Cover / Editorial / Content / Pulp necrosis in the left upper incisor as a consequence of neurovascular pedicle compression / The endo-restorative connection: The right material for the right situation / Interview: ‘A time of unprecedented change in our profession’ / Endodontists from around the world to meet in Seattle - May 6-9 - for AAE15 / Industry / There is a better way (and LVI can show you how to get there) / Submissions / Imprint
Cover
01 - 01 viewEditorial
03 - 03 viewContent
04 - 04 viewPulp necrosis in the left upper incisor as a consequence of neurovascular pedicle compression
06 - 09 viewThe endo-restorative connection: The right material for the right situation
10 - 12 viewInterview: ‘A time of unprecedented change in our profession’
14 - 17 viewEndodontists from around the world to meet in Seattle - May 6-9 - for AAE15
18 - 18 viewIndustry
20 - 22 viewThere is a better way (and LVI can show you how to get there)
24 - 24 viewSubmissions
25 - 25 viewImprint
26 - 26 viewArray
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[1] =>
roots
issn 2161-6558
the international C.E. magazine of
1
2015
_C.E. article
Pulp necrosis in the left
upper incisor
_technique
The endo-restorative
connection
_interview
Dr. Robert S. Roda:
‘A time of unprecedented
change’
International Edition • Vol. 6 • Issue 1/2015
endodontics
[2] =>
[3] =>
editorial _ roots
I
Saving teeth is a
worthy endeavor
Fred Weinstein, DMD, MRCD(C),
FICD, FACD
Endodontists are heroes. We save teeth — which is worth every effort, if you ask me. But to stay on top
of your game, you have to stay up to date on the latest technology and treatment options. In this issue of
roots, you can find many articles designed to enhance your knowledge.
Dr. Javier Martínez Osorio and Dr. Sebastiana Arroyo Bote offer a case report on a 17-year-old patient
who came into their clinic because she noticed a color change of the upper-left central incisor. A pulp
necrosis of the 2.1 incisor was diagnosed and treated. Dr. Jason H. Goodchild reports on the materials he
finds most useful in restoring endodontically treated teeth. In an interview, Dr. Robert S. Roda, president
of the American Association of Endodontists, discusses his background, those who influenced him most
in his career, his passion for diagnosing and treating patients and the latest initiatives of the AAE. We also
offer a preview of the AAE’s upcoming annual meeting, to be held this May in Seattle.
There’s even more.
By reading the article by Dr. Osorio and Dr. Bote in this issue of roots, and then taking a short online
quiz about their article at www.DTStudyClub.com, you will gain one ADA CERP-certified C.E. credit. Keep
in mind that because roots is a quarterly magazine, you can actually chisel four C.E. credits per year out of
your already busy life without any lost revenue and time away from your practice.
To learn more about how you can take advantage of this C.E. opportunity, visit www.DTStudyClub.
com. You need only register at the Dental Tribune Study Club website to access these C.E. materials free of
charge. You may take the C.E. quiz after registering on the DT Study Club website.
I know that taking time away from your practice to pursue C.E. credits is costly, and that is another
reason roots is such a valuable publication. I hope you will enjoy this issue and that you will take advantage
of the C.E. opportunity.
For those of you attending the upcoming AAE meeting this spring in Seattle, be sure to say hello to
me in person. I’ll also be at the Midwinter Meeting in Chicago and at CDA Presents the Art and Science of
Dentistry in Anaheim, Calif.
As always, I welcome your comments and feedback.
Sincerely,
Fred Weinstein, DMD, MRCD(C), FICD, FACD
Editor in Chief
roots
1
I 03
_ 2015
[4] =>
I content_ roots
page 10
page 06
I C.E. article
I industry education
06
24 There is a better way (and LVI can show you
how to get there)
ulp necrosis in the upper left incisor as a
P
consequence of neurovascular pedicile
compression
_Dr. Javier Martínez Osorio and Dr. Sebastiana Arroyo
Bote
I technique
10
The endo-restorative connection: The right
material for the right situation
page 14
_Mark Duncan, DDS, FAGD, LVIF, DICOI, FICCMO
I about the publisher
25
_submissions
26
_imprint
_Jason H. Goodchild, DMD
I interview
14 Dr. Robert S. Roda: ‘A time of unprecedented
change in our profession’
_Fred Michmershuizen, Managing Editor
I meetings
18 Endodontists from around the world to meet in
Seattle, May 6-9, for AAE15
1
endodontics
2015
_C.E. article
Pulp necrosis in the left
upper incisor
_technique
_interview
Dr. Robert S. Roda: ‘A time
of unprecedented change’
20
Wykle Research offers Calasept Endo line
22
Planmeca’s endodontic imaging mode
page 18
1_ 2015
the international C.E. magazine of
The endo-restorative
connection
I industry
04 I roots
roots
International Edition • Vol. 6 • Issue 1/2015
issn 2161-6558
I on the cover
Photograph provided by Dr. Craig Barrington.
page 20
page 22
[5] =>
[6] =>
I C.E. article_ pulp necrosis
Pulp necrosis in the left upper
incisor as a consequence
of neurovascular pedicle
compression
Authors_Dr. Javier Martínez Osorio and Dr. Sebastiana Arroyo Bote
_c.e. credit
_Abstract
This article qualifies for C.E.
credit. To take the C.E. quiz, log
on to www.dtstudyclub.com.
Click on ‘C.E. articles’ and
search for this edition (Roots
C.E. Magazine — 1/2015). If
you are not registered with the
site, you will be asked to do so
before taking the quiz. You may
also access the quiz by using
the QR code below.
We report a case of a 17-year-old patient who
came into the clinic because she noticed a color
change of the upper-left central incisor (2.1) of 48
hours’ duration. During clinical inspection, the 2.1
incisor presented a darker color than the rest of the
teeth. After performing a complete exploration and
obtaining no response to vitality tests, a pulp necrosis
of the 2.1 incisor was diagnosed.
Differential diagnosis begins with the completion of the medical record. The patient had received
orthodontic treatment, and she had been operated to
extract a supernumerary tooth in the anterior region
of the upper maxilla. The patient does not remember
having suffered injuries or trauma in the incisal region. An oral orthopantomography is requested, in
which a high-density area is observed at periapical
level in the 2.1 area.
A three-dimensional CAT (computed axial tom-
(Photos/Provided by
Dr. Javier Martínez Osorio and
Dr. Sebastiana Arroyo Bote)
06 I roots
1_ 2015
Fig. 1
ography) is requested, which shows the presence of
a supernumerary in the periapical 2.1 region, located
in palatine and upward oriented. Necrosis by compression of the neurovascular pedicle of 2.1 due to
the eruption-follicule growth of the supernumerary
is diagnosed. Pulpectomy and surgical removal of
the supernumerary are performed. During surgical
removal of the supernumerary, the 2.1 neurovascular
pedicle is located edematizod-congestive and cause
of the 2.1 pulp necrosis.
_Clinical case
A 17-year-old patient who had undergone orthodontic treatment four years before came into
the clinic because she noticed a color change in her
upper right central incisor lasting a few hours. The
patient noted a pink color (Fig. 1) with a slight pain
that ceased with anti-inflammatory (AINE). In an
initial visit to her general dentist, vitality tests were
Fig. 2
[7] =>
C.E. article_ pulp necrosis
Fig. 3
performed, detecting a slight response. After that, the
patient was referred to a specialist.
When she visited the endodontist, the tooth had
changed color and had darkened over to a graybrown color. In addition to that, the tooth did not
respond to pulp vitality tests anymore. During the
visit, the endodontist performed periapical radiographs of the area (Fig. 2). The existence of a supernumerary at the apical level of the incisive growing
toward the floor of the nasal cavity was confirmed.
The endodontist requested a cone-bean computed
tomography (CBCT), to study the position and assess
the possibility of surgical extraction.
CBCT images show the position of the supernumerary relative to the roots of neighboring teeth,
confirming growth toward the apical region of 2.1, i.e.
180 degrees relative to the orientation, it should have
Fig. 4
I
Fig. 5
to erupt within the dental arch. 3-D reconstruction
shows this phenomenon very didactically (Figs. 3–6).
Endodontic treatment of 2.1 was performed,
removing the congested pulp and observing some
bleeding during the course of it. The length of the
shutter-percha obturation was deliberately longer
than usually in order to facilitate surgery (Figs. 7–9).
Surgical treatment was planned based on a
semilunar flap on the periapical region of 2.1 and a
minimum root resection without bezel, using a 0.23
round bur, with a straight handpiece, of about 2 mm
approx, exposing the supernumerary’s crown. The
supernumerary’s crown was sectioned by the middle third coronary level, incisal portion was removed
(Fig. 11). A hole was made in what would be the middle and cervical third of supernumerary, to force up
(Fig. 12) and make the extraction through the oste-
Fig. 6
Fig. 7
Fig. 8
Fig. 9
roots
1
I 07
_ 2015
[8] =>
I C.E. article_ pulp necrosis
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
otomy practiced for apicoectomy, thereby achieving
a complete extraction (Fig. 13) with minimal trauma
to the bone and roots of the incisors.
The edematous pedicle that was compressed
by the follicle eruption of the supernumerary, and
caused a lack of blood supply to the pulp left central
incisor, can be observed in the image, pressed by a
hemostat (Fig. 14).
Afterward, a preparation a retro was performed
using a Satelec Ultrasonic system and a proper insert.
Conduit was sealed a retro with SuperEBA, thereby
achieving sealing of the conduit at apical level (Figs.
15, 16). The flap was closed with three silk sutures (Fig.
17), which were removed after seven days.
Supernumerary tooth after extraction can be
observed in the picture (Fig. 18).
Two months after the intervention, an internal
bleaching treatment was performed to improve the
color of the incisor.
In the last two pictures, we can observe the clinical
appearance (Fig. 19) and the radiographic progression (Fig. 20) after three years of evolution.
Fig. 17
Fig. 16
08 I roots
1_ 2015
Fig. 18
[9] =>
C.E. article_ pulp necrosis
Fig. 19
_Discussion
Diagnostic and anatomical data provided by CBCT
studies, which has been widely used in endodontic
diagnostics including fractures and fissures or in
implant studies, is not commonly used in surgical
planning yet. The relevant and detailed information
that this imaging technique provides, especially
about the position of supernumerary tooth, is further
proof that it should be present in the protocol of the
case during the surgical planning.
The second point of discussion is the pathway
used to approach the supernumerary. We could have
used a palatal pathway, but the CBCT study revealed
that the vestibular pathway was less risky, provided
greater visibility and better respected the important
anatomical structures, such as neighboring teeth,
without injuring them by accident or increasing the
risk of causing an iatrogenic injury.
Another important point to be observed is the
pathophysiological mechanism that resulted in pulp
necrosis. We suspected an apical or periapical resorption of 2.1 because of the expansive growth of the
erupting follicle and secondary osteolysis, which cannot be excluded. To eliminate the greatest amount of
cells involved in the resorptive-destructive process, an
apicoectomy was performed. Nevertheless, pulp congestion suggests that the most probable pathophysiological mechanism involved was venous stasis of the
venous pack that enters the incisor, just before apex.
Last point of discussion is when these supernumerary teeth should be removed. If possible, the best
moment for removal is before showing any pathology
signs, always individualizing each patient, performing a
clinical and radiographic follow-up of the case in order
to choose the right time is necessary.
_Conclusion
The presence of supernumerary teeth in the permanent dentition has a frequency of between 0.1
Fig. 20
and 3.8 percent, one of the possible complications
being necrosis of adjacent teeth, so we must take
into account the possibility of supernumerary teeth
existence during diagnosis, especially in patients
with pulp necrosis without previous traumatic dental
pathology._
_about the authors
roots
Javier Martínez Osorio graduated in medicine in 1981
from Barcelona University.
He specialized in dentistry
in 1983 and plastic surgery
in 1987. He is a member
of the Spanish Society of
Implantology, Endodontic,
Conservative Odontology
and Maxillofacial Surgery.
He is associate professor of
conservative dentistry and
endodontic, faculty of odontology at Barcelona University
since 1996. He maintains a private practice in implants and
endodontic surgery in Barcelona, Spain. He is an author
of publications and lectures around the world on current
concepts in endodontic surgery and implantology. He is
president of the Catalonia Society of Odontology. He may be
contacted at 16486jmo@comb.cat.
Sebastiana Arroyo Bote
graduated in medicine in
1983 from Barcelona University. She specialized in
dentistry in 1985. She is
a member of the Spanish
Society of Endodontology
and Conservative Dentistry.
She is associate professor of
conservative dentistry and
endodontology, Barcelona
University, since 1992. She
maintains a private practice in conservative dentistry and
endodontic treatment in Barcelona, Spain. She is an author
of publications and lectures on current concepts in endodontology and esthetic conservative dentistry. She may be
contacted at 20506sab@comb.cat.
roots
1
I 09
_ 2015
[10] =>
I technique_ restoration
The endo-restorative
connection: The right
material for the right
situation
Author_ Jason H. Goodchild, DMD
Fig. 1_Clinical presentation of tooth
No.4 after root-canal therapy
has been completed. Note that
three walls of dentine remain,
minimizing the need for a dowel or
post. (Photos/Provided by
Jason H. Goodchild, DMD)
Fig. 2_Tooth No.4 isolated with
Palodent Plus sectional matrix.
Fig. 3_Placement of SDR into the
isolated preparation of tooth No. 4.
Fig. 4_After placement and
20-second curing of SDR.
Fig. 1
_Successful restoration of the endodontically
treated tooth continues to be one of the most
challenging procedures in dentistry. This is largely
because of the complexity of the process, a myriad of
available treatment options and a confusing array of
dental literature dealing with individual components
of this multifaceted treatment equation.1
Long-term retention of an endodontically treated
tooth is dependent on the collective success of the
tooth canal filling and coronal restoration. Put simply, if the root canal filling or the coronal restoration
is inadequate, either is equally contributive to an
unsuccessful outcome.2 Therefore, the first step in
developing an appropriate treatment plan for a tooth
requiring root canal therapy is to determine if the
tooth will be restorable. Factors that may influence
this determination include: the amount of remaining
Fig. 2
10 I roots
1_ 2015
Fig. 3
coronal tooth structure after caries excavation and
the ability to develop a 1.5- to 2-mm circumferential
ferrule, periodontal health, occlusion, crown-to-root
ratio, tooth location, number of adjacent teeth, requirement to use the tooth as an abutment for a fixed
partial denture or removable partial denture and the
presence of para-functional habits.3
If the tooth has been judged restorable and has
received adequate root canal therapy, the next
treatment-planning decision involves the need for
a post and core, or just a crown build-up. A post or
dowel has been historically placed to retain the foundational core and to add retention of the crown that
would have normally been gained from coronal tooth
structure.4 Determining factors at this stage include
evaluating the height and thickness of remaining
dentin after tooth preparation, the number of dentin
Fig. 4
[11] =>
[12] =>
I technique_ restoration
Fig. 5
Fig. 6
Fig. 5_The final crown build-up on
tooth No. 4. Because a full coverage
restoration was planned for a
subsequent appointement, the crown
build-up was completed with a 2-mm
layer of hybrid composite,
to cap SDR.
Fig. 6_The final radiograph of tooth
No.4, showing the completed root
canal filling and composite core.
Note the excellent adaptation and
radiopacity of SDR.
walls remaining and the final occlusal scheme.5 In
clinical situations where there is little dentin remaining (less than 4 mm of the coronal tooth structure,
but at least 2 mm dentin ferrule), the use of a post
is indicated (e.g., DENTSPLY® Core and Post System
including X.Post™).
With two or more walls remaining, or greater than
one half of the coronal tooth structure remaining, the
dentist may choose to forgo a post and simply use
composite to place a crown build-up. In selecting the
material best suited for a build-up material, dentists
must consider the size and geometry of the preparation, as well as access to enable light transmission. In
areas where light transmission is difficult or impossible, a dual or self-cure composite (like core.X™ flow)
is indicated. However, in areas where the tooth can
be isolated with a sectional or circumferential matrix
and it can be accessed with a curing light, SDR® is an
excellent material choice because of its cavity adaptation and bulk-filling properties.
Because SDR can be placed in 4-mm increments,
large cavity forms can be restored in fewer procedural steps. In areas where the core build-up will
be placed into function, SDR should be capped with
a 2-mm layer of hybrid composite (like Ceram.X®).
Also, because of its self-leveling handling and high
radiopacity, SDR can make the process easier not
only during placement but also when evaluating the
restoration on postoperative radiographs.
In most cases, the last step in restoring the endodontically treated tooth involves the decision to
place an indirect restoration to achieve cuspal or full
coverage. In general, cuspal or full coverage is recommended to prevent fracture and increase long-term
survival.6,7
Learn more about how SDR can help simplify
composite placement at www.dentsply.eu._
_References
1.
12 I roots
1_ 2015
Atlas AM, Raman P. Restoration of the endontically treated
tooth. Caulk Clinical Dentistry 2013;1(1):20-36.
2.
3.
4.
5.
6.
7.
Gillen BM, Looney SW, Gu LS, et al. Impact of the quality
of coronal restoration versus quality of root canal fillings
on success of root canal treatment: a systematic review and
meta-analysis. J Endod 2011;37:895-902.
Morgano SM, Brackett SE. Foundation restorations in fixed
prosthodontics: current knowledge and future needs. J
Prosthet Dent 1999; 82:643-657.
Schillingburg HT. Preparations for Extensively Damaged
Teeth. In: The Fundamentals of Fixed Prosthodontics. 1997.
3rd Ed. Quintessence Publishing Co. Carol Stream, IL. p.
194.
Bandlish RB, McDonald AV, Setchell DJ. Assessment of the
amount of remaining dentine in root-treated teeth. J Dent
2006;34:699-708.
Tang W, Wu W. Smales RJ. Identifying and reducing the
risks for potential fractures in endodontically treated teeth. J
Endod 2010;36:609-617.
Aquilino SA, Caplan DJ. Relationship between crown
placement and the survival of endodontically treated teeth. J
Prosthet Dent 2002;256-263.
Source: Caulk newsletter, Issue 17, August 2014.
_about the author
roots
Jason H. Goodchild, DMD,
is a graduate of Dickinson
College in Carlisle, Pa. He
received his dental training
at the University of Pennsylvania School of Dental
Medicine, where he still
holds a faculty position as a
clinical associate professor
in the Department of Oral
Medicine. Goodchild is a research dentist at DENTSPLY
Caulk, involved in educating dentists on new materials and
techniques to improve clinical practice. He has published
numerous articles and lectures internationally on the topics
of treatment planning, restorative dentistry, pharmacology,
emergency medicine in dentistry, enteral sedation dentistry
and dental photography.
[13] =>
[14] =>
I interview_ Robert S. Roda, DDS, MS
Interview: ‘A time of
unprecedented change
in our profession’
Author_Fred Michmershuizen, Managing Editor
_Robert S. Roda, DDS, MS, president of the American Association of Endodontists (AAE), runs a private
endodontic practice in Scottsdale, Ariz., and serves as
a visiting lecturer at the Arizona School of Dentistry
and Oral Health and as an adjunct assistant professor
at Baylor College of Dentistry in Dallas.
In an interview, he discusses his background,
those who influenced him most in his career, his
passion for diagnosing and treating patients and the
latest initiatives of the AAE.
Please introduce yourself to our readers. What is
your background, and where do you work?
I graduated from university and dental school
at Dalhousie University in Halifax, Nova Scotia,
Robert S. Roda, DDS, MS (Photos/
Provided by AAE)
14 I roots
1_ 2015
and worked there for 10 years as a general dentist.
I returned to do my endodontic residency at Baylor
College of Dentistry in Dallas, where I received my MS,
and began private endodontic practice in Scottsdale,
Ariz. I became very active in the Arizona Dental Association, the American Dental Association and the
AAE. I went through the board process and became
a diplomate of the American Board of Endodontics
in 1998.
I have lectured extensively, published in dental
journals and am the mentor for the East Coast Endodontic Study Club in Nova Scotia. I have always
wanted to give back to my profession and the patients we serve, so for me it is not work but a very
enjoyable part of my career.
The AAE recently launched a new Root Canal
Safety website. How do you work to educate the public and the profession about endodontics?
False claims that root canals cause cancer or other
diseases are circulating on the Internet, and the AAE
offers tools to help endodontists and other dental
professionals talk to patients who may have read this
misinformation and have questions. It’s important
that we provide authoritative and reliable information about the safety of endodontic treatment, while
debunking myths that root canal treatment causes
health problems. Resources are available at www.
aae.org/rootcanalsafety.
We also provide patient education, information
and clinical resources to support saving the natural
tooth. We recently released new treatment videos
that help patients understand endodontic procedures and hopefully steer them to an endodontist for
treatment. You can view them at the AAE’s YouTube
channel, www.youtube.com/rootcanalspecialists.
[15] =>
[16] =>
I interview_ Robert S. Roda, DDS, MS
I look for? What tests do I need? Over the years, by a
combination of formal education and close observation of patients, I have developed a skill set that helps
me to diagnose a patient’s problem. This is the skill set
of the endodontist.
We are the diagnosticians of the teeth and surrounding structures, and — along with performing
root canal therapy at the highest level (which I also
enjoy doing) — this is the cornerstone of our type of
practice.
Who influenced you most in your career?
I studied at Baylor under three of the four people
who had the greatest influence on my endodontic
career. From Dr. Jack Harrison, I learned to be a critical thinker. From Dr. Jerry Glickman, I learned how to
get things done efficiently and well. Finally, from Dr.
Jim Gutmann, I learned the value of putting all of the
information (and there were volumes of it) together,
adding what’s new, and applying it to unique situations in patient care.
The fourth person who had a large influence on
my career was Dr. Jim Kramer, who was the first
endodontist to graduate from Baylor’s program and
the first endodontist I worked with. His combination
of hard work, caring about others and knowledge on
how to run a patient-centered practice has left me
with enduring attitudes and philosophies that I pass
on to any who will listen. He knew, as I did, that if all
of your clinical decision-making was about what is
best for the patient, that everything else would fall
into place.
Root Canal Awareness Week is one
of the many initiatives of the AAE.
The poster for this year’s campaign
says, ‘Root canals don’t cause
pain — they relieve it.’
The AAE website, www.aae.org, also has valuable
clinical information to help educate practitioners
in areas like case assessment, treatment planning,
traumatic dental injuries and other issues that impact patient care.
What else is new at the AAE?
One of our newer programs is the Cracked Tooth
Initiative. Cracked teeth are becoming a modern epidemic that is robbing people of otherwise perfectly
good teeth. So little is truly known about it that we
are left with few options to help retain the tooth. Our
initiative will facilitate the opening of new venues
of research, with the long-term goal of eliminating
cracked teeth as a cause of tooth loss.
On a personal note, what do you like best about the
specialty of endodontics?
I have always been intrigued by diagnosis. It’s like
a complex puzzle, but it is real time, it’s important and
this patient’s health depends on my efforts. What is
this patient feeling? What is causing it? What should
16 I roots
1_ 2015
Is there something that people might be surprised
to know about you?
I grew up all over the world. My father worked for
Trans World Airlines, and I was born in Paris, bounced
around the United States through junior high, went
to high school in Germany at the Frankfurt International School, and attended university and dental
school in Canada. I’m a third culture kid, and I am
as comfortable in a restaurant in a foreign country
where no one speaks English as I am in a fast-food
joint in Chicago.
With all of this travel, I learned to never make
snap judgments about people. Everyone has a different point of view based on different cultural,
religious and historical experiences, but deep down
inside, we all have similar basic needs. I’ve learned
to try to understand what is below the sometimesstrange surface of people to see what it is they are
made of. Some of my most long-term friendships
started that way.
Do you have anything you would like to add?
It is a time of unprecedented change in our
profession. Economic, demographic and political
[17] =>
interview_ Robert S. Roda, DDS, MS
I
‘It gives me a great sense of encouragement to see that my
association is so engaged in all the facets of my specialty.
Coupled with the work of the ADA and its tripartite system,
the AAE gives us the tools and information and action to
help us help ourselves navigate these stormy waters.’
forces are colliding to reshape the practice environment for America’s dentists. Dental spending
by patients is flat. Alternative methods to clinical
delivery are consuming a growing part of the
dental market share each year. Reimbursements
from third-party payers are expected to continue to decline. And students are leaving dental
schools with extremely large debts. Managing
these changes by ourselves would be impossible,
but we don’t have to face this alone, because the
AAE offers help and resources that span a wide
spectrum.
It gives me a great sense of encouragement to see
that my association is so engaged in all the facets
of my specialty. Coupled with the work of the ADA
and its tripartite system, the AAE gives us the tools
and information and action to help us help ourselves
navigate these stormy waters.
Understanding change in the environment, embracing change in our membership and creating
change in how we do things are among the hallmarks
of a successful organization, and the AAE is a successful organization.
I am honored to serve as its president._
AD
roots
1
_ 2015
I 17
[18] =>
I meetings_ AAE15
Endodontists from around
the world to meet in Seattle,
May 6-9, for AAE15
Author_AAE Staff
_Registration is now open for AAE15, the annual
meeting of the American Association of Endodontists, taking place May 6 to 9 at the Washington
State Convention Center in Seattle. The AAE’s annual
meeting is billed by the association as “the most comprehensive endodontic education summit, vendor
exhibition and networking opportunity in the world.”
“AAE15 will provide our members and guests
with outstanding education, entertainment and
Seattle will host the annual meeting
of the American Association of
Endodontists, taking place May 6
to 9. (Photo/Provided by
www.freeimages.com)
18 I roots
1_ 2015
networking events,” said AAE President Dr. Robert S.
Roda. “Our program will focus on future trends and
growth to help practitioners prepare for the next
generation of advancements in the art and science
of endodontics.”
AAE15 offers more than 100 high-quality educational sessions in a variety of tracks, including “Future
Directions on Nonsurgical Root Canal Treatment,”
“Surgical Endodontics — What Lies Ahead” and
“Where Will Biology and Technology Take Endodontics?” Attendees also can register for hands-on workshops featuring leading experts in microsuturing,
cone-beam computed technology and resorption.
In addition, AAE15 includes the largest endodontic exhibit hall in the world, with nearly 100 vendors
offering the latest in endodontic equipment, materials and supplies.
Consistent with the meeting’s future-looking
theme, the keynote speaker for AAE15 is Dr. Michio
Kaku, best-selling author of “The Future of the Mind,”
who will share his vision for the future of science and
technology during the general session.
Other special events include the President’s
Breakfast; the Louis I. Grossman Ceremony, recognizing the newest diplomates of the American Board
of Endodontics; and the Edgar D. Coolidge Luncheon,
honoring the AAE’s 2015 award winners.
To view the entire meeting schedule and register, visit www.aae.org/AAE15.
Dental professionals who join the AAE receive
a member discount on meeting registration of
more than 40 percent. Learn more about AAE
membership at www.aae.org/join. You can also
connect with the AAE through the AAE Facebook page at www.facebook.com/endodontists,
the AAE YouTube channel at www.youtube.com/
rootcanalspecialists and Twitter at www.twitter.
com/savingyourteeth._
[19] =>
[20] =>
I industry_ Wykle Research
Wykle Research
offers Calasept
Endo line
Fig. 1_Calasept Irrigation Needles
(Photos/Provided by Wykle Research)
Fig. 2_Calasept Irrigation Syringes
_Wykle 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 high-quality,
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
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
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 distributes Calasept Endo
products by Nordiska Dental, a Swedish manufacturer of dental supplies. Wykle Research and
Nordiska Dental 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._
Fig. 1
Fig. 2
20 I roots
1_ 2015
[21] =>
[22] =>
I industry_ Planmeca
Planmeca’s endodontic
imaging mode: Detailed images
without noise or artifacts
Author_Planmeca staff
_Specifically designed for endodontic studies, Planmeca’s advanced endodontic imaging mode provides
perfect visualisation of even the finest anatomical
details. It is available for all X-ray units belonging to
the Planmeca ProMax® 3D family and is ideal for endodontics as well as other cases that require imaging of
small anatomical details, such as imaging of the ear. The
imaging program produces extremely high-resolution
images with a very small voxel size (only 75 µm).
Thanks to the Planmeca AINO™ noise removal and
Planmeca ARA™ artifact removal algorithms, noisefree and crystal-clear images are produced.
_Planmeca ARA removes artifacts
efficiently
Metal restorations and root fillings in the patient’s
mouth can cause shadows and streaks in CBCT images. The intelligent Planmeca ARA artifact removal
algorithm removes these artifacts efficiently from
Planmeca ProMax 3D images.
_Planmeca AINO removes noise from
CBCT images
A particularly low radiation dose or small
(Photos/Provided by Planmeca)
22 I roots
1_ 2015
voxel size can cause noise in 3-D X-ray images.
The new Planmeca AINO Adaptive Image Noise
Optimiser is an intelligent noise filter that
reduces noise in CBCT images without losing
valuable details.
The filter improves image quality in the endodontic imaging mode, where noise is inherent
due to the extremely small voxel size. It is also
especially useful when using the Planmeca Ultra
Low Dose™ protocol, where noise is induced by
the particularly low dose.
Planmeca AINO also allows reducing exposure
values and consequently the radiation dose in all
other imaging modes.
_Efficient tooth segmentation
The Planmeca Romexis® all-in-one software platform will soon provide a new, intuitive and efficient
tool for segmenting a tooth and its root from a CBCT
image.
The guided process enables quick segmentation of a patient’s full dentition. Surface models of
segmented teeth can be visualised, measured and
utilised in Planmeca Romexis.
For more information, contact Planmeca._
[23] =>
[24] =>
I industry education_ LVI
There is a better way
(and LVI can show you
how to get there)
Author_Mark Duncan, DDS, FAGD, LVIF, DICOI, FICCMO, Clinical Director, LVI
The Las Vegas Institute for Advanced
Dental Studies. (Photo/Provided by
Las Vegas Institute for Advanced
Dental Studies)
24 I roots
1_ 2015
_You know how those days go — all morning long,
it felt like you were struggling to keep on track with
the schedule. Your team is frustrated because they
haven’t had their full hour lunch more than one day
a week in as long as they can remember. You walked
by the sterilization room 15 minutes ago, and it sure
sounded like they were complaining to each other
because you said to work in that emergency, and
they were struggling to figure out figure out how to
pick up their kid from daycare on time on time. Again.
You want them to enjoy working here, but you
have to be able to pay the bills. And your best assistant
asked you again if she can have that raise you have
been promising her. Don’t they understand?
Today will be another day of three chairs and
patient after patient asking you questions about
treatment, all eager to get started with getting their
mouth fixed, but yet you still won’t see any of them
show up on the schedule. They said they wanted to
do the work, but for some reason, they never seem to
come back and do it.
They say insurance doesn’t cover it, or they ask for
a pre-determination. Too bad they don’t know the
pre-determination doesn’t mean much.
Today, you have 27 patients on your schedule and
will work your butt off and still not have a chance to
pee. It looks like you should be able to be done by 5,
but today will finish worse than yesterday.
It feels like half of your patients are crankier than
you are, and your team isn’t really talking to you
today, and you know when you get home, all you will
want to do is go to sleep and wake up on Saturday —
except it’s still Tuesday!
It doesn’t make sense — you have taken C.E. courses
every time they come to town. The new insurance plan
was supposed to make things easier. You bought a
bunch of new equipment to save money on taxes — of
course now you have to pay for it every month — but
why does it seem like the harder you work, the further
behind you get? There has to be a simple reason.
Well, it turns out there actually is — and it’s something that you learned when you were about 5! Do
unto others. More specifically, build systems in your
office so that you can treat your patients the way you
would want to be treated — comprehensively and with
exceptional information to make good decisions — and
produce a consistent experience time after time.
While doing that, add exceptional care — esthetic
adhesive excellence like you see in the journals. But how?
Well, the answer happens to be the foundation that LVI
was built upon — building the excellence in a patientcentered practice. And the programs at LVI have been
teaching clinical excellence and communication and
business systems for almost 20 years to help doctors
do a better job of not only seeing the patient but, more
importantly, connecting with them. Two decades of not
only communication but comprehensive diagnosis and
clinical excellence. As a result, the doctors at LVI have a
statistically higher professional satisfaction and income.
Isn’t it time you go find out what they are doing
differently? Yes. Yes it is — and congratulations on the
journey you are about to start._
[25] =>
about the publisher_ submissions
I
submissions
formatting requirements
Please note that all the textual elements
of your submission:
• complete article
• figure captions
• literature list
• contact info (email address please)
• author bio
must be combined into one Microsoft Word
document. Please do not submit multiple files
for each of these items. In addition, images
(tables, charts, photographs, etc.) must not
be embedded in the text document. All images
must be submitted separately, and details
about how to do this appear below.
If you are interested in submitting a C.E.
article, please contact us for additional instructions before you make your submission.
_Text length
Article lengths can vary greatly — from a
mere 1,500 to 5,500 words — depending on
the subject matter. Our approach is that if
you need more or less words to do the topic
justice, then please make the article as long or
as short as necessary.
We can run an extra long article in multiple parts, but this is usually discussing a subject matter where each part can stand alone
because it contains so much information. In
addition, we do run multi-part series on various topics. In short, we do not want to limit
you in terms of article length, so please use
the word count above as a general guideline
and if you have specific questions, please do
not hesitate to contact us.
_Text formatting
Please use single spacing and do not put extra
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Boldface should be reserved for article headlines, headers and subheads please.
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There are menus in every program that
will help you apply all sorts of special formatting.
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Please number images consecutively by
using a new number for each image. If it is
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Insert figure references in your article
wherever they are appropriate, whether that
is in the middle or end of a sentence, but
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• We require images in TIF or JPEG format
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If you have an image that is greater than
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the image to fill up more space should there
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Also, please remember that you should
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You may submit images through a
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files via email or post a CD containing your
images directly to us (please contact us
for the mailing address as this will depend
upon where in the world you will be mailing
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Please do not forget to send us a head
shot photo of yourself that also fits the
image requirements noted above so that it
can be printed along with your article.
_Abstracts
An abstract of your article is not required.
However, if you choose to provide us with
one, we will print it in a separate box.
_Contact info
At the end of every article is a contact info
box with contact information along with a
portrait photo of the author.
Please note at the end of your article the
exact information you would like to appear
in this box and format it according to the
previously mentioned standards.
A short bio (50 words or less) may precede the contact info if you provide us with
the necessary text.
_Questions? Comments?
Please do not hesitate to contact us for our
International C.E. Magazine Author Kit or if
you have other questions/comments about
the article submission process:
Group Editor Kristine Colker
k.colker@dental-tribune.com
Roots Managing Editor Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor Sierra Rendon
s.rendon@dental-tribune.com
roots
1
I 25
_ 2015
[26] =>
I about the publisher _ imprint
roots
the international C.E. magazine of endodontics
U.S. Headquarters
Tribune America
116 West 23rd Street, Ste. 500
New York, NY 10011
Tel.: (212) 244-7181
Fax: (212) 244-7185
feedback@dental-tribune.com
www.dental-tribune.com
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
President/Chief Executive
Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor
Kristine Colker
k.colker@dental-tribune.com
Roots Managing Editor
Fred Michmershuizen
f.michmershuizen
@dental-tribune.com
Managing Editor
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor
Robert Selleck
r.selleck@dental-tribune.com
Education Director
Christiane Ferret
c.ferret@dtstudyclub.com
Marketing Director
Anna Kataoka
a.kataoka@dental-tribune.com
Product/Account Manager
Humberto Estrada
h.estrada@dental-tribune.com
Product/Account Manager
Maria Kaiser
m.kaiser@dental-tribune.com
Product/Account Manager
Will Kenyon
w.kenyon@dental-tribune.com
Feedback & General Inquiries
feedback@dental-tribune.com
Editorial Board
Marcia Martins Marques, Leonardo
Silberman, Emina Ibrahimi, Igor Cernavin,
Daniel Heysselaer, Roeland de Moor, Julia
Kamenova, T. Dostalova, Christliebe Pasini,
Peter Steen Hansen, Aisha Sultan, Ahmed
A Hassan, Marita Luomanen, Patrick Maher,
Marie France Bertrand, Frederic Gaultier,
Antonis Kallis, Dimitris Strakas, Kenneth Luk,
Mukul Jain, Reza Fekrazad, Sharonit
Sahar-Helft, Lajos Gaspar, Paolo Vescovi,
Marina Vitale, Carlo Fornaini, Kenji Yoshida,
Hideaki Suda, Ki-Suk Kim, Liang Ling Seow,
Shaymant Singh Makhan, Enrique Trevino,
Ahmed Kabir, Blanca de Grande, José Correia
de Campos, Carmen Todea, Saleh Ghabban
Stephen Hsu, Antoni Espana Tost, Josep
Arnabat, Ahmed Abdullah, Boris Gaspirc,
Peter Fahlstedt, Claes Larsson, Michel Vock,
Hsin-Cheng Liu, Sajee Sattayut, Ferda Tasar,
Sevil Gurgan, Cem Sener, Christopher Mercer,
Valentin Preve, Ali Obeidi, Anna-Maria
Yannikou, Suchetan Pradhan, Ryan Seto, Joyce
Fong, Ingmar Ingenegeren, Peter Kleemann,
Iris Brader, Masoud Mojahedi, Gerd Volland,
Gabriele Schindler, Ralf Borchers, Stefan
Grümer, Joachim Schiffer, Detlef Klotz,
Herbert Deppe, Friedrich Lampert, Jörg
Meister, Rene Franzen, Andreas Braun, Sabine
Sennhenn-Kirchner, Siegfried Jänicke, Olaf
Oberhofer and Thorsten Kleinert
Tribune America is the official media partner of:
roots_Copyright Regulations
_the international C.E. magazine of roots published by Tribune America is printed quarterly. The magazine’s articles and illustrations are
protected by copyright. Reprints of any kind, including digital mediums, without the prior consent of the publisher are inadmissible and liable
to prosecution. This also applies to duplicate copies, translations, microfilms and storage and processing in electronic systems. Reproductions,
including excerpts, may only be made with the permission of the publisher.
All submissions to the editorial department are understood to be the original work of the author, meaning that he or she is the sole copyright
holder and no other individual(s) or publisher(s) holds the copyright to the material. The editorial department reserves the right to review all
editorial submissions for factual errors and to make amendments if necessary.
Tribune America does not accept the submission of unsolicited books and manuscripts in printed or electronic form and such items will
be disposed of unread should they be received.
Tribune America strives to maintain the utmost accuracy in its clinical articles. If you find a factual error or content that requires clarification, please contact Group Editor Kristine Colker at k.colker@dental-tribune.com. Opinions expressed by authors are their own and may
not reflect those of Tribune America and its employees.
Tribune America cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not
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The responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability
arising from inaccurate or faulty representation are excluded. General terms and conditions apply, and the legal venue is New York, New York.
26 I roots
1_ 2015
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Table of contents
-
Cover
01 - 01
view
-
Editorial
03 - 03
view
-
Content
04 - 04
view
-
Pulp necrosis in the left upper incisor as a consequence of neurovascular pedicle compression
06 - 09
view
-
The endo-restorative connection: The right material for the right situation
10 - 12
view
-
Interview: ‘A time of unprecedented change in our profession’
14 - 17
view
-
Endodontists from around the world to meet in Seattle - May 6-9 - for AAE15
18 - 18
view
-
Industry
20 - 22
view
-
There is a better way (and LVI can show you how to get there)
24 - 24
view
-
Submissions
25 - 25
view
-
Imprint
26 - 26
view
[toc_titles] => Cover
/ Editorial
/ Content
/ Pulp necrosis in the left upper incisor as a consequence of neurovascular pedicle compression
/ The endo-restorative connection: The right material for the right situation
/ Interview: ‘A time of unprecedented change in our profession’
/ Endodontists from around the world to meet in Seattle - May 6-9 - for AAE15
/ Industry
/ There is a better way (and LVI can show you how to get there)
/ Submissions
/ Imprint
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