Endo Tribune U.S. No. 1, 2012
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[1] =>
ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
Salary SurveyGRAPHIC:SalarySurvey
2/1/12
3:16 PM
Page 1
january/february 2012 — Vol. 7, No. 1
Clinical opinion
Canal anatomy:
The ultimate
directive in
instrument
design and
utilization
By Barry Musikant, DMD
It may sound so basic that one would
not even think to ask the question, but
what constitutes an endodontic education? After teaching thousands of dentists over many years, I believe the mechanical aspect of endodontic education
is a rote exercise. The students are presented with a set of instruments and told
how to use them.
In the case of K-files, they may be told
that the instrument must first engage
dentin by first rotating the instrument
clockwise for the flutes to engage the dentin, followed by a pull stroke that cleaves
off the engaged dentin. Or they may be
taught to use these instruments with a
watch-winding motion combined with
an up-and-down stroke that randomly
engages and cleaves small amounts of
dentin away.
The fact that the K-file design will also
impact debris and distort curved canals
to the outside wall are considered side
effects that will not occur once the dentist learns how to use these instruments
properly. Under any circumstances, any
negative side effects are not considered
as deficiency of design so much as the
dentists’ lack of skill. This mindset solidifies the continued use of K-files, even as
the introduction of rotary NiTi has taken
a greater and greater hold.
The course of endodontic instrument
development might take a different turn
if the choice of instrument design and
implementation were based on critical
analysis. As it is, the increased adoption
of rotary NiTi is confirmation that the
pre-existing use of K-files as the sole instruments to shape and cleanse canals is
inadequate.
What is ironic is that while the adoption
of rotary NiTi has been most dramatic,
drastically reducing the usage of K-files,
this clearly discernible trend has not led
to a re-examination of why K-files now
used a good deal less are still being used
at all. The irony is doubly compounded
by the fact that as the vulnerabilities,
namely instrument separation, of rotary
NiTi have become more pronounced, it
has led to a rebound in the increased usage of K-files to further shape the glide
” Continue on Page B2
www.dental-tribune.com
Endodontists see pay increase
By Fred Michmershuizen, Managing Editor
Do you save teeth for a living? If so,
your income is rising fast. That’s if recent
salary surveys are to be believed.
Although the U.S. labor market has not
yet recovered from the great recession,
there are some occupations in which
double-digit income growth is the norm.
Chief among them are dental specialists
— and endodontists are among those
leading the pack, with an 18 percent increase in income from 2009 to 2010,
according to survey results published
on the job search website CareerBuilder.
com. That’s far above the national average for all jobs of just 1.7 percent growth.
According to CareerBuilder, the average
endodontist earned $166,874 in 2010, up
from an average of $141,373 in 2009.
Two other dental specialties also reported 18 percent income growth: oral pathologist, with average pay of $188,577 in 2010
compared with $159,759 in 2009; and
periodontist, with average pay of $177,084
in 2010 compared with $150,023 in 2009.
Dental specialists aren’t the only ones
with big increases in pay. According to
the same survey results, pharmacologists earned $99,370 in 2010, up 10.4
percent from $90,012 in 2009; toxicologists earned $70,273 in 2010, up 10.4 percent from $63,655 in 2009; and academic
JOBS WITH THE FASTEST
GROWING SALARIES
Endodontist
Periodontist
Oral
pathologist
Pharmacologist
Toxicologist
Source: CareerBuilder.com
Academic
dean
deans earned $100,771 in 2010, up 8.2 percent from $93,126 in 2009.
Other jobs with larger than average
percentage pay raises, according to the
surveys, are as follows: dean of student
affairs, 8.2 percent; director of nursing school, 8.2 percent; experimental
psychologist, 8.19 percent; social psychologist, 8.19 percent; numerical con-
Graphic: Fred Michmershuizen, Dental Tribune
Photo: Dreamstime.com
trol programmer, 8.06 percent; general
surgeon, 8.02 percent; medical officer,
8.02 percent; neurosurgeon, 8.02 percent; orthopedic surgeon, 8.02 percent;
plastic surgeon, 8.02 percent; orthopedic
podiatrist, 7.79 percent; early childhood
development teacher, 7.71 percent; insurance salesperson, 7.37 percent; and credit
reference clerk, 6.45 percent.
New York meeting offers plenty for endodontists
By Fred Michmershuizen, Managing Editor
The 87th annual Greater New York
Dental Meeting, held in late November
at the Jacob K. Javits Convention Center,
offered plenty of valuable education for
endodontists, and there was an unparalleled selection of products and services
for endodontic professionals to explore.
The lecture rooms and exhibit hall aisles
were packed with meeting attendees
looking for new, exciting offerings.
Dr. Jeffrey Linden offered “The Pulse:
Endosequence, Bioceramics and the Redesigned Endovac,” an essay presentation. Linden updated previously introduced endosequence concepts, such as
how the cycling of instruments can lead
to greater efficiency and hydraulic condensation as part of an in-depth discussion of the introduction of bioceramics
in endodontics. He also included an update on the newly redesigned ENDOVA.
Dr. Hank Schiffman presented “The
Potentials of Non-surgical Endodontic
Retreatment,” a look into the limits and
potentials of non-surgical endodontic
retreatment through case studies and
literature.
Dr. Gary Glassman presented “Endodontic Solutions: Strategies for Endodontic Predictability and Profitability,”
” Continue on Page B4
Dr. Ralan Wong
leads a hands-on
endodontic
workshop.
Photos/Fred
Michmershuizen,
Endo Tribune
Above: Max Chu of SS White. Right: Stuart Cutler of Sybron
Endo with the company’s new DTC Digital Torque Motor.
[2] =>
Clinical Opinion
B2
Endo Tribune U.S. Edition | January/February 2012
“ From Page B1
path so the fracture-prone NiTi instruments are subject to less stress.
Increasing the reliance on K-files, a
system that demands a substitute in the
form of rotary NiTi, represents a dichotomy where neither system is workable by
itself with the weaknesses of both still
present when combined.
The result is a balancing act where each
tooth presents its own unique conditions
for an ever-changing combination of
these two shaping systems, a balancing
act that is inherently unstable and leads
to a reduced rate of successful outcomes.
The most obvious shortcomings of K-files
include the impaction of debris and the
distortion of curved canals to the outer
wall — something already attributed to
the lack of operator skill. Rotary NiTi’s
greatest shortcoming is unpredictable
separation, a problem intimately associated with the torsional stress1 and cyclic
fatigue2 generated by this form of motion and compounded in canals of increasing curvature.
The solution to this weakness is the use
of these instruments in reciprocation
rather than rotation. The form of reciprocation chosen for these instruments
is a hybrid one that still produces 200
full rotations per minute reducing, but
not eliminating cyclic fatigue3 while a
30-degree clockwise stroke compensates
for a 150-degree counter-clockwise arc of
motion, significantly reducing the torsional stress formerly generated by full
rotation.
The introduction of a hybrid reciprocating system without question leads
to less instrument separation. Yet, the
manufacturer of these systems also understood that marketing benefits would
be derived if the system were less expensive with fewer instruments being the
most direct way to reduce costs. They
evidently determined that the increased
costs for the one recommended instrument would be acceptable because the
overall cost to the dentist for the procedure would be reduced. All that was necessary for this new system to take off was
to convince the dentist that the canal
preparations done with one instrument
produce results that are adequate for predictable success.
The greater our understanding of pulpal anatomy as it is, rather than an idealistic rendition that makes for a comfortable fit between results and perception,
the better our judgment on what constitutes proper design and utilization as it
relates to the task at hand.
With this article you see several micro
CT scans generated by Drs. Versiani, Pecora and Neto that clearly demonstrate typical anatomy of various teeth. (See Figs 1-8,
images by Prof. Marco A. Versiani, DDS,
MS, PhD, courtesy of The Root Canal Anatomy Project, rootcanalanatomy.blogspot.
com).
In addition to anastomoses, divergent
branching and cul-de-sacs, the most
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 Fred Michmershuizen at
f.michmershuizen@dental-tribune.com.
ENDO TRIBUNE
Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com
Chief Operating Officer
Eric Seid e.seid@dental-tribune.com
Group Editor
Robin Goodman r.goodman@dental-tribune.com
Editor in Chief ENDO Tribune
Frederic Barnett, DMD BarnettF@einstein.edu
Fig. 1: Mandibular first molar (mesio-distal).
Fig. 2: Mandibular first molar (bucco-lingual).
Photos 1-8/provided by Barry Musikant, DMD/
Images by Prof. Marco A. Versiani, DDS, MS, PhD,
courtesy of The Root Canal Anatomy Project,
rootcanalanatomy.blogspot.com.
Managing Editor ENDO Tribune
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor Show Dailies
Kristine Colker k.colker@dental-tribune.com
Managing Editor
Sierra Rendon s.rendon@dental-tribune.com
Managing Editor
Robert Selleck r.selleck@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
List Manager
Robert Spencer database@dental-tribune.com
C.E. manager
Christiane Ferret c.ferret@dtstudyclub.com
Fig. 3: Mandibular second premolar
(mesio-distal).
Fig. 4: Mandibular second premolar
(bucco-lingual).
Dental Tribune America, LLC
116 West 23rd Street, Suite 500
New York, NY 10011
Phone (212) 244-7181
Fax (212) 244-7185
Published by Dental Tribune America
© 2012 Dental Tribune America, LLC
All rights reserved.
Dental Tribune American strives to maintain the utmost accuracy in its news and clinical reports. If you
find a factual error or content that requires clarification, please contact Managing Editor Fred Michmershuizen at f.michmershuizen@dental-tribune.com.
Fig. 5: Mandibular incisor (mesio-distal).
Fig. 6: Mandibular incisor (bucco-lingual).
Fig. 7: Maxillary second premolar (mesiodistal).
Fig. 8: Maxillary second premolar (buccolingual).
common feature of pulp tissue is its
asymmetric anatomy4 . Far from displaying a uniform conical shape, it is most often far wider in the bucco-lingual plane
than the mesio-distal. Thin sheaths of
tissue rather than well-defined canals
are often present. These anatomical
variations present challenges to K-files;
mostly because of their high level of canal engagement as they attempt to work
themselves apically. They must be used
with repetitive vertical strokes to cleanse
the bucco-linugal extensions of these tissue sheaths, a motion that increases the
chances of debris impaction blocking
further access to the apex. Transitioning to either hybrid reciprocating NiTi
or full rotary NiTi, both systems tend
to stay centered within the canal and as
many studies point out, the wider extensions of oval canals are not cleansed. If
the maximum preparation of a canal is
prepared to a 25/08, it may look adequate
in the mesio-distal dimension, but be
totally inadequate in the bucco-lingual
plane where the canal diameter is often
five to six times greater. A canal may look
very much like our ideal preconception
in one plane and totally invalidate that
perception when seen after 90 degrees of
rotation.
If the cleansing of highly asymmetric
canal anatomy is the goal that drives instrument design, then what we have at
present is too often not up to the task.
What we need are more rational designs
based on a critical analysis of the interaction between design utilization and
Dental Tribune American 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.
Opinions expressed by authors are their own and may
not reflect those of Dental Tribune America.
Editorial Board
Frederic Barnett, Editor in Chief
Dr. Roman Borczyk
Dr. L. Stephen Buchanan
Dr. Gary B. Carr
Prof. Dr. Arnaldo Castellucci
Dr. Joseph S. Dovgan
Dr. Unni Endal
Dr. Frnando Goldberg
Dr. Vladimir Gorokhovsky
Dr. Fabio G.M. Gorni
Dr. James L. Gutmann
Dr. William “Ben” Johnson
Dr. Kenneth Koch
Dr. Sergio Kuttler
Dr. John T. McSpadden
Dr. Richard E. Mounce
Dr. John Nusstein
Dr. Ove A. Peters
Dr. David B. Rosenberg
Dr. Clifford J. Ruddle
Dr. William P. Saunders
Dr. Kenneth S. Serota
Dr. Asgeir Sigurdsson
Dr. Yoshitsugu Terauchi
John D. West
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[3] =>
Endo Tribune U.S. Edition | January/February 2012
results. Let’s propose the use of relieved
reamers designed with a flat (Fig. 9) along
their entire working length used in watchwinding motion that may be generated
both manually and in a 30-degree reciprocating handpiece. All the instruments
including a thin 0.06 mm tipped reamer
have vertical flutes that when used with
a horizontal watch-winding motion will
immediately shave dentin away. The vertical pull stroke is simply employed to
carry the debris occupying the flutes to be
brought coronally and wiped away.
The vertical orientation of the flutes
tend to sweep through any debris that
may be present in the canal when the
reamers are directed apically rather than
impacting debris apically the way the
horizontal flutes on a K-file (Fig. 10) tend
to do5. With full depth far more easily attained with a relieved reamer than a Kfile, leaning the vertically oriented blades
against a broad sheath of tissue is more
likely to remove that tissue than if the
main function of the blades is to engage
and disengage until the pull stroke is employed, an action that occurs with K-files.
Unbeknownst to most dentists, NiTi
instruments are predominantly shaped
like reamers even though they are still
called files. They recognize the inherent
advantages of an instrument that shaves
dentin away rather than first embedding
into it. Yet, NiTi instruments must stay
centered lest they encounter anatomy
that may lock and bind anywhere along
length6. Locking and binding is good for
neither NiTi nor stainless steel, but where
there is a large gap between deformation
and fracture for stainless steel, NiTi has
little room between the two effectively
allowing for safe usage within very narrow margins. These narrow safety margins empirically appreciated by dentists
are major incentives for conservative
NiTi canal preparations which in light
of the real anatomy that must be instrumented can lead to inadequate shaping
and cleansing.
What I am attempting to show here
are the possible consequences that occur simply because the instruments that
have been traditionally employed are
not designed to treat the canal anatomy
as it is. It may provide pleasing results
Fig. 9 (left): Photo of a relieved reamer with a
flat side. Note the decreased number of
vertically oriented flutes. Fig. 10 (right):
Photo of a K-file. Note the increased number
of horizontal flutes. Photos 9–12/Provided by
Barry Musikant, DMD
Clinical Opinion
Figs. 11,12: These radiographs show the ability of flat-sided reamers (SafeSiders) used in a
reciprocating handpiece (Endo-Express) to shape, irrigate and clean irregular shaped canals
effectively. They were used without the fear of binding or breakage.
when viewed in the mesio-distal plane,
but micro-CT scans clearly tell us there
is far more to the story that must be
addressed. Graduating dentists will be
far more able to make sensible rational
B3
Barry Lee Musikant,
DMD, is a member of the
American Dental Association, American Association
of Endodontists, Academy
of General Dentistry, the
Dental Society of New
York, 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). As a partner in the
largest endodontic practice in Manhattan, Musikant’s
35-plus years of practice experience have established him
as one of the top authorities in endodontics. To find more
information from Dr. Musikant, please visit www.
essentialseminars.org, email info@essentialseminars.org
or call (888) 542-6376.
decisions if they are taught instrument
design as it relates to function, which in
turn will produce results that are consistent with the stated goals. That is far
better than using instruments that meet
our ideal preconception of a canal anatomy that often exists nowhere but in our
minds.
Editor’s note: References are available
upon request from the publisher.
AD
[4] =>
B4
news
Endo Tribune U.S. Edition | January/February 2012
AAE leadership supports dental advocacy
For the fourth year in a row, the American
Association of Endodontists Board of Directors became Capital Club members of the
American Dental Political Action Committee. All members of the board who attended
the American Dental Association’s 2011 Annual Session in Las Vegas made personal donations of at least $200 to the cause.
The group of 21 endodontic leaders took
a break from their interim meeting and
visited the ADPAC booth in person to
make the contributions.
ADPAC works to fund and elect congressional candidates who support dental
health and understand the importance
oral health contributes to overall wellness, regardless of party affiliation. The
group also provides educational opportunities for dentists interested in running
American Association of Endodontists
President Dr. William T. Johnson, left, stands
with Dr. Dennis J. Zent, AAE member and
co-chair of ADPAC. Photo/Provided by AAE
for public office. Individual dentists can
make a positive impact on the political
forces that affect the dental profession
by contributing to ADPAC.
“The two most important things AAE
members can do to support advocacy on
behalf of the dental profession are supporting ADPAC and participating in the
ADA’s Grassroots Action E-List, which
notifies participants when they should
contact their representatives in Washington about dental issues,” said Dr. Dennis J.
Zent, AAE member and co-chair of ADPAC.
Individuals can join the Action E-List by
visiting the ADA website. Once registered,
participants will receive alerts requesting
communication with members of Congress as dental and oral health issues arise.
The AAE stands shoulder to shoulder
with the ADA in its many advocacy initiatives in Washington, such as urging
the U.S. Department of Health and Hu-
man Services to include oral health as a
leading health indicator, and pushing for
an end to an antitrust exemption currently enjoyed by health insurers that allows them to share fee information (dentists are not exempt).
“The AAE appreciates the opportunity to
support ADPAC because it gives dentistry a
voice in Washington and also helps create
an environment where better and more accessible care is provided to patients,” said
AAE President Dr. William Johnson.
The AAE urges its members to become
involved in organized dentistry and advocacy initiatives through its Step Up!
program, whose aim is to advance endodontics through leadership and community service.
(Source: AAE)
AD
“ From Page B1
a program addressing the concepts and
skills necessary for acquiring the expertise and confidence to perform the highest quality endodontics.
Dr. Joseph D. Maggio presented “Twisted
Rotary Files: Improving Your Shape.” He
discussed following radiographic interpretation for proper case selection, access
preparation, and canal shaping. Maggio
also presented “Resilon-A Superior Seal to
Promote Periradicular Health.”
Dr. Ralan Wong presented “Understanding the Concepts of Endodontics: A
Hands-on Workshop.”
Wong
said root canal
procedures have
been easier to
manage yet have
become
more
complicated due
to the advent of
technological
advancements.
Dr. Barry L.
Musikant pre- Meeting attendees visit
sented
“Intro- the NSK booth.
duction to Endodontic Instrumentation.” He said the
reciprocating use of reamers both relieved and unrelieved helps solve problems that are often encountered and not
satisfactorily overcome with the manual
use of K-files and the subsequent use of
various rotary NiTi systems. Musikant
also presented “Advanced Endodontic
Techniques.”
On the exhibit hall floor, there were
plenty of new and exciting products and
services of interest to endodontists.
The DTC Digital Torque Motor was
introduced by SybronEndo. According
to rep Stuart Cutler, the motor features
a simplified interface that expresses
torque in actual gram centimeter units.
Easy Endo introduced ProSmart, a universal root canal obturation system. According to rep Sandy Weisz, ProSmart is
a simple, self-sealing point and paste system that uses polymers that absorb water
and expand laterally into the root canal.
New Revo-S obturation tools, available
from Micro-Mega, are designed for reliable and practical filling of the root canal. Revo-S can be used for both lateral
condensation and thermomechanical
condensation obturation techniques.
[5] =>
Endo Tribune U.S. Edition | January/February 2012
products
The Jordco System
Founded by two practicing dentists in
1979, Jordco has developed products that
help dentists deliver optimum care, simplify the delivery of care, improve staff
safety and reduce cross contamination.
Today, Jordco continues to set the standard
for utility, infection control, innovation
and innovative dental product design.
Jordco continues to refine its product
line and has recently introduced the Jordco System. The system works on the premise that Jordco products complement each
other and work in concert from diagnosis
through all phases of treatment.
Treatment products include:
• Endoring II—Hand-held Endodontic
Assistant
• EndoGel—Endodontic Lubricating Gel
• e-Ruler—Endodontic File Measuring
Instrument
• Jordco Mixing Sticks—Cement and
Composite Mixing Tools
• Pure Bond Dispensers—Bonding
Agent and Composite Dispenser
Diagnosis products include:
• e-Dx—Dual Diagnotic Instrument
Organizing and Storage products include:
• Endoring II Color Editions--Hand-held
• Endodontic Assistants
• Jordco e-Foam—Endodontic Foam
• FileCaddy—Bulk File Storage System
• Endoring Marking Tabs—Endodontic
Organizing Tool
Safety and Convenience products include:
• Pure Floss Dispenser—Sanitary Dual
Floss Dispensing System
• Pure Buff –Polishing Wheel System
During its 32-year history, Jordco has
evolved into a world-class dental products innovator and manufacturer by
embracing the latest science, production
technology and commitment to quality.
Twenty years ago, the founders assumed
all domestic and international marketing responsibility for their entire product
Roydent C Files
Roydent C-Files are made of a heat-treated
stainless steel,
creating a stiffer file that is
ideal for gaining access to
calcified canals
with challenging orifices. Its
non-cutting tip
guides the file
safely along the
canal.
Packaged
six to a box,
the files are Roydent C Files Photo/
Roydent Dental Products
designed to be
strong yet flexible, and they offer the following features:
• Pre-applied silicone stops, color-coded by length: 21 mm — white, 25 mm
— yellow.
• Heat-tempered steel for stiffness.
• Sharp edges twisted to the tip.
• Non-cutting tip follows canal curve.
For more information, contact Roydent
Dental Products, 608 Rolling Hills Drive,
Johnson City, Tenn. 37604, (800) 9927767, www.roydent.com.
line while further expanding their
research and development program.
This consolidation allowed Jordco to
open an FDA-registered assembly and
distribution center located in Beaverton, Ore. All of Jordco’s products are
developed and manufactured in the
United States. All of Jordco’s manufacturing partners are located in the United
States and all share a common dedication
to quality in every Jordco part produced.
Consolidation also allowed Jordco to establish a quality system compliant with
the international standard ISO 13485 for
medical devices. The Jordco Quality System is used to comply with biannual FDA
inspections, FDA Premarket Notification
510 (k) approvals and CE mark acceptance.
The Jordco Quality System is the driving
force behind the company’s determination to develop, manufacture, package
and distribute world-class products to
the dental profession. The Jordco team of
employees work passionately to fulfill the
goal spelled out in the Jordco quality system: Jordco’s vision is to provide the den-
B5
tal community with quality products that
will simplify the delivery of care.
In addition to major changes in the Jordco
business model, the founders also moved
forward to connect to their professional
roots with U.S. and international dental
schools. For more than 15 years, Jordco’s
Student Sample Program has supplied Endoring II samples free of charge to the vast
majority of the undergraduate and graduate endodontic programs in the United
States. The same program is also provided
to many schools in the United Kingdom,
Canada and Australia. Jordco is proud to
participate in many continuing education
events throughout the world and partners
with a number of leading clinicians who
use its products in C.E. courses.
New Jordco endodontic and dental
products are under development and will
be released to further compliment the
Jordco System. To learn more about Jordco
products, visit the company’s website and
soon to open e-Store at www.jordco.com.
AD
[6] =>
Full Page Ad:
Pharmamedia P&G
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