In Chicago - endodontists have plenty to be excited about / Americans fear losing teeth more than flu or root canal / Secrets to better - safer - easier and far less costly endodontics / Wykle Research expands its Calasept Endo line
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[1] =>
ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
March 2013 — Vol. 8, No. 3
www.dental-tribune.com
Clinical opinion
In
Chicago,
endodontists
have
Secrets to better,
safer, easier and
plenty
to
be
excited
about
far less costly
endodontics
Advancements
in bioceramic
hat is a long title, but that is pre- nanotechnology
cisely what will happen once one
understands the principles (se- are announced
crets) behind what one is trying
By Barry Musikant, DMD
T
to accomplish endodontically. So, let’s address each part of this article’s title.
Better endodontics
Better endodontics, defined as superior results, occurs because of two main
factors. The use of K-reamers both unrelieved and relieved, where relieved
means the incorporation of a flat along
the instrument’s working length rather
than the use of K-files (Fig. 1). K-reamers
are designed with fewer and more vertically oriented flutes that will simultaneously engage the dentin and immediately shave it away when a watch-winding
motion is employed.
Because of the fewer number of flutes,
there is less engagement with the canal
walls, resulting in less resistance to apical negotiation. With the dentin being
immediately shaven away with the first
clockwise motion, the instrument encounters even less resistance, further
easing the way for apical negotiation. Using relieved K-reamers, the initial apical
” See BETTER, page C2
By Fred Michmershuizen,
Managing Editor
T
he weather outside was dreary, but inside the Chicago Dental Society’s 148th Midwinter
Meeting, held in late February,
there was plenty for endodontists to
be excited about. The exhibit hall was
teeming with new technology to help
improve patient care, plus products
and services to make practices more
efficient and more profitable.
Brasseler USA held a press conference
to announce advancements in bioceramic nanotechnology for endodontic
treatment. EndoSequence BC Sealer,
introduced in 2009, is a component
of Brasseler’s complete obturation system.
Unlike conventional sealers on the
market, BC Sealer utilizes moisture
naturally present in dentinal tubules to
initiate its setting reaction. The material
does not shrink.
Dr. Allen Ali Nasseh, a practicing endo-
Dr. Allen Ali Nasseh, before his presentation on the use of bioceramics in endodontic
treatment. Photo/Fred Michmershuizen, Dental Tribune
dontist from Boston who has completed
4,000 procedures using the material,
presented results of various cases.
“The physical properties of bioceramics will allow us not only to change the
way we fill a root canal but, more importantly, how we do endodontics,” Nasseh
said.
Mike McLaughlin, national manager –
endodontics for Brasseler USA, also spoke
at the press conference, offering more information on the product.
Award for Buchanan
Dr. L. Stephen Buchanan, a popular presenter who conducted a daylong course
on “The Art of Endodontics,” was honored at the meeting with the Gordon J.
Christensen Lecturer Award.
Other speakers in Chicago included
Dr. Clifford Ruddle, who presented “Creating Endodontic Excellence,” and Dr.
Thomas Ziemiecki, who offered “Options for the Restoration of the Endodontically Treated Tooth.”
Americans fear losing teeth
more than flu or root canal
More Americans fear losing their natural teeth than getting the flu, according
to a survey conducted this year by the
American Association of Endodontists.
Despite an especially bad flu season
that taxed hospital emergency rooms
nationwide and led some cities to declare a public health emergency, more
survey respondents hoped to avoid losing a permanent tooth (74 percent) than
get the flu (73 percent).
Outdated concerns about root canal
treatment may have been an underlying factor — 70 percent of respondents
say they want to avoid getting a root canal, and 60 percent were more anxious
about root canal treatment than getting
a tooth pulled (57 percent), or receiving a
dental implant (54 percent).
During its seventh annual Root Canal
Awareness Week, March 17-23, the AAE
wants to dispel myths surrounding root
canal treatment and encourage general
dentists to involve endodontists in case
assessment and treatment planning to
save patients’ natural teeth.
“Ninety-four percent of general practitioners agree that endodontists are partners in delivering quality dental care,”
said AAE President Dr. James C. Kulild.
“By working together, general dentists
and endodontists can treat patients comfortably and save their natural teeth”
Endodontists’ enhanced training, combined with high levels of expertise, use of
cutting-edge technology and impressive
success rates are the main reasons patients
trust dental specialists, according to the
AAE survey. By partnering with endodontists, general dentists can help patients feel
less anxious while delivering the highest
quality of care. In fact, 89 percent of patients report being satisfied after root canal treatment by an endodontist.
To encourage collaboration between
general dentists and endodontists, the
AAE has several free resources available
for download. By using these tools during
Root Canal Awareness Week and throughout the year, general dentists ensure they
are developing the best treatment plans
to save natural teeth and keep patients
satisfied. Additional clinical resources are
available at www.aae.org/dentalpro.
To help promote Root Canal Awareness
Week, dentists can print an AAE poster to
share in offices and clinics. For more information, visit www.aae.org/rcaw, follow
the AAE on Twitter at @savingyourteeth
or search #rootcanal. You also can contact
If you need a root canal,
see an endodontist.
March 17 – 23, 2013
Root canals don’t cause pain—they relieve it!
In fact, modern root canals are virtually painless.
Ask your dentist about an endodontist who specializes in root canals
to put you at ease and save your natural tooth for a lifetime!
For more information about root canals and to find a root canal
specialist near you, visit www.aae.org.
This poster is one of the many resources
available for Root Canal Awareness Week.
Photo/Provided by AAE
Meredith Friedman, AAE public relations
coordinator, at mfriedman@aae.org.
(Source: AAE)
[2] =>
clinical opinion
C2
“ BETTER, Page C1
negotiation is far less restrictive, giving
the dentist the ability to reach the apex
of many more canals more quickly and
predictably.
One should use them to appreciate the
dramatic difference compared to K-files.
The way they are used is as important as
the design of the instrument in providing better endodontics. Their motion
is confined to either a tight, manual,
watch-winding motion or limited to a
30-degree arc of motion when used in a
reciprocating handpiece.
Used in either manner, the small amplitude of motion reduces both torsional
stress and cyclic fatigue to the point where
they are incapable of inducing instrument
separation, which are factors associated
with rotating NiTi that tend to make these
instruments used more conservatively.
Given the complex pulpal anatomy
that exists, more conservative preparations that limit instrumentation to conical shapes tend to leave a good deal of debris in the extensions of what are often
asymmetric, highly oval canals (Fig. 2).
Both relieved and unrelieved K-reamers,
whether used manually or in a reciprocating handpiece, can be used more aggressively and without fear of breakage
against the lateral walls of oval canals,
from the thinnest instrument onwards.
The full debridement of the canal can
be addressed as they can be used in larger
sizes and more aggressively because separation is not an issue. In short, both the design of the reamers and the way they are
used give the dentist the ability to produce
a superior result in three dimensions.
Safer endodontics
When instruments remain intact while
performing their mechanics, the process is a safer one. Instruments confined
to such a short arc of motion are highly
resistant to breakage. Keeping the instrument predictably intact is the first order
of improved safety. When the dentist
has confidence that the integrity of the
instrument is not procedurally compromised, there is no secondary compromise
in the shaping of the canals. Improved
shaping leads to superior irrigation and
obturation, which are the three components of successful endodontics. Once
one gets beyond the basics of keeping instruments intact, superior shaping, irrigation and obturation can be interpreted
as the pillars of safer endodontics.
Easier endodontics
Not for one moment do I want to imply
that endodontics is easy. Negotiating and
fully cleansing the complex anatomy of
even what appear to be simple singlerooted teeth can be challenging. Yet, we
might agree that removing instrument
separation as a risk factor removes procedural stress, and that removal makes
us breathe a little easier, which in turn
makes the procedure easier.
When breakage is no longer a factor
of concern, we are comfortable in negotiating highly curved canals in the prescribed manner, knowing that we have
eliminated the two factors that produce
instrument separation, namely, excessive torsional stress and cyclic fatigue.
Once we are no longer discouraged in
widening the canals because of the possibility of separation, we discover that irrigation is more effective and obturation
becomes much easier.
Endo Tribune U.S. Edition | March 2013
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
Fig. 1: Photograph showing a relieved reamer
(top) vs. K-File (bottom). Note the greater
number of flutes of the K-File. Photo/Barry
Musikant, DMD
Fig. 2: The anatomy in the mesial root of a
mandibular molar that is clearly not conical in
shape. It is far wider bucco-lingually than it is
mesio-distally. The green color represents the
untouched pulp tissue in the canals. Photo/
Courtesy of www.rootcanalanatomy.blogspot.com
Editor in Chief ENDO Tribune
Frederic Barnett, DMD barnettF@einstein.edu
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
Product/Account Manager
Humberto Estrada h.estrada@dental-tribune.com
Marketing director
Anna Kataoka-Wlodarczyk
a.wlodarczyk@dental-tribune.com
Fig. 3
Fig. 4
Education DIRECTOR
Christiane Ferret c.ferret@dtstudyclub.com
Tribune America, LLC
116 West 23rd Street, Suite 500
New York, NY 10011
Phone (212) 244-7181
Fax (212) 244-7185
Published by Tribune America
© 2013 Tribune America, LLC
All rights reserved.
Tribune America 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
Fig. 6
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. Opinions expressed by authors are their own
and may not reflect those of Tribune America.
Editorial Board
Fig. 7
Fig. 8
Figs. 3–8: Case examples. Photos/Barry Musikant, DMD
Even in difficult situations where an
abrupt curve may be present, the dentist
will appreciate the advantages of a reamer design that significantly improves
tactile perception of what the tip of the
instrument is encountering, giving him
the ability to distinguish between a solid
wall and a tight canal.
Unlike a tight canal, a solid wall produces no tugback, telling the dentist that
he must remove the instrument, bend it
at the tip and manually attempt to negotiate around the impediment using short
arcs of movement in conjunction with
a pecking motion. Employing this technique prevents separation even in these
types of difficult situations.
Easier endodontics is intimately bound
to safer and better endodontics. Of
course, we can denigrate the description
“easier” by coupling it to varying degrees
of insufficient canal preparation, but
that is not our goal. We are always using
the word easier in the context of producing the best result we can within the pa-
rameters of the systems we are using. By
widening the parameters for safety, in effect, we give the dentist a greater ability
to produce better and easier results.
Far less costly endodontics
The fact that rotating NiTi instruments
are vulnerable to breakage has set up conditions for the use of these instruments.
The No. 1 suggestion from the manufacturers is to limit them to a single usage.
Being expensive, these instruments will
be used by many dentists more than
once in defiance of company suggestions, while knowingly or unknowingly
accepting the liability associated with
extended use. These instruments are far
more expensive than both unrelieved
and relieved K-reamers.
Unlike rotating NiTi instruments, even
the smallest sizes of K-reamers can be
used several times as long as the canal
has not grossly distorted them, some” See BETTER, page C4
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
Dr. John D. West
Tell us what you think!
Do you have general comments or criticism
you would like to share? Is there a particular
topic you would like to see articles about in
Endo Tribune? Let us know by e-mailing
feedback@dental-tribune.com. We look
forward to hearing from you! If you would
like to make changes to your subscription
(name, address or to opt out) please send us
an e-mail at database@dental-tribune.com
and be sure to include which publication
you are referring to. Also, please note that
subscription changes can take up to 6 weeks
to process.
[3] =>
[4] =>
C4
Clinical opinion
“ BETTER, Page C2
Other points to consider
thing that happens more often to the
thinnest instruments that first enter
the canals and go to length. Rather than
separating, the worst that happens to a
K-reamer from excessive use in the manner prescribed is dullness, a feature that
must be looked at as a luxury compared
to the separation of NiTi instruments.
I have estimated the savings that occur with the adoption of the reciprocating system compared to the use of most
rotary NiTi systems to be in the range of
90 percent. One should understand that
40 years ago, endodontics was the envy
of the dental profession because it was
considered the least expensive specialty.
Today, due to the introduction of a whole
array of rotating NiTi systems and the
adoption of complex thermoplastic techniques, endodontics is the most expensive of dental specialties.
We have covered the essentials in describing the benefits that derive from
incorporating K-reamers — both unrelieved through a 10 and relieved thereafter — used both manually and enginedriven, and confined to short amplitudes
of motion that result in better, safer, easier and far less expensive endodontics.
From the past four years of research,
we now know that rotating NiTi instruments have great potential to induce
micro-fractures1–4 that can then propagate under the additional forces of obturation, post placement and normal
function, leading to a higher incidence of
vertical fracture. We know that the manufacturers are presently marketing single-instrument, reciprocating shaping
systems that have clearly been shown to
inadequately debride canals.
They are doing this to make things easier, safer and less expensive for the dentist.
Unlike, the K-reamer system, NiTi systems
will not produce a better result, something that should be at the heart of any
new system. Safer, easier and less expensive systems that are less expensive than
other NiTi systems mean little if they are
not compatible with better results.
One should always keep in mind that
when we take an X-ray of our results, we
are only seeing what we have added, the
radiopaque material. What we don’t see
is the non-radiopaque material we have
left behind. The fact that we have created
and filled a conically shaped space may
have little bearing on the actual degree
of debridement that took place.
The best time to address the myriad
of thin isthmuses that may be present is
with the thinnest instruments designed
to engage the least while shaving dentin
away most efficiently. The crown-down
techniques used with rotating NiTi instruments emphasize centered prepara-
Wykle Research expands
its Calasept Endo line
W
ykle Research has announced the release of two
new Calasept Endo products, which it distributes for
Nordiska Dental of Sweden, the manufacturer of Calasept and Calasept Plus.
Calasept Irrigation Needles are highquality, double-side-vented, luer-lock irrigation needles that optimize the cleansing of canals, creating a “swirl effect.”
The needles are available in 27 g or 31 g,
in packs of 40 needles.
Features include the following:
• Bendability
• Luer-lock hub
• Sterile and disposable
• Designed for ease in cleaning roots
• High-quality stainless steel
Fig. 1: Calasept Irrigation Needles Photos/Provided by Wykle Research
Calasept Irrigation Syringes are 3 ml
luer-lock, single-use syringes. They are
color coded to eliminate risk when using multiple irrigation liquids. They are
available in packs of 20 syringes, 10 white
and 10 green.
Features include the following:
• High-quality, three-part syringe
• Color coded
• Luer lock
These new products complement
Wykle’s popular Calasept line, which
includes Calasept and Calasept Plus calcium hydroxide paste for temporary
filling of root canals, sold in packages of
four syringes with 20 needles. Calasept
EDTA is 17 percent EDTA solution. Calasept CHX is 2 percent chlorhexidine solution for irrigation. Both solutions are
packaged with a luer adaptor for easy
filling of syringes.
Wykle Research is committed to producing the highest quality dental products available and to providing superior
service to dental practitioners worldwide in order that they may improve
the oral health of people everywhere
and, in so doing, to maintain a healthy
Endo Tribune U.S. Edition | Month 2013
Barry Lee Musikant,
DMD, FICD, 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). He is 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
Musikant, visit www.essentialseminars.org, email
info@essentialseminars. org or call (888) 542-6376.
tions, where deviation from the center
is fraught with the possibility of instrument separation. Used most cautiously,
these instruments are not designed to
explore the many off-centered tissue
inclusion (nooks and crannies) that may
exist along the length of the canal.
It has taken me many years to appreciate the simplicity that is necessary to produce superior results. We have been fed a
continuous amount of dogma on the benefits of so many vulnerable rotating NiTi
systems that it appears our only decision
is to decide which NiTi system to use. Yet,
for me at least, it is the exclusion of this
entire avenue of endodontic shaping that
has given our practice the ability to tackle
all our cases with the freedom that comes
from knowing separation is not an issue,
and from that basic understanding all the
other benefits follow in its wake.
Figures 3 through 8 are examples of several of the more complex cases we have
shaped using relieved and unrelieved
K-reamers both manually and in the
30-degree reciprocating system. We are
cleansing these canals to a greater extent
because the imposition of breakage does
not apply. We are purposely working all
the walls of highly oval canals because
centering is not a requirement for safe usage. Greater preparation of canals assures
superior irrigation and its activation by
using the 30-degree reciprocating handpiece as a sonic source of energy accomplishing two tasks at the same time.
As time goes on, this relatively simple
message is gaining momentum and is
open to anyone who is willing to go off
the beaten path of marketing that the big
companies do so well.
References
1.
2.
Fig. 2: Calasept Irrigation Syringes
and prosperous environment for its
employees and the community.
Wykle Research distributes Calasept
Endo products by Nordiska Dental, a
Swedish manufacturer of dental supplies. Wykle Research and Nordiska Den-
3.
tal will continue to provide new endo
products.
For more information, contact Wykle
Research at (800) 859-6641 or visit the
company online at www.wykleresearch.
com.
4.
Yoldas O, et al. Dentinal Microcrack Formation during Root Canal Preparations
by Different NiTi Rotary Instruments
and the Self-Adjusting File. J Endodont
2012;38(2):232–235.
Kim Hyeon-Cheol, et al. Potential Relationship between Design of Nickel-Titanium
Rotary Instruments and Vertical Root Fracture. J Endodont 2010;36(7):1195–1199
Carlos Alexandre Souza Bier, et al. The Ability of Different Nickel-Titanium Rotary Instruments To Induce Dentinal Damage
During Canal Preparation. J Endodont
2009;35(2):236–238.
Shemesh H, Bier CA, Wu MK, Tanomaru-Filho
M, Wesselink PR. The effects of canal preparation and filling on the incidence of dentinal
defects. Int Endod J. 2009;42(3):20813.
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[title] => In Chicago - endodontists have plenty to be excited about
[page] => 01
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[title] => Americans fear losing teeth more than flu or root canal
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[toc_titles] => In Chicago - endodontists have plenty to be excited about
/ Americans fear losing teeth more than flu or root canal
/ Secrets to better - safer - easier and far less costly endodontics
/ Wykle Research expands its Calasept Endo line
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