 Poor handling injury can result
in operator and/or patient injury to the eye and/or
skin.6 Injection beyond the apical foramen can result
in the following:6
• immediate and severe pain
• edema to adjacent tissue
• edema to the lip, infraorbital region and side
of face
• intense bleeding from within the canal space
• skin and mucosa bleeding
• intestinal bleeding
• paraesthesia
• secondary infection.
Allergy from NaOCl is rare but has been reported
and may result in severe pain, a burning sensation,
edema and transient paraesthesia.6
Fig. 4
_Methodology
Although there is no universally accepted irrigation protocol regarding endodontic treatment,3 it is
the duty of clinicians to apply evidence-based dentistry within clinical parameters to provide their patients with the highest standard of care with minimal
morbidity. The use of NaOCl has numerous beneficial
factors that maximize treatment success; however, it
is the application of the liquid that can cause injury.
Micro-volume management of NaOCl has
been proposed. The concept is based on the
premise that endodontic instruments have irregular surfaces, crucial for dentinal preparation,
and that liquids exhibit surface tension characteristics.7 By placing an instrument into a suitable
container, the NaOCl will be carried within the
surface texture of the instrument (Figs. 1, 2). As
the operator inserts the instrument into the canal
(Fig. 3), the NaOCl is carried with it. Upon instrument movement, the NaOCl is released into the
canal space (Fig. 4). Surface tension and permeability of porous media (dentin) will also increase
the ability of the liquid to percolate into the
canal.7 This approach is radically different than
current philosophies, as the NaOCl is introduced
into the canal space in a micro-volume amount
without any pressure. The operator has control
of the minimized liquid while benefitting from
its effectiveness.
The micro-volume management of sodium
hypochlorite has been applied to numerous clinical cases. Post-operative obturation radiographs
of completed clinical cases have been presented
(Figs. 5–9).
_Discussion
The canal system inside a tooth is very complex.
Although there is the presence of one or more
canals, there also exist numerous micro tunnels,
ribbons and sheets throughout the canal network.8 The canals are also housed within a porous
roots
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[8] =>
I C.E. article_ irrigation
Fig. 5_Radiograph of endodontic
treatment on #47.
Fig. 6_Radiograph of endodontic
treatment on #26.
Fig. 7_Radiograph of endodontic
treatment on #16.
Fig. 8_Radiograph of endodontic
treatment on #36.
Fig. 5
Fig. 6
Fig. 7
Fig. 8
dentinal structure, for which the permeability has
been distinguished.9 Although the elimination of
the pulp is a relatively predictable clinical procedure, the introduction of liquids into this complex
micro-network porous development further complicates matters. If the clinician introduces liquids, then the successful removal of those liquids
is key to clinical success. Concepts of multiphase
fluid flow through porous media, and capillaries,10 permeability of porous media11 and surface
tension fluid mechanics7 must be recognized to
validate and further advance canal irrigation.
Micro-volume management of NaOCl has been
suggested as a delivery modality to maximize its
bactericidal effects yet minimize its injurious effects. Surface tension fluid mechanics and permeability7,10,11 suggest that the NaOCl can be carried
within the surface irregularities of endodontic in-
strumentation and deposited into the canal space
and percolate within the complex network of the
canal. The passive management of the irrigant in
micro-volume would greatly reduce complications
due to poor handling. CHX has been suggested as
the larger volume, positive pressure irrigant that
may be delivered into the canal space. CHX has
favorable antibacterial characteristics but minimal
injurious effects, if mismanagement of the irrigant has occurred. If positive pressure delivery of
CHX is required, the operator should regulate the
pressure and avoid the risk of injection beyond the
apex. The use of EDTA (ethylenediaminetetraacetic
acid) could be employed after NaOCl, to minimize
the formation of precipitates.2
The application of micro-volume management
of NaOCl suggests that the canal space can be effectively cleaned in a conservative manner. Application
‘NaOCl has several advantages
for its role as an endodontic irrigant,
but its use must be exercised with
caution in order to prevent injury.’
08 I roots
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[9] =>
C.E. article_ irrigation
of this principle has been applied to clinical cases with
little to no post-endodontic sensitivity. Obturation
has been completed with ThermaSeal and Thermafil
(DENTSPLY). Even though there is evidence of sealer
extrusion, the absence of post-operative symptoms
and pathology suggests adequate volume for sufficient disinfection.
Further laboratory studies are required to understand permeability, fluid mechanics and multiphase
fluid flow through porous media and their relation to
the micro-management of NaOCl. Additional clinical
investigations should be implemented to assess and
validate the efficiency and efficacy of micro-volume
management of sodium hypochlorite on endodontic
therapy.
_Conclusions
Introduction of lubricants and irrigants into the
canal complex is crucial for endodontic success.
The action of fluids in the canal complex must be
understood within the context of permeability, fluid
mechanics and multiphase fluid flow through porous
media.
NaOCl has several advantages for its role as an
endodontic irrigant, but its use must be exercised
with caution in order to prevent injury. Application
of NaOCl as a passive, micro-volume liquid has been
illustrated.
Further consideration is required to validate the
theory. The potential to minimize morbidity while
maximizing clinical endodontic success seems promising for both clinician and patient._
_References
1.
2.
3.
4.
5.
6.
7.
Dang E. Comparison of sodium hypochlorite and
chlorhexidine gluconate: quality of current evidence. The
Journal of Young Investigators: An Undergraduate, PeerReviewed Science Journal 2008:23(1):1–9.
Basrani BR, Manek S, Rana SNS, Fillery E. and Manzur A.
Interaction between sodium hypochlorite and chlorhexidine
gluconate. J Endod 2007;33: 966–969.
Dutner J, Mines P, and Anderson A. Irrigation trends among
American Association of Endodontists members: a webbased survey. J Endod: 2011;-: 1–4.
3M ESPE: Peridex™ Chlorhexidine Gluconate (0.12%) Oral
Rinse Fact Sheet: 2009.
Clarkson RM, and Moule AJ. Sodium hypochlorite and its
use as an endodontic irrigant. Australian Dental Journal
1998;43:(4).
Hülsmann H. & Hahn W. Complications during root canal
irrigation-literature review and case reports. International
Endodontic Journal: 2000;33:186–193.
TrefethenL.Surfacetensioninfluidmechanics.Encyclopaedia
Britannica. (12ed.) Wiley:Chicago,1969;1–7.
Fig. 9_Radiograph of endodontic
treatment on #16.
Fig. 9
8.
West JD, Roane JB and Goering AC. Cleaning & shaping of
the root canal system. In Cohen S. and Burns RC. Pathways
of the Pulp. (6th ed.) Mosby:St. Louis,1994;179–218.
9. Trowbridge HO. and Kim S. Pulp development, structure &
function. In Cohen S. and Burns RC. Pathways of the Pulp.
(6th ed.) Mosby:St. Louis,1994;296–336.
10. Templeton CC. and Rushing SS. Jr. Oil-water displacements
in microscopic capillaries. Journal of Petroleum Technology.
1956;8:(9):211–214.
11. Crotti MA. Motion of Fluids in Oil and Gas Reservoirs.
Mosby:New York,1978;8–14.
_about the author
roots
Les Kalman, B.Sc (Hon),
DDS, graduated from the
University of Western Ontario with a doctor of dental
surgery degree in 1999. He
then completed a GPR at
the London Health Sciences
Centre. He has been involved in general dentistry
within private practice since
2000. He has served as
the chief of dentistry at the
Strathroy-Middlesex General hospital. In 2011, he transitioned to full-time academics as an assistant professor at
the Schulich School of Medicine and Dentistry. Kalman’s
research focuses on clinical innovations, including the
Virtual Facebow app. Kalman is also the director of the
Dental Outreach Community Services (DOCS) program,
which provides free dentistry within the community.
Kalman has authored articles ranging from pediatric impression to immediate implant surgery in both Canadian
and American journals. He has been a product evaluator for
several companies, including GC America and Clinician’s
Choice. Kalman is the co-owner of Research Driven, a
company that deals with intellectual property development. Kalman is a member of the American Society for
Forensic Odontology, International Team for Implantology, Academy of Osseointegration, American Academy of
Implant Dentistry and the International Congress of Oral
Implantology. He has been recognized as an academic
associate fellow (AAID) and diplomate (ICOI). He can be
contacted at lkalman@uwo.ca.
roots
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[10] =>
I education_ surgical skills
A new paradigm in
surgical training
Author_L. Stephen Buchanan, DDS, FICD, FACD
Above: A fully segmented CT volume
in preparation for 3-D printing.
_In 1985, Dr. Gary Carr introduced microscopes
and ultrasonic handpieces to the specialty of endodontics in an effort to improve the quality and
outcomes of surgical retrograde procedures.1 Before
this, we used micro-head handpiece attachments
that were still too big to use effectively, and their
gears were prone to seizing up in the middle of the
retro-prep procedure. The best visualization tools we
had were headlamps and loupes — making it nearly
impossible to retro-fill canals in a definitive manner.
With perfect light and multiple levels of magnification, endodontic surgery became a much more predictable procedure as we became better at finding roots
and their canals from an apical approach. Perhaps as
important, ultrasonic cutting tips allowed us —for the
first time — to literally prepare up the root canal, dramatically increasing the quality of the preparation and
the integrity of the following retro-seal. Thank you, Gary.
But a funny thing happened on the way to surgical
heaven. As more endodontists trained up and incorporated these tools into their practices, they found out
that light, magnification and ultrasonics could also
aid us in non-surgical retreatment of failing RCT cases.
Suddenly we could find calcified canals that were invisible before, we could remove separated instruments,
we could remove cemented posts, and surgery became
the procedure that was done only after non-surgical
retreatment had been done and had failed.
As much as non-surgical retreatment improved
our retreatment successes — placing a perfect retroseal over a leaking, infected canal is an invitation to
failure — there was an unintended consequence of
this new endodontic treatment planning concept.
Graduate students were trained to first do non-surgical retreatment on every failing RCT case before doing
any surgical retreatment; however, the reality of twoyear, post-graduate endodontic programs meant that
the residents typically graduated before they could
see their conventional retreatment cases fail, and
were thus cheated of the opportunity to practice their
surgical skills before getting out into practice.
Furthermore, while some dental schools such as
UCLA and UOP (Westwood in Los Angeles and Pacific
Heights in San Francisco, respectively) are situated in
nice neighborhoods, most are not, making it less likely
that a patient undergoing non-surgical retreatment
would have the means to return to the post-grad
clinic if that treatment did not work out. At that point,
the offending tooth would usually be extracted, again,
cheating the resident of the chance to save the tooth
Fig. 1
Fig. 2
Fig. 1_Segmentation begins with
the canals, roots and crowns of the
teeth. (Images/Provided by Stephen
Buchanan, DDS, FICD, FACD)
Fig. 2_The PDL was segmented next
as a separate object surrounding
the roots.
10 I roots
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[11] =>
[12] =>
I education_ surgical skills
Fig. 3_The bone segment has
been added.
Fig. 4_The fourth segmented
object: the soft tissue.
Fig. 5_The printed prototype
surgical replica.
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
while polishing his or her surgical skills.
For some of us in the specialty, that’s just fine. Me?
I fear for our specialty’s future.
Clinicians typically treatment plan procedures they
know and avoid those procedures they do not know
how to do. That’s why implant surgeons replace teeth
with implants when it would be more ideal to save some
of those teeth, it’s why endodontists became known
for treating and retreating hopeless teeth, and it’s why
so many cases are retreated with complex and laborious non-surgical procedures, cutting off well-done
crowns, posts, and cores — despite the fact that the
added cost of restoration afterward makes it cheaper to
remove the tooth and drop a titanium bolt in.
So how do we train our endo residents to be better
surgeons? The best solution I’ve heard is what Dr. Tom
Levy has done at USC — all RCT failures are retreated
non-surgically, then they are cut — and several positive
things have come from this. Most important, endodontists who come out of USC now are much more confident when the flaps are back and the bleeding begins.
The other payback for this teaching strategy —
non-surgical retreatment, followed immediately by the
surgical placement of apical retroseals — was that retreatments done in USC’s program became much more
successful. That’s not surprising in light of the study
by Andreason, Rud and Jensen in 1972 — a computerdriven, multi-variate analysis of the factors involved in
success and failure of root canal therapy.2,3 They found
that when well-done RC treatment failed, apical surgery
usually resolved the case. Why? Because most of the
anatomic complexities in root canals are found in the
apical third, so removal of the root apex removes the
etiologic factor.
It was with these issues in mind that I resolved to
find better ways to teach endodontic surgical skills, not
only to residents but also to those endodontists already
in specialty practice. Of all the challenges I see when
residents begin their surgical experience, it’s the sheer
terror of the unknown that most inhibits them, specifically, where are the dangerous places underneath the
soft tissue flap? In considering the best way to address
this challenge, I was reminded of how pilots and astronauts are trained to do the most dangerous things in a
safe, predictable manner — with flight simulators. So
why can’t we do this in endo training?
We can train on cadavers, as Dr. Carr did when
developing his ultrasonic surgical technique, but that
is a whole can of worms, so to speak. Cadaver heads
are gross, expensive and they are hard to come by. But
until recently, cadavers were our best option, short
of training on living humans; however, 3-D printing technology has come into its own over the past
couple of years and now offers an alternative. In a
previous article4 published in this journal, I described
how 3-D printing can be used to create anatomically
authentic tooth replicas, complete with all the accessory canals, fins, isthmii and canal curvatures.
Fig. 6_The soft material replicating
the gingiva being incised.
Fig. 7_The soft material raised off
the replicated bone with a periosteal
elevator.
Fig. 8_After cutting through the
replicated cortical plate, medullary
tissue is met.
12 I roots
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[13] =>
[14] =>
I education_ surgical skills
Fig. 9_Apicsection of the MB root
showing the MB1 canal.
Fig. 10_Further apicsection of the
MB root showing the MB2 canal.
Fig. 11_Ultrasonic tip ready to cut a
retroprep in the MB1 canal.
Fig. 12_Suturing begins.
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13_Suturing completed.
Fig. 13
This same technology can also be used to create
replicas for teaching surgical concepts and procedures; however, printing a complete jaw section
requires more preparation as well as a more sophisticated printer, because several different replica materials are needed to model hard and soft tissues. Before
that can happen, each of the different anatomic
structures to be represented must be “segmented”
from the full CT volume. In other words, a computersavvy anatomist must discriminate between the
different structures. In the illustrations shown,
first the canals, roots and crowns of the teeth were
segmented together (Fig.1), followed by the PDL (Fig.
2), the bony structures (Fig. 3) and, finally, the soft
gingival tissues (Fig.4).
Seen in Figure 5 is the first 3-D printed prototype
from this segmented CT dataset. The surgical replica
has the soft tissues modeled with a clear, rubber-like
material (colored with a red felt-tip marker), that
incises nicley with a standard 15C blade (Fig. 6), after
which it is easily reflected with a periodontal elevator (Fig.7).
Like the TrueTooth Replicas, the model material
is a bit softer than dentin, so handpiece burs are run
at half speed to better replicate the tactile feedback
from cutting bone tissues. Cutting through the
14 I roots
1_ 2014
replicated bone reveals the MB root end of the MB
(Fig. 8), and further osseous access reveals the MB1
and MB2 canals in the simulated cut root surface
(Figs. 9, 10), after which an ultrasonic retro-prep tip
is used to prepare the canal ends for filling (Fig. 11).
Suturing the soft-tissue material (Figs. 12,13), again,
simulates very accurately the experience of closing
surgical flaps in patients.
While this prototype has been printed with clear soft
tissue and white bone and tooth structure, following
replicas will be printed with red-colored soft tissue,
PDL and intra-trabecular medullary tissue polymers,
the teeth will be colored light yellow, and the bone and
enamel will be printed in white model medium._
Editorial note: A complete list of references is
available from the publisher.
_about the author
roots
L. Stephen Buchanan, DDS,
FICD, FACD, is a diplomate
of the American Board of
Endodontics and an assistant clinical professor at the
postgraduate endodontic
programs at USC and UCLA.
He maintains a private practice limited to endodontics
and implant surgery in Santa
Barbara, Calif., and is the
founder of Dental Education
Laboratories, a hands-on training center serving general
dentists and endodontists who want to upgrade their skills in
new endodontic and implant technology. Dr. Buchanan can
be reached through his business, Dental Education Laboratories, www.DELendo.com, info@endobuchanan.com.
[15] =>
industry_ Air Techniques
I
Endodontics made
more efficient with
the ScanX Swift
Author_Howard Golan, DDS
_Technology has made endodontic treatment
faster and more efficient. However, there are still
parts of the endodontic protocol that cannot be
avoided that add time to the procedure.
Taking radiographs is a fundamental part of
endodontics. When traditional film radiographs are
exposed and processed, there is a unit of time that
goes by that the practitioner has to get up from the
chair, leave the room and wait for the X-rays to be
exposed and processed.
Digital sensor technology has significantly
decreased this unit of time. The instantaneous
processing of the digital image allows the practitioner to step out of the room and within minutes
return to the procedure. No longer does the auxiliary have to process the film in another room,
sometimes at the other end of the office, wait for
the processing time, either dip or automatic, then
return to the practitioner for evaluation.
However, digital sensor technology does have
its negatives. First, the sensor girth makes it
sometimes very difficult for placement in the
patient’s mouth. Now compound that by trying
to fit this sensor around a rubber dam and clamp.
As a practitioner who has done his fair share of
endodontics, placement of the film is of utmost
importance in order to see the apex of the tooth
being worked on. When a rubber dam clamp is
placed, a rigid sensor can be difficult to place in
the right position. If it moves or the patient moves
it because he/she is uncomfortable, then repeat
exposures may be needed.
The ScanX Swift (Photos/Provided by
Air Techniques)
roots
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[16] =>
I industry_ Air Techniques
A second disadvantage of sensor technology is
cost. These sensors are expensive, and when they
break down, which is inevitable, or they are out of
warranty, their replacement cost is high.
An endodontic clinician has another option
that takes advantage of digital technology,
reduces the cost in the future and will not have
any placement or exposure issues like one can
have with sensors. Phosphor storage plates
(PSPs) are thin, flexible digital sensors that are
exposed similarly to traditional dental film. With
similar dimensions to film, PSPs allow for ease
of placement and can be used with rubber dams
and ring systems. Like other digital radiological
technology, the dosage required to expose PSPs
is less than traditional film. Furthermore, the
plates are disposable. The replacement cost of
the plates per the number or exposures per plate
ends up being similar to traditional film costs.
The processor for these plates, although an initial
investment similar to sensors, has no moving
parts and has a lifespan years and years longer
than sensors.
As with sensors, PSP technology can have disadvantages. One is the separate processing and
exposure mediums. Once a PSP is exposed in the
patient’s mouth, the PSP is delivered to the processor that is usually in a non-treatment room or
hallway with a computer attached. Thus, the auxiliary or clinician exposes the PSP, removes his/her
gloves and walks the plate to the digital processor.
This prevents the instantaneous advantage that
sensors have over PSPs.
However, a new PSP processor has been developed to close the gap between the exposure and
the processing. The ScanX Swift™ (Air Techniques)
is a one-slot PSP processor that is small enough
to fit on a countertop in a dental treatment room.
Thus, the auxiliary does not need to leave the
16 I roots
1_ 2014
treatment room after exposing the film. Once the
plate is exposed, the auxiliary places the plate into
the ScanX Swift, and in seconds, the image is in
front of the operator ready for evaluation. In addition, there is a protective barrier that is placed
over the ScanX Swift’s slot so that the auxiliary
exposing the film does not have to deglove in
order to process the image.
The ScanX Swift provides the endodontic practice
with almost instantaneous digital X-ray processing
by moving the digital processor into the treatment
room. This saves time. The one-slot processor provides a more economical option for those practices,
such as endodontics, that do not take a large amount
of X-ray series.
The ScanX Swift enhances infection control
and lowers the cost of gloves and disposables by
allowing the exposer of the X-ray to remain in
the treatment room and contain possible crosscontamination.
Finally, the PSPs are disposable, reducing high replacement costs in the future. Endodontic practices
should seriously consider incorporating the ScanX
Swift into their X-ray protocols. They will enjoy its
convenience, long-term cost savings and quality of
image processing._
_about the author
roots
Howard Golan, DDS, is a
graduate of the University
of Michigan School of Dentistry. He completed a general practice residency at
North Shore University Hospital on Long Island, New
York. After his GPR, Golan
completed a two-year implant surgery and advanced
prosthetic fellowship at
NSUH. He has maintained
a busy private practice on Long Island that he shares with
his father, Marshall Golan, DDS. Golan implemented lasers
into his practice in 2004 and has attained his mastership
certification in the World Clinical Laser Institute. Golan has
been fortunate to be asked to lecture and teach laser-assisted
dentistry throughout the United States and internationally.
He is the co-founder of the Center for Laser Education and
is a faculty member with the World Clinical Laser Institute,
teaching certification training courses for that organization.
Golan has instituted CAD/CAM technology into his practice
for seven years and has lectured on the subject. He is a
graduate of the Alleman Center for Biomimetic Dentistry.
He graduated from Concord Law School and has passed
the California Bar Examination, obtaining his license to
practice law in that state. Golan excels in teaching quick
and productive integration of laser-assisted dentistry,
minimally invasive concepts and CAD/CAM technology
into dental practices. He practices and teaches a biomimetic
philosophy and is passionate about conserving tooth, soft
tissue and bone.
[17] =>
[18] =>
I industry_ Lasers4Dentistry
X-Runner all-tissue ablative
laser scanning handpiece
Designed for use with the Lightwalker AT dental laser system
Author_Lasers4Dentistry staff
Fig. 1_ The X-Runner
scanner. (Photos/Provided by
Lasers4Dentistry)
Fig. 2_ The shape and size of
X-Runner cuts.
Fig. 1
_Lasers4Dentistry, a division of Technology4Medicine (www.T4Med.com), recently launched
the X-Runner™ digital laser scanning handpiece.
The X-Runner was designed specifically for the
award-winning LightWalker AT Dual Wavelength
dental laser. X-Runner is the first ablative all-tissue
laser scanning handpiece in the dental industry. The
X-Runner has automated all-tissue ablation capabilities and lets the user instantly adjust spot size and
shape of the cutting area.
X-Runner is the perfect tool to use whenever
precise, deep or wide cuts need to be made in hard
or soft dental tissues. The shape and size of an ablation area can be selected in advance to optimize
the cutting process, enabling dentists to work more
precisely, faster, with enhanced patient comfort and
with greater ease than ever before. The new X-Runner
is ideal for a wide range of treatments, from standard
cavity and veneer preps to high-precision surgical
and implantology procedures.
All parameters and settings that are available with
the Lightwalker AT’s standard laser handpieces (energy, frequency, mode, spray) can also be used with
X-Runner. Dentists can instantly switch between the
new automated modality and the classic handpiece
modality without the need to swap handpieces.
X-Runner offers a variety of treatment shapes (circular, rectangular/linear and hexagonal, etc.) that
can be set according to a number of parameters, such
as the size of the ablation area (width and length, or
diameter in the case of the circle and hexagon) as well
as the number of laser passes needed to produce the
Fig. 2
18 I roots
1_ 2014
desired ablation depth. X-Runner can also produce a
precise linear cut, for instance, to cut the root apex or
to perform an incision in soft-tissue surgery. You can
watch the X-Runner in action at www.t4med.com.
The award-winning Lightwalker AT is a highperformance, ultra fast and versatile laser with both
Er:YAG and Nd:YAG wavelengths and a long list of
technological and clinical advancements that puts it
in a class of its own.
Lasers4Dentistry leads the U.S. market with ongoing
significant breakthroughs in dental laser technology:
• Exclusive PIPS Laser Endo
• The only true dual-wavelength laser with both
Nd:YAG & Erbium, fully integrated in the same system
• The only choice with 20 watts of Erbium power —
the highest power laser available for ultra fast cutting
of both hard and soft tissue
• The only laser with 15 watts of Nd:YAG energy
for treating periodontal disease, soft-tissue surgery
and effective biostimulation
• Industry-leading, 50 µs Super Short Pulse (SSP),
resulting in faster cutting and more comfort and less
need for local anesthetic
• The only laser with Quantum Square Pulse (QSP)
technology for ultimate performance, cutting speed,
comfort and precision
• Proprietary Variable Square Pulse (VSP) increases cutting precision and speed and provides
patients with a more comfortable experience
• The only laser available with an all-tissue ablative scanner, X-Runner
• OPTOflex® articulated arm delivery system, the
gold standard for efficiency, ergonomics and reliability
• Optional high-visibility green aiming beam
• Internal air supply and built-in compressor,
eliminating external air lines and improving performance and mobility
• Exclusive options for esthetic procedures, including treatments for wrinkles, pigmented and
vascular lesions and other advanced cosmetic indications._
[19] =>
[20] =>
I industry education_ LVI
LVI Core I three-day course
is designed for doctors and
their teams to learn together
Author_Mark Duncan, DDS, FAGD, LVIF, DICOI, FICCMO, Clinical Director, LVI
Las Vegas Institute for Advanced
Dental Studies offers Core I, a threeday course for doctors and their
teams. (Photo/Provided by Las Vegas
Institute for Advanced Dental Studies)
20 I roots
1_ 2014
_As a patient, I expect the best care I can find. As
a doctor, I want to deliver the best care possible. That
takes us to the power of continuing education, and as
doctors we are faced with many choices in continuing education.
As a way to introduce you to the Las Vegas Institute for Advanced Dental Studies, or LVI, I want
to outline what LVI is about and what void it fills
in your practice. The alumni who have completed
programs at LVI were given an independent survey,
and unlike the typical surveys, 99.7 percent said they
love practicing dentistry, and of those surveyed, 92
percent said they enjoy their profession more since
they started their training at LVI. That alone is reason
enough to go to LVI and find out more.
While the programs at LVI cover the full breadth
of dentistry, the most powerful and life-changing
program is generally reported as being Core I, or
Advanced Functional Dentistry — The Power of
Physiologic-Based Occlusion. This program is a
three-day course that is designed for doctors and
their teams to learn together about the power of
getting their patients’ physiology on their side. In
this program, doctors can learn how to start the
process of taking control of their practice and start
to enjoy the full benefits of owning their practice
and providing high-quality dentistry.
Whether he or she works in a solo practice or in a
group setting, every doctor can start the process of
creating comprehensive care experiences for his or
her patients.
We will discuss why some cases that doctors are
asked by their patients to do are actually dangerous
cases to restore cosmetically. We will discover the
developmental science behind how unattractive
smiles evolve and what cases may need the help of
auxiliary health care professionals to get the patient
feeling better. The impact of musculoskeletal signs
and symptoms will be explored and how the supporting soft tissue is the most important diagnostic
tool you have. Not simply the gingiva, but the entire
soft-tissue support of the structures not just in the
mouth but also in the rest of the body.
A successful restorative practice should not be
built on insurance reimbursement schedules. An
independent business should stand not on the whims
and distractions of a fee schedule but rather on the
ideal benefits of comprehensive care balanced by the
patients’ needs and desires.
Dentistry is a challenging and thankless business, but it doesn’t have to be. Through complete
and comprehensive diagnosis, there is an amazing
world of thank-yous and hugs and tears that our
patients bring to us, but only when we can change
their lives. The Core I program at LVI is the first step
on that journey.
That’s why when you call, we will answer the
phone, “LVI, where lives are changing daily!”_
[21] =>
I about the publisher_ submissions I
submissions
formatting requirements
Please note that all the textual elements
of your submission:
• complete article
• figure captions
• literature list
• contact info (email address please)
• author bio
must be combined into one Microsoft Word
document. Please do not submit multiple files
for each of these items. In addition, images
(tables, charts, photographs, etc.) must not
be embedded in the text document. All images
must be submitted separately, and details
about how to do this appear below.
If you are interested in submitting a C.E.
article, please contact us for additional instructions before you make your submission.
_Text length
Article lengths can vary greatly — from a
mere 1,500 to 5,500 words — depending on
the subject matter. Our approach is that if
you need more or less words to do the topic
justice, then please make the article as long or
as short as necessary.
We can run an extra long article in multiple parts, but this is usually discussing a subject matter where each part can stand alone
because it contains so much information. In
addition, we do run multi-part series on various topics. In short, we do not want to limit
you in terms of article length, so please use
the word count above as a general guideline
and if you have specific questions, please do
not hesitate to contact us.
_Text formatting
Please use single spacing and do not put extra
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Boldface should be reserved for article headlines, headers and subheads please.
Please do not “center” text on the page,
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If you need to make a list or add footnotes
or endnotes, please let the word processing
program do it for you automatically.
There are menus in every program that
will help you apply all sorts of special formatting.
_Image requirements
Please number images consecutively by
using a new number for each image. If it is
imperative that certain images are grouped
together, then use lowercase letters to designate the images in a group (i.e., Fig. 2a, Fig.
2b, Fig. 2c).
Insert figure references in your article
wherever they are appropriate, whether that
is in the middle or end of a sentence, but
before the period rather than after. Our
preference is to have figure references noted
in the appropriate place within the text, as it
helps the readers to orient themselves when
moving through the article. In addition,
please note:
• We require images in TIF or JPEG format
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If you have an image that is greater than
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starting image is in terms of bytes, the more
leeway the designer has in terms of resizing
the image to fill up more space should there
be room available).
Also, please remember that you should
not embed the images into the body of the
text document you submit. Images must
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submission.
You may submit images through a
zipped file via e-mail, unzipped individual
files via email or post a CD containing your
images directly to us (please contact us
for the mailing address as this will depend
upon where in the world you will be mailing
them from).
Please do not forget to send us a head
shot photo of yourself that also fits the
image requirements noted above so that it
can be printed along with your article.
_Abstracts
An abstract of your article is not required.
However, if you choose to provide us with
one, we will print it in a separate box.
_Contact info
At the end of every article is a contact info
box with contact information along with a
portrait photo of the author.
Please note at the end of your article the
exact information you would like to appear
in this box and format it according to the
previously mentioned standards.
A short bio (50 words or less) may precede the contact info if you provide us with
the necessary text.
_Questions? Comments?
Please do not hesitate to contact us for our
International C.E. Magazine Author Kit or if
you have other questions/comments about
the article submission process:
Group Editor Kristine Colker
k.colker@dental-tribune.com
Roots Managing Editor Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor Sierra Rendon
s.rendon@dental-tribune.com
roots
1
I 21
_ 2014
[22] =>
I about the publisher _ imprint
roots
the international C.E. magazine of endodontics
U.S. Headquarters
Tribune America
116 West 23rd Street, Ste. 500
New York, NY 10011
Tel.: (212) 244-7181
Fax: (212) 244-7185
feedback@dental-tribune.com
www.dental-tribune.com
Roots Managing Editor
Fred Michmershuizen
f.michmershuizen
@dental-tribune.com
Managing Editor
Sierra Rendon
s.rendon@dental-tribune.com
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
Managing Editor
Robert Selleck
r.selleck@dental-tribune.com
President/Chief Executive
Officer
Eric Seid
e.seid@dental-tribune.com
Education Director
Christiane Ferret
c.ferret@dtstudyclub.com
Group Editor
Kristine Colker
k.colker@dental-tribune.com
Marketing Director
Anna Kataoka
a.kataoka@dental-tribune.com
Product/Account Manager
Humberto Estrada
h.estrada@dental-tribune.com
Product/Account Manager
Will Kenyon
w.kenyon@dental-tribune.com
International Product/Account
Manager
Jan Agostaro
j.agostaro@dental-tribune.com
Feedback & General Inquiries
feedback@dental-tribune.com
Editorial Board
Marcia Martins Marques, Leonardo
Silberman, Emina Ibrahimi, Igor Cernavin,
Daniel Heysselaer, Roeland de Moor, Julia
Kamenova, T. Dostalova, Christliebe Pasini,
Peter Steen Hansen, Aisha Sultan, Ahmed
A Hassan, Marita Luomanen, Patrick Maher,
Marie France Bertrand, Frederic Gaultier,
Antonis Kallis, Dimitris Strakas, Kenneth Luk,
Mukul Jain, Reza Fekrazad, Sharonit
Sahar-Helft, Lajos Gaspar, Paolo Vescovi,
Marina Vitale, Carlo Fornaini, Kenji Yoshida,
Hideaki Suda, Ki-Suk Kim, Liang Ling Seow,
Shaymant Singh Makhan, Enrique Trevino,
Ahmed Kabir, Blanca de Grande, José Correia
de Campos, Carmen Todea, Saleh Ghabban
Stephen Hsu, Antoni Espana Tost, Josep
Arnabat, Ahmed Abdullah, Boris Gaspirc,
Peter Fahlstedt, Claes Larsson, Michel Vock,
Hsin-Cheng Liu, Sajee Sattayut, Ferda Tasar,
Sevil Gurgan, Cem Sener, Christopher Mercer,
Valentin Preve, Ali Obeidi, Anna-Maria
Yannikou, Suchetan Pradhan, Ryan Seto, Joyce
Fong, Ingmar Ingenegeren, Peter Kleemann,
Iris Brader, Masoud Mojahedi, Gerd Volland,
Gabriele Schindler, Ralf Borchers, Stefan
Grümer, Joachim Schiffer, Detlef Klotz,
Herbert Deppe, Friedrich Lampert, Jörg
Meister, Rene Franzen, Andreas Braun, Sabine
Sennhenn-Kirchner, Siegfried Jänicke, Olaf
Oberhofer and Thorsten Kleinert
Tribune America is the official media partner of:
roots_Copyright Regulations
_the international C.E. magazine of roots published by Tribune America is printed quarterly. The magazine’s articles and illustrations are
protected by copyright. Reprints of any kind, including digital mediums, without the prior consent of the publisher are inadmissible and liable
to prosecution. This also applies to duplicate copies, translations, microfilms and storage and processing in electronic systems. Reproductions,
including excerpts, may only be made with the permission of the publisher.
All submissions to the editorial department are understood to be the original work of the author, meaning that he or she is the sole copyright
holder and no other individual(s) or publisher(s) holds the copyright to the material. The editorial department reserves the right to review all
editorial submissions for factual errors and to make amendments if necessary.
Tribune America does not accept the submission of unsolicited books and manuscripts in printed or electronic form and such items will
be disposed of unread should they be received.
Tribune America strives to maintain the utmost accuracy in its clinical articles. If you find a factual error or content that requires clarification, please contact Group Editor Kristine Colker at k.colker@dental-tribune.com. Opinions expressed by authors are their own and may
not reflect those of Tribune America and its employees.
Tribune America cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not
assume responsibility for product names or statements made by advertisers.
The responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability
arising from inaccurate or faulty representation are excluded. General terms and conditions apply, and the legal venue is New York, New York.
22 I roots
1_ 2014
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-
Cover
01 - 01
view
-
Editorial
03 - 03
view
-
Content
04 - 04
view
-
Passive micro-volume management of sodium hypochlorite in endodontic treatment
06 - 09
view
-
A new paradigm in surgical training
10 - 14
view
-
Endodontics made more efficient with the ScanX Swift
15 - 16
view
-
X-Runner all-tissue ablative laser scanning handpiece
18 - 18
view
-
LVI Core I three-day course is designed for doctors and their teams to learn together
20 - 20
view
-
Submission Guidelines
21 - 21
view
-
Imprint
22 - 22
view
[toc_titles] => Cover
/ Editorial
/ Content
/ Passive micro-volume management of sodium hypochlorite in endodontic treatment
/ A new paradigm in surgical training
/ Endodontics made more efficient with the ScanX Swift
/ X-Runner all-tissue ablative laser scanning handpiece
/ LVI Core I three-day course is designed for doctors and their teams to learn together
/ Submission Guidelines
/ Imprint
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