Endo Tribune U.S. No. 5, 2011
Endodontists in San Antonio / Getting the nomenclature of endodontic mechanics right / Scenes from the AAE
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ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
May 2011
Fig. 1: Photo of
a K-file. Note the
high number of
horizontally
oriented flutes.
Fig. 2: Photo of a
relieved reamer.
Note the reduced
number of
vertically
oriented flutes.
(Photos/
Provided by
Barry Musikant)
www.endo-tribune.com
Vol. 6, No. 5
Endodontists
in San Antonio
Fig. 1
For more
AAE photos,
please see
page 5C.
Fig. 2
Getting the
nomenclature
of endodontic
mechanics
right
By Barry Lee Musikant, DMD
Unless our language precisely
describes what we want to accomplish when shaping canals, we can
easily be led astray. For example,
K-files, instruments designed with
a large number of highly horizontal
flutes (Fig. 1), are typically used with
a watch-winding motion, and we correctly say that we are cutting the
dentin.
However, cutting the dentin is not
our goal. It is the removal of dentin
that is basic to shaping, and cutting
merely makes an indentation without
removal.
To drive this point home, consider
the action of shaving your face or legs.
Hair is removed because the cutting
blade is at right angles to the plane
of motion, resulting in the shaving of
the hair and its consequent removal.
If the blade were in the same plane as
the plane of motion, we would be slicing into our faces or legs. We would
be cutting, but we would not be producing removable shavings.
As long as the K-files are used with
a motion that is in the same plane as
the flutes, we will be cutting without
removal. With this knowledge, we
have a better appreciation of exactly what we want the instruments to
accomplish, namely shaving dentin
away rather than making indentations
into the dentin without any removal
of the dentin. Now obviously, K-files
g ET page 4C
The San Antonio Convention Center is the site of the American Association of Endodontists’ annual meeting from
April 13–16. (Photos/Sierra Rendon, Managing Editor)
AAE meets in Texas during city’s annual ‘Fiesta’
The American Association of
Endodontists (AAE) held its annual
session April 13 to 16 at the Henry
B. Gonzalez Convention Center in
San Antonio, Texas.
The theme of the meeting, which
offered attendees the chance to
earn up to 31 continuing education credits, was “Bridging the Gap:
Partners in Interdisciplinary Care.”
The focus of the meeting was on
collaboration among dental professionals for optimal patient care.
“The AAE emphasizes the importance of working with general dentists and other specialists to improve
patient outcomes,” said AAE President Dr. Clara M. Spatafore.
The meeting commenced with
a keynote presentation by Christopher Gardner, an acclaimed
motivational speaker and author
of the bestselling autobiography,
Attendees stream in and out of the
AAE exhibit hall in San Antonio.
“The Pursuit of Happyness.” Gardner shared the important steps to
creating a successful and fulfilling life while telling his personal
story of seemingly never-ending
obstacles and the ways he overcame them. Other special guests
included comedians John Pinette
and Kathleen Madigan, who entertained attendees the last evening of
the annual session during the President’s Dinner.
To further enhance communication and strengthen relationships
among dental practitioners, the AAE
2011 annual session included two
new events promoting networking
and the sharing of ideas and experiences.
A “Lunch-n-Learn” event and
roundtable discussions allowed
attendees the opportunity to share
professional opinions and questions
in a less structured environment.
For exposure to endodontic techniques, the AAE’s popular Master
Clinician Series showcased live surgeries by leading experts in the field.
Master clinicians included Drs. Dan
g ET page 2C
[2] =>
2C
News
Endo Tribune | May 2011
f ET page 1C
Dr. Richard Rubinstein performs a
live mandibular molar microsurgery
during an educational program at the
AAE meeting in San Antonio.
AD
B. Ang, Todd M. Geisler, James L.
Gutmann, James C. Kulild, Stephanie
L. Mullins, Richard A. Rubinstein and
Fabricio B. Teixeira. Attendees were
able to witness implant placement,
molar surgeries and a demonstration
of regenerative endodontic procedures.
The AAE also hosted its Access to
Care Project during the annual session. Through a partnership with the
San Antonio Christian Dental Clinic and Henry Schein Dental/Henry
Schein Cares, prescreened patients
received care from licensed Texas
endodontists and endodontic residents from dental schools throughout the state.
“We wanted to give our members
and all attendees an intimate look
at the best technique for performing endodontic procedures,” Spatafore said. “Participants were able to
return to their own practices with a
new appreciation for the spectrum
and efficacy of the endodontist’s
armamentarium.”
Headquartered in Chicago, the
AAE represents more than 7,200
members worldwide. The AAE was
founded in 1943 and 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.
Next year’s AAE meeting will be
held April 18–21 in Boston. ET
ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
Publisher & Chairman
Torsten R. Oemus
t.oemus@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
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
International C.E. Sales Manager
Christiane Ferret
c.ferret@dtstudyclub.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
© 2011 Dental Tribune America.
All rights reserved.
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 | April 2011
Industry Opinion & Products 3B
[4] =>
4C
Industry Opinion
f ET page 1C
remove dentin from the walls of the
canal, but it doesn’t occur until the
instrument is pulled from the tooth.
Upon the pull stroke, the blades are
finally at more or less a right angle
to the plane of motion and will now
shave the dentin from the walls of
the canal.
At best the horizontal component
of motion, otherwise known as watch
winding, accomplishes little more
than engaging and disengaging the
dentin. Not until the pull stroke is
employed is dentin shaved away.
Once one understands what is
going on, the K-files can rightfully be
looked at as incorporating inefficient
designs for what we want to accomplish. The more the flutes engage
the walls of the canal, the greater
the resistance to apical negotiation.
One of the features of horizontal
flutes is that more can be crowded
into the working length (usually 16
mm), compounding the problem of
increased resistance along length.
Added liabilities include the
increased stiffness of the instrument
as the number of flutes increase, a
function that reflects the number of
twists incorporated along the shank
of the instrument. Given the predominant watch-winding motion, the
K-file represents an instrument that
engages more, shaves dentin away
far less efficiently and is stiffer, producing poor tactile perception.
An instrument that is stiffer is
more likely to spring back to the
straight position rather than record
the curve it is negotiating through,
a fact that causes the K-file to selectively work against the outside wall
of curved canals upon the pull stroke,
leading to canal transportation in the
apical third.
Until we get our nomenclature
correct, substituting dentinal shavings for cutting, we will tend to confuse just what we want from the
instruments we use. Once we understand what we want to accomplish,
we immediately understand why
the design and utilization of K-files
defeat our goals for efficient undistorted shaping. We also understand
why reamers both unrelieved (Fig. 2)
and relieved with fewer more vertically oriented flutes fulfil our more
accurate definition of what we want
instruments to accomplish.
Unlike the K-files, the more vertically oriented flutes used with the
same watch-winding motion will
now not only cut dentin but shave it
away. Where the K-files incorporate
a design that leads to a viscous cycle
of increasing engagement and resistance along length, the reamers are
immediately and constantly removing
dentinal shavings in a virtuous cycle.
To begin with, the reamers have
significantly less engagement along
length than the K-files, but immediately upon employing a watch-winding motion the vertically oriented
blades (Fig. 3) are removing dentin.
As the instruments travel apically, the
dentin is continuously being shaved
away, compensating for the deeper
penetration.
Using more flexible instruments
that cut more effectively keeps
the instruments more centered in
the canal on the down stroke. On
the upstroke where the K-files are
designed to work against the outer
wall, the relieved reamers’ increased
flexibility combined with the vertically oriented flutes makes them poor
shavers of dentin against all the walls
of the canal and the outer walls of
curved canals in particular, reducing
the potential for canal distortion in
the apical third.
Watch-winding, whether used correctly with reamers or incorrectly
applied with K-files, has the benefit of
reducing the arc of motion to a point
where torsional stress and cyclic
fatigue are generally not issues that
lead to instrument separation.
With the incorporation of rotary
NiTi, both torsional stress and cyclic
fatigue become factors that can lead
to instrument separation. With separation directly related to greater canal
curvature, and the increasing tip size
and taper of the rotary NiTi instruments, the dentist is motivated to
limit the canal preparation to dimensions that are likely to lead to inadequate irrigation and obturation.
Another way to look at cutting and
shaving is to understand that cutting
is always a component of shaving, but
shaving is not necessarily a component of cutting unless the blades are
at right angles to the plane of motion.
With this understanding, a lot of the
confusion that surrounds the term
“cutting” is removed. What we should
get from this discussion is that cutting
is insufficient to accomplish our goals
and we should concentrate on those
techniques that emphasize shaving
that results in shaping (Figs. 4–6).
From a point of view of the larger
picture, schools would encourage the
understanding of important endodontic mechanical concepts if they adopt
language that clearly and accurately
reflects what we want to accomplish.
Teaching via indoctrination rather
than critical thinking makes for muddled imagery that can take us off into
useless tangents that result in uninformed decision-making that is ultimately bad for the dentist and his or
her patients. 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). 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.
Endo Tribune | May 2011
Fig. 3: Close-up photo of the flat on a relieved reamer.
Fig. 4a
Fig. 4b
Figs. 4–6: Radiographs
highlighting the clinically
superior results achieved when
using relieved reamers in a
reciprocating handpiece.
Fig. 5
Fig. 6
[5] =>
ENDO Tribune | May 2011
AAE Annual Meeting 5C
Photos/Sierra Rendon, Managing Editor
Scenes from the AAE
Group’s annual meeting took place April 13–16 in San Antonio
Fig. 1
Fig. 4
Fig. 2
Fig. 5
Fig. 3
Fig. 1: AAE attendees stop by the
Roydent booth.
Fig 2: Dr. James Johnsen, president
of Jordco, displays a selection of
products designed to make it easier
to perform a root canal procedure.
Fig. 3: Attendees pick up information at the Global Surgical booth.
Fig 4: Ines Aravena of Innovadontics displays the anesto device.
Fig. 5: A crowd gathers to hear
about new products at the
SybronEndo booth.
AD
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