Endo Tribune U.S.
AAE launches new website / Cleaning and shaping with new technology / Industry / The interrelationships between complex canal anatomy and the instruments that shape them
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[1] =>
ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
November 2010
www.endo-tribune.com
Vol. 5, No. 11
AAE launches new website
The American Association of Endodontists (AAE) has developed and
launched a new website that offers
more content and easier navigation
for dental professionals, members and
patients.
The enhanced site’s home page provides immediate access to the current
issue of the Journal of Endodontics,
features a complete calendar of U.S.
and international endodontic events,
offers current news from the AAE and
other dental outlets, as well as links to
various AAE communities, including
RSS feeds, discussion forums, Facebook and YouTube. All pages in the
site contain a link to the “Find an
Endodontist” search engine.
Immediate Past President Dr. Gerald N. Glickman was the chair of the
special committee that was charged
by the AAE Board of Directors with
creating a website that would be more
accessible.
“Internet usage has increased significantly in the past 10 years, and
these improvements provide a wealth
of free resources and continually
updated information in an appealing,
easy-to-use format,” he explained.
The new site allows dental professionals to access numerous tools about
the intricacies of endodontic treatment.
Facebook page and YouTube channel to further connect with the dental
community.
Discussion boards are also available on the website for endodontists
and general dentists to post questions
or comments to their colleagues.
Visit the new www.aae.org to see
all of these resources and more. Questions about the new site can be directed to communications@aae.org.
About the American Association
of Endodontists
The new AAE website at www.aae.org.
“We want to ensure through the new
site structure that all of our audiences,
particularly our general practitioner
colleagues, are aware of the resources
that the AAE has for them,” said AAE
President Dr. Clara M. Spatafore.
By entering the “Dental Professionals” section, general practitioners
have a wide range of clinical tools
at their fingertips, including current
and past issues of the ENDODONTICS: Colleagues for Excellence newsletter, case assessment and referral
tips, implant resources and a speakers
list for those interested in inviting an
endodontist to present at a continuing
education meeting.
As social media has taken on an
important role in communication, the
AAE site has incorporated several of
these outlets, including RSS feeds that
anyone can subscribe to, as well as
the ability to share site links through
networking pages such as Facebook,
LinkedIn, Twitter and more. Additionally, the Association has launched a
The American Association of Endodontists, headquartered in Chicago, Ill.,
represents more than 7,200 members
worldwide, including approximately
95 percent of all eligible endodontists in the United States. Endodontics is one of nine dental specialties
formally recognized by the American
Dental Association. The AAE, 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.
(Source: AAE)
The interrelationships between complex canal
anatomy and the instruments that shape them
By Barry Lee Musikant, DMD
Canals come in all sizes and
shapes. They can be any combination of wide, straight, narrow,
curved, smooth, gritty, filled with
tissue, devoid of tissue, patent and
blocked, non-calcified to totally calcified. It is the challenge to first
negotiate these canals to length and
then to widen them to the point that
they are cleansed in three dimensions without distortion.
From a practical point of view, we
are primarily concerned with those
canals that challenge us to get to
the apex.
However, we should be aware
that even those canals that are wide
initially and patent to the apex must
still be properly cleansed in three
dimensions. In order of priorities,
patency is our first goal and thorough cleansing our second.
The narrower, more curved and
more calcified a canal, the great-
er the challenge in negotiating to
length. The design of the instruments and their utilization to negotiate these canals determines which
ones work most efficiently.
Today, the watch-winding motion
is the most utilized form of manual
motion. This was not always the
case. In the past, before the introduction of stainless-steel fabricated
instruments, carbon steel was the
material of choice.
Being weak in torsional resistance, instruments made from carbon steel had to be used primarily
with a push/pull stroke. To be effective cutting instruments, the flutes
were horizontally oriented along the
long axis of the instrument providing a cutting blade that was more or
less at right angles to its motion.
Whatever
the
predominant
motion of the instrument, to cut,
the blades must be more or less at
g ET page 6B
Fig. 2: Photograph showing the ease of
pre-bending a stainless-steel instrument.
Fig. 1: The horizontally oriented
flutes of a K-File.
Fig. 3: The vertical
flutes and flat of a
relieved reamer.
Fig. 4: Illustration of an asymmetrical instrument’s ability to distinguish and clean an oval
shaped canal.
[2] =>
2B
Industry
Endo Tribune | November 2010
Cleaning and shaping
with new technology
Revo-S® developed by MICROMEGA®, with only three nickeltitanium files, simplifies the initial endodontic treatment and optimizes the
cleaning action.
The asymmetrical cross-section
of Revo-S facilitates penetration by a
snake-like movement and offers a rootcanal shaping that is adapted to the
biological and ergonomic imperatives.
This system promotes a thorough
root cleaning and also offers apical
finishing. This sequence functions
according to a cutting, clearance and
cleaning cycle, thus allowing an active
upward dentinal chips elimination.
What are the advantages of the
asymmetrical cross-section?
• It enables a better root-canal penetration due to a “snake-like” movement and offers better progression
of the instrument toward the apical
region of the root canal.
• Thanks to the increased available volume, the elimination of debris
upward, the coronal is facilitated.
• The large helical groove cannot be
obstructed and that avoids the risk of
extrusion of debris beyond the instrument tip and apical foramen
• It reduces the stress on the instrument thanks to the rippling movement
of the file along the canal walls.
The REVO-S sequence has only
three instruments. This technique is
easy to use and adapted for most root
canal anatomies.
Advantages of SC1, SC2 & SU instruments include:
• Inactive tip.
• Extended helical machining up
to the coronal region increases the
instrument flexibility.
• Less stress on the instrument.
• Better debris elimination and more
efficient cleaning due to the asymmetrical cross-section of the SC1.
• SC2 is an instrument without
asymmetrical cross-section, which a
taper of .04 enables easier penetration.
Its equilateral section (three identical sides) ensures a perfect guidance
of the instrument to the apical zone
thanks to the balance of the forces.
• The equilateral section of the SC2
ensures the path through the canal to
the apical zone: no zipping.
• It has better debris elimination
and more efficient cleaning. No extrusion.
• The progressive pitch avoids zipping effects.
• SU smoothes the root-canal walls.
• Thanks to its asymmetrical crosssection, it recapitulates the action of
the first two instruments SC1 and SC2,
thus respecting the tapered shape of
the canal.
• An adequate canal preparation
with an apical finishing of .06.
The apical finishing
For a successful canal preparation,
apical finishing is essential: MICROMEGA offers an additional adapted
ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
Publisher & Chairman
Torsten R. Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witteczek@dental-tribune.com
Chief Operations Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Endo Tribune
Frederic Barnett, DMD
BarnettF@einstein.edu
(Photos/Provided by
MICRO-MEGA)
International Editor Endo Tribune
Prof. Dr. Arnaldo Castellucci
Managing Editor/Designer
Implant, Endo & Lab Tribunes
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Account Manager
Humberto Estrada
h.estrada@dental-tribune.com
Marketing Manager
Anna Wlodarczyk-Kataoka
a.wlodarczyk@dental-tribune.com
Marketing & Sales Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia Wehkamp
j.wehkamp@dental-tribune.com
Dental Tribune America, LLC
116 W. 23rd St., Suite #500
New York, NY 10011
Tel.: (212) 244-7181
Fax: (212) 244-7185
Published by Dental Tribune America
© 2010 Dental Tribune America.
All rights reserved.
solution with specific instruments:
AS30, AS35 and AS40
These instruments are complementary and not systematically used. They
allow one to efficiently enlarge the apical preparation respecting the .06 taper
already formed without modifying the
obtained preparation with the basis
sequence (SC1, SC2 and SU).
Tapering at .06 enables a debridement and a disinfection corresponding
to biological constraints of the initial
root canal treatment. This improves
the flow of the irrigating solution in
the canal and facilitates the obturation.
The MICRO-MEGA
The Revo-S sequence is available in
InGeT® (to use with a InGeT® microhead contra-angle) and in Classics
(standard handle Ø 2.35 adaptable
on any endodontic contra-angle —
AX’S Endo® for exemple).
The InGeT system includes files
and an InGeT (integrated gear tech-
nology) contra-angle, which has the
smallest head of the market. It is also
revolutionary because the driving gear
is part of the rotary file, which enormously simplifies the mechanism of
the head.
InGeT ergonomics enable an easy
access to posterior teeth and a better
visibility of the operative field. ET
ET
Corrections
Endo Tribune strives to
maintain the utmost accuracy in its news and clinical reports. If you find
a factual error or content that requires clarification, please report the
details to Managing Editor
Sierra Rendon at s.rendon@
dental-tribune.com.
Dental Tribune America makes every effort
to report clinical information and manufacturer’s product news accurately, but cannot
assume responsibility for the validity of product claims, or for typographical errors. The
publishers also do not assume responsibility
for product names or claims, or statements
made by advertisers. Opinions expressed by
authors are their own and may not reflect
those of Dental Tribune America.
Editorial Advisory Board
Frederic Barnett, DMD (Editor in Chief)
Roman Borczyk, DDS
L. Stephen Buchanan, DDS, FICD, FACD
Gary B. Carr, DDS
Prof. Dr. Arnaldo Castellucci
Joseph S. Dovgan, DDS, MS, PC
Unni Endal, DDS
Fernando Goldberg, DDS, PhD
Vladimir Gorokhovsky, PhD
Fabio G.M. Gorni, DDS
James L. Gutmann, DDS, PhD (honoris
causa), Cert Endo, FACD, FICD, FADI
William “Ben” Johnson, DDS
Kenneth Koch, DMD
Sergio Kuttler, DDS
John T. McSpadden, DDS
Richard E. Mounce, DDS, PC
John Nusstein, DDS, MS
Ove A. Peters, PD Dr. med dent., MS, FICD
David B. Rosenberg, DDS
Dr. Clifford J. Ruddle, DDS, FACD, FICD
William P. Saunders, Phd, BDS, FDS, RCS Edin
Kenneth S. Serota, DDS, MMSc
Asgeir Sigurdsson, DDS
Yoshitsugu Terauchi, DDS
John D. West, DDS, MSD
[3] =>
ENDO Tribune | November 2010
Clinical 3B
[4] =>
4B
Industry
Endo Tribune | November 2010
Ultradent offers GNYDM opportunities
Ultradent Products will present
two complimentary C.E. courses
and an opportunity to win a free
VALO dental curing light or TiLOS
Endodontic system at this year’s
Greater New York Dental Meeting.
Drs. Dan Fischer, Victor Ortiz,
Rich Tuttle and Renato Leonardo
will combine efforts in a demonstration format to present “Creating Esthetic Laminates with Direct
Composites” and “Endo-Eze TiLOS
— A Hybrid Stainless-Steel and NiTi
File System.”
Fischer and Ortiz will conduct
a live patient demonstration on
Nov. 28 in a course titled “Creating Estehtic Laminates with Direct
Composites.”
AD
In addition to diastema closure
with direct laminates, they’ll address
topics such as case selection, preoperative analysis, case planning,
stratified composite restoration,
symmetry preservation and final
polishing technique.
Attendees in this course will be
Dr. Dan Fischer, left, and Dr. Renato
Leonardo will speak at GNYDM.
(Photos/Provided by Ultradent)
entered into a drawing for a free
VALO dental curing light.
On Nov. 29, Drs. Rich Tuttle and
Renato Leonardo will lead a hands-
on demonstration in a course called
“Endo-Eze TiLOS — A Hybrid
Stainless-Steel and NiTi File System” designed for the general practitioner with a minimally invasive
practice.
In this course, they’ll cover singlevisit endodontics, mechanical intrumentation, vital and non-vital pulp
therapy and bonding techniques. A
TiLOS Endo System will be awarded
at the end of the course.
To find out more about Ultradent’s Greater New York Dental
Meeting courses, please contact the
company at (800) 552-5512 or visit
www.ultradent.com. Attendance for
either course will be on a first-come,
first-served basis. ET
How to utilize
VIBRAJECT
in endodontic
procedures
The VibraJect multiple-use dental
needle accessory is unique in that it
can be effectively utilized for endodontic irrigation by merely attaching it to
the various irrigation syringes used.
Sonic vibration is the practice of
using sound to remove foreign materials from an object. Its effectiveness
stems from the fact that all sound is the
product of vibration. When vibration
is directed toward an object, it has the
ability to dislodge materials from the
object. This procedure has been used
to clean teeth for a number of years.
Endodontic irrigation benefits from
sonic vibration. Studies have shown
that the root canal surface treated
with NaOCl and a chelating agent
such as EDTA, with sonic vibration,
loosens the coherence of the smear
layer and becomes thinner with more
opened tubule orifices. Studies have
concluded more smear layer removal
and open tubules using sonic vibration with the solutions than without
sonic vibration. Using only NaOCL has
been shown in studies to not remove
the smear layer. Removal of the smear
layer and the opening of the tubules
provide a potentially tighter adaptation
between the obturation materials and
the dentin walls of the preparation.
Sonic vibration needs a frequency
of 100-200 Hz. This is the equivalent
of 6,000-12,000 revolutions per minute. VibraJect is a device that attaches
to your current irrigation syringe and
creates a needle frequency of 180 Hz.
There are no special parts needed and
VibraJect does not require any purchase
of disposable parts, which can add an
additional $1-$2 cost to the procedure.
All-in-one vibrating syringes are
available on the market for around $800,
plus the cost of additional disposable
parts. However, VibraJect users need to
purchase nothing to achieve the advantages of sonic vibration, and VibraJect
can be purchased for about $350. ET
[5] =>
ENDO Tribune | November 2010
Clinical 5B
[6] =>
6B
Industry Clinical
f ET page 1B
right angles to that plane of motion.
Becase carbon-steel instruments
could not be used in rotation due to
the poor resistance to torsion, they
were used with the vertical push/
pull stroke, hence the horizontal
orientation of the flutes.
The problem of instrument separation was solved, but the push portion of the push/pull stroke impacted debris apically, easily blocking
the negotiation of canals that were
already curved, narrow and at times
somewhat calcified.
It actually took a major improvement in the metallurgy of endodontic instruments to undermine the
relationship of design and utilization. When stainless steel was introduced as the new-and-improved
metal from which to fabricate endAD
odontic instruments, the K-files
originally made from carbon steel
were then much more resistant to
torsional stress.
This improvement was recognized and rather than limiting the
motion to a push/pull stroke, dentists learned to use them with a
twist-and-pull that, over the years,
evolved into the watch-winding
motion we are familiar with today.
As more and more of the motion
became horizontal rather than vertical, the greater the discrepancy
between design and utilization.
A horizontal motion of an instrument with horizontal flutes (Fig.
1) allows the instrument to engage
the dentin much like a screw, but
cuts very little. To cut dentin the
instrument either had to be pulled
vertically after engaging the dentin
or used with a counterclock-wise
Endo Tribune | November 2010
stroke and apical pressure to cleave
off the dentin engaged by the clockwise stroke. In both cases extra
steps and motion are required to
cut the dentin to compensate for
the incompatibility of design and
utilization.
In cases that are already narrow, curved and at times calcified,
the greater engagement that comes
before dentin cleavage makes the
entire instrumentation procedure
that much more challenging.
The last thing that a practitioner
needs when shaping curved narrow
canals is initial greater engagement,
a stiffer instrument and one that
requires extra steps to cleave off
the dentin, with all of these factors
limiting the tactile perception that
the dentist has to what the tip of the
instrument is encountering. If we
simply go back to the concepts of
design and utilization, the problems
encountered by the present discrepancies disappear.
Watch winding is a horizontal
motion. Consequently, the instrument should be designed with vertically oriented flutes, allowing the
blades to cut dentin as soon as the
motion is initiated. In fact, every
rotary NiTi system knows this, even
as K-files are recommended. The
inconsistency in approaches makes
no clinical sense although the commercial reasons to sell more NiTi
make strong business sense.
When an instrument with vertically oriented flutes enters a canal
with a watch-winding motion, the
reamer will be more flexible, less
engaging along length and a more
efficient cutter of dentin than its
K-file counterpart. These three factors allow for less resistance as the
instrument negotiates apically.
If the tip of the instrument
encounters an impediment, the dentist will immediately be aware of it.
K-files, on the other hand, engage
too much dentin along length, preventing the dentist from making this
crucial observation. Once an impediment is recognized, the instrument
can be removed, pre-bent at the tip
(Fig. 2) and negotiated around the
impediment. You can’t do it if you
are not even aware that an obstacle
has been encountered.
The concept of matching the
design of an instrument to its function allows these instruments to
widen canals to their final shape in
the safest most efficient manner.
The cutting actions of endodontic
instruments have to be effective
in a much diversified environment
requiring flexibility and adaptability.
Anything that enhances the reduction in engagement along length,
the flexibility of the instruments
and the efficiency of cutting dentin
would be considered advancements.
That is precisely what the flat does
(Fig. 3).
When incorporated along the
length of the shank, the instrument
becomes more flexible, has a reduction in engagement and creates two
vertical columns of chisels that cut
dentin in both the clockwise and
counterclock-wise direction.
In addition, it further enhances tactile perception, improving
the dentists’ ability to differentiate
between a tight canal and a solid
wall. The asymmetric design gives
dentists the added ability to distinguish between a round and oval
canal (Fig. 4). These design features are important because that is
what the variety of canals we shape
throws at us. They represent the
challenges of negotiation.
The best way to judge a system,
in my opinion, is how effectively it
shapes a canal without extraneous
complications coming into play (Fig.
5–8).
We want to use a system that
from the perspective of the canals
we are shaping is most predictable
in producing a shape of adequate
dimensions, has minimal potential
to distort the canal and no possibility of separating during its use. We
[7] =>
Industry Clinical 7B
ENDO Tribune | November 2010
cannot rely on a system that at times
appears to be magnificent and at
other times exacerbates our problems. The same system to be correctly designed must not only produce excellent results, but must do
it consistently in all circumstances.
No one questions the fact that
curved, narrow calcified canals will
take more time to shape properly. However, at no time during the
shaping of these challenging situations should we be exposed to systems that can add to the challenges
by breaking.
The manufacturers may say these
separations result from inadequate
knowledge of their use on the part
of the dentist. I disagree. They are
the result of poor design, incorporating weaknesses that manifest themselves in separated instruments simply because the design, fabrication
material and their utilization was
not thought out enough before they
came to market.
For those interested in the techniques I advocate, you may wish
to take a free one-on-one, two- to
three-hour workshop in my office.
To set up a workshop, please call
me at (212) 582-8161 to set up an
appointment.
For those interested in an intense
two-day hands-on workshop that is
tuition-based, please call Essential
Seminars at (888) 542-6376 or visit
www.essentialseminars.org. ET
ET About the author
Dr. Barry Lee Musikant is a
member of the American Dental
Association, American Association
of Endodontists, Academy of General Dentistry, The Dental Society
of N.Y., First District Dental Society,
Academy of Oral Medicine, Alpha
Omega Dental Fraternity and the
American Society of Dental Aesthetics. He is also a fellow of the American College of Dentistry (FACD).
Musikant’s lecture schedule has
taken him to more than 250 international and domestic locations. He has
co-authored more than 300 articles
in dentistry in various international
dental journals from Argentina to
Spain, including the major journals
of the United States and Canada. As
a partner in the largest endodontic
practice in Manhattan, Musikant’s
35-plus years of practice experience
have crafted him into one of the top
authorities in endodontics.
Fig. 5
Fig. 6
Fig. 7
Figs. 5-8: Radiographs showing several cases where a
number of c-shaped canals were treated. (Photos/
Provided by Dr. Barry Lee Musikant)
Fig. 8a
Fig. 8b
AD
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