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ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
AUGUST 2009

www.endo-tribune.com

VOL. 4, NO. 8

Local anesthesia

Handpiece use

New method

The latest information
on reducing pain

Dr. Barry Musikant offers
his recommendations

Lares introduces new
way to clean, debride

Page

Implants vs. endo
Complimentary treatment
strategies or adversarial threats?
By Richard Mounce, DDS

mplant therapy and endodontic
therapy are complimentary treatment strategies each with relatively precise indications and contraindications.
When
carefully
evaluated, cases of endodontics vs.
implants might be evenly weighted in
their indications, and occasions in which
a choice between one modality or the
other is not clear are exceptional and
uncommon.
Comparison of the two modalities
should include, amongst many possible issues, the type of implant placed
as well as the care and skill behind
either of the treatment modality, a
parameter that is challenging, at
best, to measure across populations
of clinicians. The best choice
between the two modalities is often
clearly present when the patient is
allowed to choose between options
that are clearly defined and in which
the financial benefit of the clinicians
has been taken out of the equation.
The endodontic literature indicates
that the success rates of endodontic

The American Association of Endodontists has named its 2009–2010 board of directors.

AAE installs
new directors
Fig. 1: The surgical operating microscope (Global Surgical, St. Louis,
Mo.).

treatment are very evenly matched
to implants (James Porter Hannahan,
ET page 4C

AAE Foundation awards
first Endowed Faculty
Matching Grant to UT
The AAE Foundation announced
on July 13 that it had awarded its
first Endowed Faculty Matching
Grant to the endodontic department
of the University of Texas Health
Science Center at Houston.
The
$100,000
contribution,
matched by gifts from generous
alumni, will fund the John R. Ludington, Jr., DDS, MSD, Distinguished
Professorship in Endodontics. The
Ludington professor will serve as
the program’s pre-doctoral director
of endodontics. The department is

chaired by Samuel O. Dorn, DDS.
“We hope this grant will stimulate
fundraising efforts at endodontic
departments across the country,”
said Foundation President A. Eddy
Skidmore. “Our goal is to ensure
that every dental student has the
opportunity to learn about endodontics from a specialist and that
endodontics is a significant presence in dental schools across the
ET page 7C

The American Association of
Endodontists (AAE) installed five
new members of its Board of
Directors for the 2009–010 term
during its annual session, held in
April in Orlando, Fla.
They are: Margot T. Kusienski,
DMD., MS.Ed., MM.Sc., of Lititz,
Penn., District I; Steven Roberts,
DDS, of Martinez, Ga., District III;
Martha E. Proctor, DDS, MS, of
Chicago, Ill., District IV; Robert A.
Augsburger, DDS, MSD, MS, of
Tulsa, Okla., District V; and Fred S.
Tsutsui, DMD, of Torrance, Calif.,
District VII.

In addition, for the first time the
president of the AAE Foundation,
this year A. Eddy Skidmore, DDS,
MS, of Boynton Beach, Fla., will sit
on the board as a voting ex officio
member.
Dr. Margot T. Kusienski represents Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, Vermont,
Pennsylvania and Virginia. She
currently sits on the AAE Membership Services Committee, the Spe ET page 2C

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News

ENDO TRIBUNE | AUGUST 2009

ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition

ET page 1

cial Committee on Membership
Diagnostics and the Journal of
Endodontics Scientific Advisory
Board. In addition, she is treasurer of
the Lancaster County Dental Society.
The head of her own practice,
Kusienski earned both her DMD and
MS in education from the University
of Pennsylvania before receiving her
MM.Sc. and certificate in endodontics
from the Harvard School of Dental
Medicine. She has been a diplomate
of the American Board of Endodontics since 2006.
• Dr. Steven Roberts represents
Florida, Georgia, North Carolina,
South Carolina and Tennessee. A
graduate of West Point, he earned his
DDS at New York University College
of Dentistry and then served in the
U.S. Army, where he completed his
endodontic residency and received
his certificate in endodontics. He is
currently an assistant professor at the
Medical College of Georgia School of
Dentistry and serves as both director
of the undergraduate endodontic program and assistant director of the
endodontic residency program. A frequent presenter at local and national
meetings, Roberts has numerous
publications to his credit. In addition,
he has been a member of the scientific advisory board of the Journal of
Endodontics since 2007 and was the
first place winner of the 2000 Bernier
Award for Research. Roberts is a past
president of the Greater Augusta
Endodontic Society and Study Group
and is currently a member of the AAE
Educational Affairs Committee. He
has been a diplomate of the American
Board of Endodontics since 2006.
• Dr. Martha Proctor represents
Illinois, Indiana, Kentucky, Michigan,
Ohio, West Virginia and Wisconsin.
She earned her DDS from Baylor College of Dentistry and an MS from
Northwestern University Dental
School, where she also was an assis-

tant professor of endodontics. The
full-time private practitioner also has
served on numerous AAE committees
and as editor of the College of Diplomates newsletter. In addition to being
in private practice, she is currently an
assistant professor of clinical surgery
at Feinberg School of Medicine at
Northwestern University. A diplomate of the American Board of
Endodontics since 1993, she also is a
member of Omicron Kappa Upsilon
Dental Honor Society.
• Dr. Robert A. Augsburger represents Alabama, Arizona, Arkansas,
Louisiana, Mississippi, New Mexico,
Oklahoma, Public Health, Puerto
Rico, Texas, U.S. Air Force, U.S. Army,
U.S. Navy and the Veterans Administration. He earned his DDS from the
University of California San Francisco School of Dentistry and an MSD in
oral biology from George Washington
University. He has also been awarded
fellowships from the American College of Dentists, the Pierre Fauchard
Academy and the International College of Dentists. He is currently on
the faculty of Baylor College of Dentistry, the University of Missouri at
Kansas City School of Dentistry and
the University of Oklahoma College
of Dentistry. A diplomate of the American Board of Endodontics since
1984, he holds an Oklahoma
endodontic specialty license. He is a
member of Omicron Kappa Upsilon
honorary society and Sigma Xi honorary society for the sciences.
• Dr. Fred S. Tsutsui represents
California. He earned a DMD from
Fairleigh
Dickinson
University
School of Dental Medicine in 1976
and a certificate in endodontics from
the University of Southern California
in 1981. In addition to his private
practice in Torrance, Calif., he teaches at V.A. Hospital Long Beach, the
University of Southern California and
the University of California Los Angeles. Tsutsui is a past president of the
California State Association of
Endodontists. He was certified by the

American Board of Endodontics in
1991 and is a fellow of the American
College of Dentists, the Pierre
Fauchard Academy and the International College of Dentists. He is a frequent presenter on numerous
endodontic topics at local, national
and international meetings.
• Dr. A. Eddy Skidmore was elected president of the AAE Foundation.
He previously held office as president
and director of the American Board of
Endodontics and as president of the
College of Diplomates, in addition to
serving on numerous AAE committees. He earned his DDS in 1966 from
West Virginia University School of
Dentistry. In 1971, he earned a certificate in endodontics and an M.S. from
the University of Iowa College of
Dentistry. He was on the faculty of
West Virginia University School of
Dentistry from 1971–1993, when he
retired as a full time professor, chairman and graduate program director
in the department of endodontics.
During his tenure, he twice received
outstanding teacher awards as well
as a distinguished alumni award
from the university’s school of dentistry. Skidmore was in private practice in Morgantown, W.V., from
1993–2004, and is currently retired in
Boynton Beach, Fla., where he teaches part-time at the Nova Southeastern
College of Dentistry. ET

About the AAE
The American Association of
Endodontists (www.aae.org), headquartered in Chicago, represents
more than 7,000 members worldwide,
including approximately 95 percent of
all eligible endodontists in the United
States. The association, founded in
1943, is dedicated to excellence in the
art and science of endodontics and to
the highest standard of patient care.
The association inspires its members
to pursue professional advancement
and personal fulfillment through education, research, advocacy, leadership,
communication and service.

Study: Local anesthesia is truly
effective only when injected
A painful truth in dentistry today is
that for most dental procedures, local
anesthesia is truly effective only when
injected.
The problem, of course, is that both
the insertion of the needle and the
injection of the anesthetic fluid itself
can cause discomfort. Dentists have
been using topical anesthesia to
reduce the pain involved in needle
insertion and fluid injection for
decades, and they have tried to use
finer-gauge needles in the belief that
they cause less pain.
However, recent research has
shown that needle gauge has no effect
on perceived pain level. Topical anesthesia can be useful for minimizing the
pain associated with needle insertion,
but it has not been proven to address
pain associated with the actual injection of the local anesthetic solution.

A recent study in Anesthesia
Progress examined the effectiveness of
topical anesthesia in reducing pain
associated with needle insertion separately from the pain associated with
injection of the anesthetic. Results
were investigated after different intervals (two, five and 10 minutes) to
determine the time for optimal efficacy
of the topical anesthetic.
In a double-blind, placebo-controlled study, responses from 85 people
showed that the topical anesthetic was
statistically and significantly more
effective compared to the placebo for
reducing the pain caused by needle
insertion alone at all time points (two,
five and 10). However, it had no effect
on perceived pain intensity associated
with injection of the local anesthetic
solution at any of the time intervals.
At all time lengths, patients reported

the same degree of pain from anesthetic solution injections in topically anesthetized and placebo locations. Therefore, the minimum two-minute period
appears to be sufficient for the topical
anesthetic application, as a five- or 10minute delay has no added benefit in
reducing the pain of needle insertion.
To read the entire study,
“Effect of Time on Clinical Efficacy
of Topical Anesthesia,” visit:
www.allenpress.com/pdf/anpr56-02-03.pdf. ET

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[4] => ITUS_Title_MS

Clinical

ENDO TRIBUNE | AUGUST 2009

ET page 1

Paul Duncan Eleazer, Journal of
Endodontics, November 2008 {Vol.
34, Issue 11, Pages 1302–1305} and
Scott L. Doyle, James S. Hodges, Igor
J. Pesun, Alan S. Law, Walter R.
Bowles, Journal of Endodontics,
September 2006 {Vol. 32, Issue 9,
Pages 822–827} ). In essence, the
choice between the two modalities
should be made on the merits of the
individual clinical situation and of
course, as mentioned, primarily, the
patient’s wishes once he or she has
been informed of the objective facts.
As a starting place, underpinning
all treatment planning for retention
of the natural tooth is a correct diagnosis and case assessment even
before any restorative treatment is
undertaken.
Is caries present? Does the given
crown or contemplated restorations
have to be placed? All efforts that
reduce pulpal trauma are beneficial
and ultimately will diminish the
need for endodontic therapy. Secondarily, having the clinician be
aware of the pulpal status at all
stages in the restorative continuum
has significant value for all involved.
Clinically, this is manifest as a
restorative doctor that knows both
the present vitality of the tooth being
treated as well as the future viability.
Obviously, placing restorations on
teeth that ideally should be extracted
or have endodontic therapy at that
given moment is contraindicated.
A careful assessment of present
vitality and future viability at all
times in the process can lead to early
intervention as well as more confident predictability of restoration and
natural tooth retention relative to the
alternatives.
This proactive approach is far
superior to being reactive to teeth
that become symptomatic where
such a pulpal breakdown could have
been entirely anticipated. Such
anticipation can lead to a more
informed patient, much greater
retention of tooth structure, more
well organized and planned treatment, less endodontics and less tooth
loss relative to the alternatives.
In a hypothetical yet common
clinical example, if a lower molar is
tipped to the mesial; has no response
to cold testing (relative to the control
teeth); shows calcification in the
pulp chamber and a widened PDL;
and a bridge is planned from #29 to
#31 to replace a missing #30, it
makes sense to inform the patient
that the pulp in #31 is likely partially
necrotic, even in the absence of overt
symptoms, and that the tooth is a
candidate for a root canal.
To restore the tooth without
endodontic intervention is to invite a
future symptomatic painful event
that now violates the bridge and
risks iatrogenic events as well as create a cycle of microleakage. At a
minimum in this scenario, the
patient must be informed that the
tooth has a strong likelihood of
becoming symptomatic and given a
choice as to his or her preference for
early intervention or to place the

Fig. 2: RealSeal bonded obturation; SEM courtesy of Dr. Martin Trope.

Much like a tooth that is not
restored properly after endodontic
therapy and is allowed to become
contaminated (and the root canal
therapy fails), it is not the root canal
procedure that has failed but the
manner in which it was carried out.
In essence, choosing the correct
taper for the given root form will
diminish the risk of vertical fracture
as much as placing the correct coronal seal after treatment minimizes
the chances for failure of either firsttime orthograde treatment or
retreatment.
Making superficial judgments as
to the indications for endodontic
treatment and/or extraction can easily be biased by assumptions made
on previous treatment that was done
incorrectly and which unnecessarily
risked vertical fracture.

Informed consent

Figs. 3-4: Teeth that were referred for endodontic retreatment or surgery, which
were not restorable.

bridge and risk its subsequent violation.
The microleakage mentioned can
occur if the tooth is not properly
restored after the endodontic treatment under a rubber dam and ideally with a surgical operating microscope (Global Surgical, St. Louis,
Mo.) (or enhanced visualization) and
using bonded obturation with a
material such as RealSeal* in master
cone or obturator form.
In this realistic clinical scenario,
addressing the patient’s needs correctly and properly at the initial indication for endodontic intervention
can make manifest the best indications for natural tooth retention of
#31. Alternatively, #30 might be
replaced with an implant, #31 up
righted and treated endodontically
and crowned, thus in either event, a
proactive outcome (Figs. 1–2).

Restorability and periodontal
status
Clinical choices between first-time
endodontic treatment, retreatment
or extraction and implant are primarily a matter of determining whether
the tooth is restorable. This said,
there are a host of secondary factors
that must be considered and will be
discussed below as well.
Knowing which teeth should be
removed and implants placed is a
vital diagnostic skill. The author, a
full-time endodontist, empirically
estimates at one out of 10 or 15 of the
referrals for retreatment or consultation is made on a non-restorable
tooth (Figs. 2, 3). As a result, a workable criterion for restorability is
absolutely vital as treatment of these
teeth would in all likelihood lead to
later extraction.
Primary factors to consider in

restorability include: the patient’s
wishes and needs with regard to
expected function and esthetics of
the given tooth, pulpal status,
remaining tooth structure, presence
of existing iatrogenic events, risk of
future iatrogenic events if the contemplated treatment/retreatment
were to be completed, possible
existing vertical fracture, risk of vertical fracture if the contemplated
retreatment were to be carried out,
remaining bone support, periodontal
health or disease status of the tooth,
mobility, gingival tissue health, oral
hygiene, medical history (especially
patients undergoing radiation and
chemotherapy to the head and neck,
as well as those who have taken biophosphanates, especially in IV form),
dental history, bruxism and parafunctional habits, presence or
absence of pulpal vitality, the quality
of the previous cleansing, shaping
and obturation; patient anxiety, arch
position, tipping, rotation, calcified
canals, atypical root anatomy of all
types, resorptive defects and endo
perio lesions.
It is an essential aside to mention
that the quality of first-time
endodontic treatment is in some
measure determined by three things:
the length control, the degree of
microbial control during the case,
the coronal seal and the taper prepared in the shaping of the root canal
system.
This is directly relevant to one of
the indications for implant therapy,
the presence of vertical fracture that
results from failed endodontic therapy. It should be stated that it is not
the endodontic therapy that fractures
the teeth, but the lack of a correct
taper choice for the given root canal
system.

The patient should be told realistically, and without bias, what the likely outcome of treatment will be with
either treatment modality (endodontics versus implants) when the
financial interest of the clinician is
taken out of the picture. Arbitrarily
removing #8 and placing a single
tooth implant because of open apex
after trauma, for example, without
an endodontic consultation, is shortchanging the patient by not giving all
the possible options.
Alternatively, doing a second surgery on a failed root canal or possibly
doing a first exploratory surgery
where the long-term prognosis is
guarded at best, (case dependent)
often is better handled definitely by
extraction and placement of an
implant. There is an old expression
that applies: “A horrible ending is
better than a horror that never
ends.”
Simply put, remove teeth that
more ideally would be better served
with implant therapy and keep those
teeth where the predictability of
restoration is such that this is the
superior service.

Is endodontic disease present;
has the case failed?
While on the surface it might seem
simple to address this issue, it is not
always entirely clear when endodontic therapy has succeeded or failed.
What of the upper molar tooth
that has had root canal therapy and
is less symptomatic than at the time
of treatment and yet is still mildly
sensitive to percussion, perhaps
from a missed MB2 canal? Or, as can
happen, what of the clinical case
where the lesion of endodontic origin that was present heals partially
and yet still remains, albeit smaller
than it first appeared?
Each of these cases must be
addressed on a case-by-case basis,
but as a starting place, it is advised to
take a minimum of two or three radiographs of the given tooth from different angles: buccal, mesial and distal. The presence or absence of
symptoms is recorded. An absence of
symptoms to some may mean the
tooth does not need retreatment, but
actually may be the beginning manifestation of failure.

[5] => ITUS_Title_MS

Clinical 5C

ENDO TRIBUNE | AUGUST 2009
For example, overt coronal
microleakage, missed canal(s), vertical fracture, lesions of endodontic
origin where one did not exist before,
etc., would all be cases that need
retreatment or extraction (case
dependent), but which are not yet
overtly manifest if they are asymptomatic.
Asymptomatic failed endodontic
cases can easily and rapidly erupt
into symptomatic ones. Once a
determination is made that the previous root canal has failed, the clinician should default into a list of the
restorability considerations, such as
those given above to determine if the
tooth would be better removed or
retreated, all things being equal.
Part of this determination of
retreatment/restorability vs. extraction must consider whether an apical seal can be obtained and the technical deficiency that was present in
the initial treatment can be overcome. For example, if an apical
blockage and ledge has been created,
can it be bypassed and addressed
optimally? In any event, the patient
should be told clearly what the challenge that must be overcome is and
what the realistic probabilities are for
successful retreatment (Figs. 5a, 5b).

Fig. 5: Clinical case that initially had coronal microleakage, uncleaned and unfilled
space and a resulting apical lesion. Retreatment of this tooth (pictured here) located
and treated an MB2 canal as well as provided an adequate apical seal.

Is an implant better than
first- time orthograde root
canal treatment?
The answer to this question is a more
straightforward one relative to cases
where retreatment may also be an
option.
Assuming that the periodontal
support and restorability of the tooth
are adequate, it is difficult to justify
an arbitrary removal of a tooth where
an orthograde root canal treatment
has not first been attempted unless
there are significant mitigating circumstances. Performing the root
canal treatment optimally is essential
to give the tooth the best long-term
prognosis and preserve the natural
dentition (Fig. 6).

Anatomic considerations
There are few, if any, anatomic considerations that absolutely contraindicate orthograde root canal
treatment or retreatment. Apical surgery, as an adjunct to retreatment,
has similar precautions relative to
implants with regard to impingement
on vital structures such as the
mandibular canal, the mental nerve,
perforation of the lingual cortical
plate in the mandibular posterior
region as well as precautions related
to the maxillary sinus, amongst others. Horizontal and vertical lack of
bone and adequate attached gingival
tissue are also considerations that
might argue for retention of the natural tooth.

Costs: direct and indirect
The direct and indirect costs of
implant therapy are greater than
those of retreatment or first-time
orthograde therapy, but this assumes
that the endodontic therapy is successful in an apples-to-apples comparison.
The worst of all situations is one
where the patient has the tooth treat-

In a similar manner, a resorbed
lower ridge poses a challenge for clinicians placing implants in this area.
The use of computerized cone-beam
technology is invaluable to fully
appreciate these challenges clinically
as well as planned treatment. In any
event, it is a matter of debate as to
which bone grafting materials and
techniques might be optimal for situations where the mandible is
resorbed.
Sound clinical judgment and principles must obviously be applied on a
case-by-case basis.
And while this is an article directed at making treatment planning
decisions with regard to choosing
between endodontics vs. implants, it
bears mention that endodontic surgical intervention should be noted as
an option in this continuum both
with and without known sources of
odontogenic failure.
Apical surgery is invaluable to
address cases where the tooth has
had optimal endodontic treatment,
and possibly retreatment as well as
ideal coronal seal and yet failed, to
biopsy lesions of unknown origin in
combination with the need for root
end surgery and to perform
exploratory surgery if the cause of
failure is not clear.
A clinically relevant discussion of
considerations that should be made
when evaluating endodontic versus
implants has been presented.
Emphasis has been placed on a careful assessment of the restorability of
the given tooth, whether the existing
root canal has indeed failed, if
retreatment is feasible and what the
future prognosis is for the tooth in
view of the options for extraction and
replacement with an implant. ET
* SybronEndo, Orange, Calif.

Fig. 6: Clinical treatment carried out to the highest standard with the surgical
operating microscope, rotary nickel titanium Twisted Files*, RealSeal bonded obturation* and a bonded composite occlusal filling, Maxcem (Kerr, Orange, Calif.).

About the author
ed or retreated or has surgery, then
loses the tooth and ends up with an
implant. This unfortunate circumstance can be addressed and most
often avoided through a proper
restorative evaluation and consideration for treatment prior to the firsttime orthograde treatment and possible retreatment as outlined in this
article.

Advantages and indications
for implant therapy
Advantages of implant therapy
include the prevention of bone loss
after tooth removal if the implants
are placed six to nine months after
tooth removal, and functional and
esthetic tooth replacement, amongst
other factors.
A primary consideration that must
be taken into account to provide an
optimal implant utilization is the
placement of the implant in a location that does no harm to vital existing structures, and in which the
implant will be given enough time to
properly integrate. Additional considerations are correct loading of the
implant with regard to avoidance of
lateral forces and correct axial load-

ing forces.
Implant utilization also carries
with it the advantage that it can be of
service in a variety of other situations
that might be beneficial to the
patient, where this might not exist
otherwise: complete upper and
lower denture stabilization and the
single tooth implant (especially in
the upper anterior region and combined single crown/fixed partial denture restoration scenarios assuming
that the implants are loaded correctly as well as placed into areas of adequate bone and tissue health and
receive adequate postoperative
care).
In all implant treatment it is essential that the clinician appreciates how
the bone will heal post extraction, the
effects of systemic medications and
the changes and variations in bone
quality that may occur in various
clinical scenarios. A reduced amount
of bone into which an implant is
placed, parafunctional habits, limited
space between the upper and lower
arches and atypical sinus anatomy
may all lead to changes in implant
length or placement strategies relative to other areas.

Dr. Richard Mounce lectures globally
and is widely published. He is in private practice in endodontics in Vancouver, Wash. Mounce offers intensive,
customized
endodontic
single-day training programs in his
office for one to two doctors at a time.
For more information, contact
Dennis at (360) 891-9111 or write
RichardMounce@MounceEndo.com.

[6] => ITUS_Title_MS

Opinion

ENDO TRIBUNE | AUGUST 2009

Rationale vs. rationalizations
By Barry Lee Musikant, DMD

I interpret the use of a rationale as
a well-defined description of the positive reasons we favor a concept or
technique. Rationalization represents
the manipulation of facts to favor a
concept or technique that is inimical
to the truth. I believe that much of the
support for rotary NiTi is based on
rationalization rather than a solid
rationale.
Rotary NiTi has replaced some of
what K-files did in the past (Fig. 1). Kfiles are still required for this initial
canal shaping. So rotary NiTi is more
an adjunct to the use of K-files rather
than a substitute for them. Rotary
NiTi requires the support of the systems they are proclaiming to replace.
K-files are the wrong instrument to
use for initial glide path creation. The
flutes are horizontally inclined, tending to screw in and out of the canal
walls without efficiently cutting the
dentin when used with the recommended watch-winding motion.
To continue to advocate the use of
K-files when K-reamers and relieved
K-reamers (SafeSiders) (Fig. 2) work
more efficiently, furthers the rationalization for the use of rotary NiTi
without strengthening any rationale
argument for their use. One must
ignore the great improvements in initial canal shaping that relieved reamers bring to the table to justify the use
of rotary NiTi. Employing the benefits
of relieved reamers, used either
manually with a tight watch-winding
stroke or in the 30-degree reciprocating handpiece (Fig. 3), one quickly
realizes that the glide path created
with these instruments is just the
start of their effective usage. They are
used with great efficiency and safety
through the entire shaping procedure, opening even highly curved
canals to a 35 with a 25/06 overlayed
taper. Simpler, safer and less expensive means exist to shape canals.
Those advocating rotary NiTi must
emphasize the limitations imposed
on rotary NiTi systems. Over the
years, this list of limitations has
grown with greater burdens placed
on the operator using these systems.
The ultimate rationalization is that
the cause of failure is based on the
incompetence of the practitioner and
not on the design and delivery of the
rotary NiTi systems.
Rationalization of rotary NiTi
instrumentation places burdens upon
the practitioner, including:
1. Instruments that are prone to
fracture (Fig. 4).
2. Case selection.
3. Crown-down preparations.
4. Frequent replacement.
5. Minimal apical preparation.
6. Long learning curve.
The rational argument for relieved
reamers include:
1. They are virtually invulnerable
to breakage because torsional stress
and cyclic fatigue are virtually elimi-

Fig. 3: 30-degree reciprocating handpiece.
Fig. 1: At left, K-file. Fig 2: At right,
flat-sided reamer.

auxiliary canals along the way. In
addition, both the gutta-percha and
the cement placed at room temperature warm to body temperature,
expanding about 1.75 percent in the
process, creating an even better seal.
Techniques based on their rational
use rather than a rationalization of
their use stand a far better chance of
being successful clinically (Figs. 5–7).
To continue with this discussion,
consider joining endomailmessage
board.com.
You will find it a whole new arena
for independent thought. ET

About the author

Fig. 4: Compression and Tension
placed on a Rotary NiTi instrument.

nated.
2. They are used safely at oscillating speeds of 3000–4000 cpm.
3. Vertically oriented flutes cut
more efficiently when a horizontal
motion is incorporated.
4. They are more flexible, less
engaging and produce a superior tactile perception than K-files.
5. The relieved reamers distinguish between a solid wall and
engaging a tight canal, and differentiate between a round and oval canal.
Recognizing both these conditions
tells a dentist when to pre-bend an
instrument, how to negotiate around
a blockage and when to reattach the
instrument to the reciprocating
handpiece.
Another example of rationalization versus a solid rationale includes
thermoplastic obturation. Supporters
of thermoplastic systems emphasize
the adaptation of gutta-percha to the
canal. They deemphasize the fact
that thermoplasticized gutta-percha
shrinks 4 percent to 5 percent as it
cools.

Fig. 5–7: Techniques based on their
rational use rather than a rationalization of their use stand a far better
chance of being successful clinically.

The rationale for the system is
based on a room-temperature, nonshrinking cement binding chemically
and physically to gutta-percha and
the canal walls. The cement is coupled to a master gutta-percha point
that fits with at least 85 percent accuracy throughout its length and close
to 95 percent accuracy in the apical
third. In turn, the gutta-percha point
can be well-coated with the cement
and placed into the canal. The
cement, more flowable at room temperature than thermoplastic guttapercha, is driven laterally and then
escapes coronally, obturating any

Barry Lee Musikant, DMD, is codirector of dental research and cofounder of Essential Dental Systems
(EDS). The company’s roots stemfrom the desire for product improvements to the items of focus in lectures and daily practice. His research
and business partner is Allan S.
Deutsch, DMD. Musikant and
Deutsch have a combined 60-plus
years of practice experience. You
may contact either of them at
info@edsdental.com

[7] => ITUS_Title_MS

Industry 7C

ENDO TRIBUNE | AUGUST 2009

Lares introduces new laser endo procedure
Lares Research has introduced
Photon
Induced
Photoacoustic
Streaming™ (PIPS™), a revolutionary
method for chemically cleaning and
debriding the root canal system
using Er:YAG laser energy at subablative power levels.
The procedure (patents applied
for) is being called the first real
breakthrough in endodontics in 50
years.
The PIPS procedure uses the
power of an Er:YAG laser to create
photoacoustic shock waves within a
15 percent EDTA solution introduced in the canal. The containment
of the shock waves within the canal
system thoroughly streams the
EDTA solution through the entire
canal, selectively removing debris.
The sub-canals are left clean and the
dentinal tubules are free of smear
layer. The procedure is equally
effective for final water rinsing prior
to obturation.
With the PIPS procedure, the
entire root canal and sub-canal system is more effectively cleaned and

debrided than with traditional
instrument-only techniques, reducing the risk of re-infection.
The procedure is less invasive
and
preserves
more
tooth
endoskeleton than traditional instru-

Pulpdent launches Web site
Pulpdent has launched a comprehensive new Web site that
offers clinical information and
case studies, as well as in-depth
information about Pulpdent’s
proven products for dental professionals.
The Web site can be found at
www.pulpdent.com.
The Pulpdent Web site is easy
to navigate and includes articles
and other educational content,
news and events, and product
information.
Product
pages
include a product overview,
instructions for use, MSDS sheet,
and in many cases, related articles
and studies, frequently asked
questions and illustrated step-bystep clinical procedure instructions. There are PowerPoint presentations for many of the
products.
“We wanted the Web site to be
informative and easy to use,” said
Ken Berk of Pulpdent, “but above
all, we wanted it to be a place dental professionals will enjoy coming to. It’s like a dental amusement park.” Visitors to the Web
site will find a link for signing up

ET page 1

country.”
The Endowed Faculty Matching
grant was introduced in 2008. It provides an annual opportunity for
endodontic programs to receive up
to $100,000 to support an endowed
faculty position at their institutions.

ment techniques because filing is
limited to a maximum size of ISO
#20, maintaining more post-restoration tooth strength. Sub-ablative
power levels eliminate the risks of
ledging and demineralization inherent with other laser endodontic
methods. Less filing and more efficient cleaning saves the clinician
and patient significant chair time
per canal relative to traditional techniques.
The PIPS procedure was developed by Dr. Enrico DiVito, along
with his research team at Medical
Dental Advanced Technologies
Group, (MDATG) with assistance
from Dr. Mark Colonna. The
MDATG team of dentists, engineers
and biochemists carefully optimized
the PIPS procedure for use with the
Lares Fotona PowerLase® AT, the
world’s most advanced all-tissue
laser. DiVito is founder of the Arizona Center for Laser Dentistry and
is a pioneer in the research and
development of minimally invasive
laser endodontic procedures.

The PowerLase AT laser is
uniquely suited for optimum performance of the PIPS procedure.
The super short, 50 microsecond
Er:YAG pulse duration available on
the PowerLase AT, combined with
the efficient design of the PIPS tips
(patents applied for), allows the lowest possible energy per pulse and
repetition rate, minimizing thermal
effects and maximizing the propagation of the PIPS shock waves.
The PIPS procedure is available
only to past and future purchasers of
the PowerLase AT. Lares is a recognized leader in the development,
manufacture and distribution of oral
cutting technology, supplying dentists with precision handpieces and
high performance lasers worldwide.
The company has been an innovator
in the field of dental lasers since it
began offering lasers to dental clinicians in 1997. For more information,
call (888) 333-8440, ext. 2050, or go
to www.laresdental.com. ET
(Source: Lares Dental)

New Mectron facilities
inaugurated in India
By Claudia Salwiczek, DTI

to receive the free Pulpdent informational e-newsletter and an
archive of past newsletters.
Customers can also place
orders for Pulpdent products on
the Web site, and Pulpdent will
forward the order to the customer’s preferred dental dealer
for processing.
Pulpdent manufactures highquality products for the dental profession, including adhesives, composites, sealants, cements, etching
gels, calcium hydroxide products,
endodontic specialties and bonding accessories. For more information call (800) 343-4342 or visit
www.pulpdent.com. ET
(Source: Pulpdent)

The intention of the AAE Foundation
program is to promote academic
excellence and to help ensure that
endodontics will be taught by specialists. The grant is also intended to
boost the recipient institutions’
fundraising capacity.
The Endowed Faculty Matching
Grant is one of a constellation of
funding initiatives that include

The new Mectron facilities were
inaugurated with a grand ceremony
in Bangalore, India, this summer.
The company, which also has
branches in Mumbai and New Delhi,
has been based in the south Indian
city since December 2004. Under the
direction of Managing Director M.
Radhakrishnan, the company moved
into a new, larger building and
increased the number of its employees from four to 60
Initially a purely distributional
structure, Mectron India soon
attracted well-known brands looking for a serious partner in the challenging Indian market. Today,
Cavex, Euronda, Heraeus Kulzer,
KaVo, K-Driller, Schulz and Villa are
distributed exclusively through
Mectron India.
In order to better satisfy all distribution partners and achieve the new
objective of on-site product assembly, a well-situated 5,000 square
meters site, situated only 15 minutes
away from the new Bengaluru International Airport, was purchased in

competitive grants for research,
support to endodontic educators,
and awards for endodontic students
and clinicians who seek to pursue a
career in education.
The AAE Foundation is the philanthropic arm of the American
Association of Endodontists. Its
mission is to advance research and
education in the specialty of

M. Radhakrishnan (managing director), Wolf Narjes (area sales director)
and Fernando Bianchetti (companyowner) at the inauguration of the new
Mectron facilities in Bangalore.

Bangalore. Less than a year later,
representative and functional facilities have been built on the land, with
spacious meeting rooms, modern
offices and, of course, a show room
exhibiting all the brands the company distributes.
Such an investment demonstrates
a strong commitment to Mectron
India’s distribution partners and
shows the confidence of the Italian
mother company Mectron s.p.a. in
the potential of the Indian dental
market. ET

endodontics. It is the only organization that provides support to
every accredited endodontic program in the United States and
Canada. The foundation invests
approximately $1 million in the
specialty annually. ET
(Source: American Association of
Endodontists Foundation)

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Implants vs. endo (entree) / News / Implants vs. endo / Rationale vs. rationalizations / Industry

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