roots C.E. No. 2, 2013

Cover / Editorial / Content / Predictable Endo 102: Why warm and soft is so good / MounceFiles: A safe - economical and efficient option for canal preparation / No more supremely stinky teeth / Industry / Submissions / Imprint

Open PDF View E-paper Edit Epaper Edit Epaper ads save

Table of contents

Open Link

roots
issn 2161-6558

the international C.E. magazine of

2

2013

_C.E. article

Predictable Endo
102: Why warm and
soft is so good

_instrumentation

MounceFiles: A safe,
economical and
efficient option for
canal preparation

_education

No more supremely
stinky teeth

North America Edition • Vol. 4 • Issue 2/2013

endodontics

[2] =>

[3] =>

editorial _ roots

Welcome
to paradise
As I am writing this, I am getting ready to travel to Honolulu for the American Association of Endodontists meeting. Hawaii is a wonderful place to visit, and I am thrilled that AAE is holding its annual session
this year in paradise. You might very well have picked up this copy of roots at the event.
In this issue, be sure to read the report on tools for endodontic instrumentation by Dr. Rich Mounce,
and the article on the new TrueTooth replicas by Dr. L. Stephen Buchanan.
Every issue of roots also contains a C.E. component. By reading the article on obturation by Dr. John
Stropko, then taking a short online quiz about his article at www.DTStudyClub.com, you will gain one ADA
CERP-certified C.E. credit. Keep in mind that since roots is a quarterly magazine, you can actually chisel four
C.E. credits per year out of your already busy life without the 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.
Annual subscribers to the magazine ($50) need only register at the Dental Tribune Study Club website to
access these C.E. materials free of charge. Non-subscribers may take the C.E. quiz after registering on the
DT Study Club website and paying a nominal fee.
I know that taking time away from your practice to pursue C.E. credits is costly in terms of lost revenue
and time, and that is another reason roots is such a valuable publication. I hope you will enjoy this issue of
roots and that you will take advantage of the C.E. opportunity.
For those of you who are in Hawaii for the AAE, please say hello to me in person. It is always a pleasure
to rub elbows with others in the specialty. Roots Managing Editor Fred Michmershuizen is also here. Watch
for his report on the meeting, plus lots more educational articles, in the next issue of roots.
Until then, I wish you all the best.

Fred Weinstein, DMD, MRCD(C),
FICD, FACD

Sincerely,

Fred Weinstein, DMD, MRCD(C), FICD, FACD
Editor in Chief

roots
I 03
2
_ 2013

[4] =>

I content_ roots

page 18

page 06

I C.E. article
06	Predictable Endo 102: Why warm and
soft is so good
_John J. Stropko, DDS

I about the publisher
37
38

_submissions
_imprint

roots

North America Edition • Vol. 4 • Issue 2/2013

issn 2161-6558

I instrumentation
18	MounceFiles: A safe, economical and
efficient option for canal preparation

page 26

the international C.E. magazine of

endodontics

2

2013

_Rich Mounce, DDS

I industry education
26	No more supremey stinky teeth
_L. Stephen Buchanan, DDS, FICD, FACD

I industry
30

PIPS Laser Endo harnesses the power
of the Lightwalker

32 Wykle Research expands its
Calasept Endo line
34

Plasma light source from Seiler

page 30

04 I roots
2_ 2013

_C.E. article

Predictable Endo 102:
Why warm and soft is
so good

_instrumentation

MounceFiles: A safe,
economical and
efficient option for
canal preparation

_education

No more supremely
stinky teeth

I on the cover

The image is of a TrueTooth™ training replica. Designed
by Dr. L. Stephen Buchanan and re-created by a 3-D
printer, these are authentic replicas of the internal and
external anatomy of CT-scanned extracted teeth, with
bleach-dissolvable material in the root canal passageways.
TrueTooth training replicas are available exclusively from
www.DELendo.com and are patent pending.

page 32

page 34

[5] =>

[6] =>

I C.E. article_ obturation

Predictable Endo 102: Why
warm and soft is so good
System ‘S’ for injectable or carrier-based GP
Author_John J. Stropko, DDS

_c.e. credit
This article qualifies for C.E.
credit. To take the C.E. quiz,
log on to www.dtstudyclub.
com. Subscribers to the magazine can take this quiz for
free and will be emailed an
access code after the magazine’s release. If you do not
receive the code, please write
to support@dtstudyclub.com.
Non-subscribers may take the
quiz for $20. You can access
the quiz by using the QR code
below. The quiz will be available on April 15.

06 I roots
2_ 2013

“There’s a difference between interest and commitment. When you’re interested in something, you
do it when it’s convenient. When you’re committed
to something, you accept no excuses, only results.”
—Ken Blanchard

_Abstract
The author has been in private practice and a
continuing student for the past 50 years. The first
half was spent practicing restorative dentistry,
and the second half in a specialty practice limited
to endodontics. On the road to predictability, it
became apparent there was a definite relationship present between root canal treatment, periodontal status, prosthetics and/or subsequent
restorative procedures. Each operator has to decide what steps for a more predictable outcome
they are willing to trust another to do. This article
is an attempt to share some “secrets of success”
and perhaps serve as a checklist for a system that
works in the attempt to achieve predictability of
endodontic treatments.
During the earlier years of the past century, several techniques were devised for the obturation of the
canal system after removal of the diseased pulp, or
necrotic tissue. Some of the most popular were silver
points, lateral condensation of gutta-percha (GP),
Sargenti paste and chloropercha. Currently there are
seven techniques that utilize gutta-percha as the
obturation material of choice:
1) Single cone
2) Lateral condensation
3) Chloropercha technique
4) Vertical compaction of warm GP (Schilder, continuous wave, System “B,” McSpadden, System “A”)
5) Carrier-based (Thermafil)
6) Injection of thermo-plasticized GP (often referred
to as “squirting” using a Calamus or Obtura unit)
7) Mechanically assisted compaction (Pac Mac).

In 1967, Dr. Herb Schilder, often referred to as “the
father of modern endodontics,” introduced the concept of filling the root canals in three dimensions.1
The Schilder Technique involved a new and different
approach for obturation of the canal system and
resulted in much controversy.
Evidently, the controversy did create interest
from some doctors, because in the mid 1970s new
ideas and techniques evolved that became most of
what are the currently accepted concepts of modern
endodontic principles and techniques. Today, the numerous clinical reports, published research and the
rapid advancements in technology have significantly
changed the operator’s obturation preferences. Ease
of communication, along with modern marketing,
has become a very important determinant when
making a choice of techniques.
More recent studies have discounted some previous obturation materials that were popular, but
some form of GP still remains the most acceptable
and widely used. The purpose of this article is to
share a simple, six-step protocol (System “S”) in a
straightforward manner, to achieve predictability of
endodontic treatment for the benefit of the patient.
There are six important components to the
System “S” protocol:
1) Proper shaping with patency
2) Adequate cleaning, disinfection and drying
3) Delivery of pre-warmed GP to apex (Calamus/
Obtura)
4) Coronal seal for the rest of the system
5) Respect for the endo-pros relationship
6) Use of the surgical operating microscope (SOM)
for the entire endodontic treatment.
The author believes that as long as the gutta-percha
is introduced to the apical third of the canal system,
pre-warmed and pre-softened, the deformation and
adaptation to the canal walls is more predictable,
resulting in a better seal that is significantly less “sealer-

[7] =>

C.E. article_ obturation

Fig. 1

Fig. 4a

dependent.” It has been shown that the pre-warmed
techniques (Obtura and Thermafil) produce a better
seal than lateral condensation.2 Due to the lack of deformity inherent at room temperature, the techniques
utilizing non-softened GP are more “sealer-dependent.” The two most popular thermoplastic obturation
techniques are the “carrier-based” (e.g., Thermafil)
and “direct injection” (e.g., Calamus/Obtura). The pros
and cons of each will be discussed, but regardless of
the technique used, the “shape” of the prepared canal
system is of utmost importance and must be discussed.

_Access and shaping the canal system
In the early ’70s, Schilder clearly stated the requirements for the proper shape using GP to achieve
three-dimensional obturation of the canal system:
1) The root canal preparation should develop a
continuously tapering cone shape.
2) It should have decreasing cross-sectional diameters at every point apically and increasing at each
point as the access cavity is approached.
3) It should have multiple planes, which introduces the concept of “flow.”
4) The foramen should not be transported.
5) The apical opening should be kept as small as
practical in all cases.
There were several other requirements more clinically definitive. Following are a few of them: After
placement of the rubber dam, an appropriate access is
made. Unless the access is large enough for adequate

Fig. 2

Fig. 3

Fig. 4b

Fig. 5

vision, appropriate instrumentation may be compromised and canals missed. A perfect example is a maxillary first molar; if the access is made as though there
was an MB2, it is amazing how many times an MB2 is
found. A general rule of thumb is, if you access for it, you
are more likely to find it. A proper access will also facilitate the creation of the continuously tapering shape of
the canal, necessary for the warm GP technique.
Occasionally after caries or old restorations are
removed, a “pre-endodontic” restoration may be required to control and maintain a sterile environment
until the endodontic treatment is complete. This can
usually be accomplished using a bonded composite
technique.
Shaping should be confined to the anatomy of canal
system, following the natural curvatures. Instrumentation beyond the apex is unnecessary and may needlessly enlarge and deform the apical foramen.3 Using
the Schilder protocol to achieve the desired shape of
the canal system was a time-consuming process. It
involved the tedious use of pre-curved files and reamers to follow the anatomical curvatures of the canal.
Other requirements that caused some controversy then (and still does), besides the size of the
access opening, was the need to keep the apical foramen as small as possible, and to maintain patency
throughout the entire process. The majority of more
recently published research and clinical studies have
confirmed the rational for an appropriate access and
correct shaping.
In the early 1990s, technology brought about the
introduction of rotary instruments, relieving the op-

Fig. 1_Typical rotaries, one of
several popular brands. (Photos/
Provided by John J. Stropko, DDS,
unless otherwise noted)
Fig. 2_NaOCl irrigating syringes can
be warmed in a beaker on a coffee
warmer. Note the anesthetic syringes
on a heating pad in the background.
Fig. 3_The Endo Activator is used
for the ‘tsunami effect’ for cleaning
canals.
Fig. 4a_The canal system can be
very complicated.
Fig. 4b_The Walter Hess studies with
vulcanite clearly demonstrated the
complexity of canal systems.
Fig. 5_Set of three Stropko Irrigators
with various 27-gauge tips bent for
use. Arrow points to the dedicated
‘air-only,’ single-button DCI syringe.

roots
I 07
2
_ 2013

[8] =>

I C.E. article_ obturation
Fig. 6_When drying canals with air,
needles must be notched or sidevented (arrows).
Fig. 7_The Chapman Huffman in-line
air regulator and 0-15 psi gauge
works well.
Fig. 8_Fresh absorbent points are
used to remove excess sealer until
‘blotchy.’
Fig. 9_Only a very thin layer of
sealer needs to coat the walls for
lubrication. (Photo/Courtesy of Bob
Sharp, Sacramento, Calif.)
Fig. 6

Fig. 7

Fig. 8

erator of considerable time spent creating an acceptable shape. The ProFile rotary bur (Tulsa Dental) with
0.04 and 0.06 taper, was introduced to the profession.
Creating the shape necessary for the successful use
of the warm obturation techniques was made easier
and faster.
By the beginning of this century, numerous
designs gradually evolved utilizing varying tapers,
active or passive cutting blades, etc. (Fig. 1). At first,
the biggest problem with the rotary files was breakage during use. But modern nickel titanium (NiTi)
metallurgy technology has developed more, and
more dependable, rotary files. As a result, today the
separation of a rotary instrument during use is of
virtually little or no concern.
It has also been shown that proper shape permits
more thorough irrigation and the removal of significantly more debris from the prepared canal system.
Disinfecting irrigation should be used between each
instrument during the entire shaping process and
patency continually maintained with a #10 file. Note:

08 I roots
2_ 2013

Fig. 9

The quantity of irritants used is not as important as
the frequency of use. The irrigation protocol, instruments, fluids, etc., are in constant evolution and becoming more effective. However, a clean and sterile
environment of the canal system prior to obturation
is still the objective.

_Irrigation for cleaning the canal system
After shaping is completed, final cleaning can be
effectively accomplished by the alternative use of:
1) Warm 3- to 6-percent NaOCl
2) 17 percent aqueous EDTA for approximately 30
seconds (smear layer removal)
3) Warm 3- to 6-percent NaOCl (further disinfect
and stop action of the EDTA).

[9] =>

C.E. article_ obturation

Fig. 10a

Fig. 10b

Fig. 10c
Fig. 10a_A furcal perforation in the
distal root of a mandibular first molar.
Fig. 10b_Canal filled just apical to
furcal perforation.
Fig. 10c_MTA placed to repair the
perforation.
Fig. 11a_The Calamus Dual unit
with a thermal handpiece. (Photo/
Courtesy of Dentsply Tulsa Dental
Specialties)

Fig. 11a

The NaOCl can be effectively warmed by placing the
irrigating syringes in a beaker of water set on a small coffee warmer (Fig. 2). The canal(s) are completely flooded
with the desired solution; an Endo Activator (Dentsply) is
appropriately used for the “tsunami effect,” then re-irrigated with the same solution for flushing of debris (Fig.
3). The NaOCl is then effectively removed with a capillary
tip (Ultradent) attached to a high-speed evacuator. Other
solutions (hydrogen perozide, chlorhexidine, 17 percent
aqueous EDTA, MTAD, etc.) can also be used alternately,
depending on operator preference.
Close observation with an SOM will clearly indicate complete cleaning of the canal system when no
debris is flushed out during the irrigation process.
During the evacuation with the capillary tip, it becomes apparent if there is a joining of the canal systems within the root. For example, if using the SOM
as the MB1 canal is being evacuated and it is noted
that fluid is simultaneously being drawn from the
MB2 canal, there is a good indication that the system
is complicated and does join at some point (Figs. 4a,b).
There are occasions, especially in lower molars, where
the mesial root canal system unexpectedly joins with
the distal root canal system.

Fig. 11b

Fig. 11b_An Obtura III Max Pack Dual
also has the thermal handpiece.

On occasion, the maxillary canal system will have
the DB or MB canal system connected to the palatal
system. These “surprises” are important to be aware
of, before obturation of the canal system, especially
when using either carriers or injectable GP.

_Drying canals with F•I•R•E
The canal(s) are Flooded with 95 percent ethanol
(Everclear, available at local liquor store), agitation of
the fluids are Initiated with an activator for the tsunami
effect, then Re-irrigated with the 95 percent ethanol,
and then Evacuated with the capillary tip. The canal(s)
are then best dried by using a Stropko Irrigator on a dedicated, air-only syringe (DCI), but if a three-way syringe is
used, be sure to express all water from the line first (Fig. 5).
Next, with a 27- or 30-gauge notched or sidevented needle (Monoject), fitted to the tip of the
Stropko Irrigator and bent as necessary, to easily
dry the canal system (Fig. 6). Important note: It is essential to regulate the air pressure to the syringe at
1 to 3 psi and use a side-vented or notched needle,
to prevent any possibility of inadvertently forcing air
through the apical foramen. This is easily achieved

roots
I 09
2
_ 2013

[10] =>

I C.E. article_ obturation
Fig. 12_The plugger is pre-fit, short
of binding, to avoid unnecessary
contact with the canal walls during
deep compaction of the softened
GP. (Image/Courtesy of Arnaldo
Castellucci, Florence, Italy)
Fig. 13_The GuttaCore carriers are
just one of many popular products for
carrier-based GP. (Photo/Courtesy of
Dentsply Tulsa Dental Specialties)

Fig. 13

Fig. 12

with an in-line regulator, the Chapman-Huffman
Regulator & Gauge, Part #17-050-00 (Fig. 7).
As dentists, we are accustomed to a “blast” of air
while using the usual air/water syringe tip and high
air pressure to the A/W syringes. With a properly regulated Stropko Irrigator fitted with an appropriate small
gauge needle, only a “kiss” of air is necessary to create
the flow necessary for thorough air drying of the canal.
On occasion, one has to direct the air to a sensitive
area on himself or herself to be sure the air is even
flowing. Just watching the evaporation that occurs
within the canal, while using the SOM, is enough to
convince any operator that there is indeed a flow of air.
There is enough physiologic back pressure of the apical
environment (1.5 mm Hg) to prevent movement of the
air past the terminus in the correctly shaped canal. In
almost 20 years, with many different doctors using the
Stropko Irrigator to “air dry” canals, the author has only
heard of one unfavorable incident. In that one case, the
doctor did not use a side-vented needle and did not
regulate the air pressure to the air syringe.
To repeat, when the Stropko Irrigator is used with
the properly regulated air pressure (1 to 3 psi) and the
appropriate 27- to 30-gauge, side-vented/notched
needle is used, there is no fear of forcing air into
apical tissues.

_Sealer application
To the SOM user, the ineffectiveness of drying
the canal with a paper point is soon realized. It is

10 I roots
2_ 2013

also easy to observe how differently the Kerr Pulp
Canal Sealer EWT (SybronEndo) acts when the
canal is in fact dry, not just blotted. After blotting
with a paper point, the sealer tends to act like a
drop of oil when placed on the canal wall. But
when the surface is dried, using alcohol and air as
described above, the sealer readily spreads onto
the canal wall, much like a coat of paint.
The complete dryness of the canal to the desired working length is checked with a clean absorbent point that fits to length. This also gives
the operator an excellent chance to recheck the
working length and dryness of the canal. Any
sealer (Kerr EWT, Roth, AH Plus, etc.) can be used
as long as the heat of the warm GP does not cause
a “flash set.” The end 3 mm of a sterile paper point
is coated with the sealer of choice and placed into
the canal to the working length.
The author uses Kerr Pulp Canal Sealer EWT,
mixed per usual directions, but a little “on the thin
side.” Using short, rapid apical-coronal movements,
the walls of the canal are completely coated with
sealer. The use of the SOM is a great aid for observing
when the coating of the canal wall by the sealer is
complete. Then, a sterile absorbent point is used, in
the same manner, to remove any excess sealer that
may remain.
Depending on the amount of sealer placed at the
beginning, more than one absorbent point may be
necessary to get the “blotchy appearance” on the
final point (Fig. 8). Only a thin coat of sealer is necessary for lubrication, so very little remains on the walls
of the canal (Fig. 9).
One of the most common mistakes, made at first,
is using too much sealer. When this happens, the
excess sealer will be extruded back into the chamber,
or apically when the warm GP is placed. In some
cases, the GP may be prevented from completing
the desired “flow” apically. Typically, only one or
two points are normally needed once the operator
achieves proficiency at applying the correct amount
of sealer to begin with. Thermoplastic GP techniques
are not sealer-dependent and depend more on the
sealer as a lubricant and facilitate the flow of the
thermoplastic GP.

[11] =>

C.E. article_ obturation

Fig. 14b

Fig. 14a

Fig. 15

Fig. 14a_A Prepi bur (Dentsply) is
used to sever the handle of the carrier
at level of the orifice. (Photo/Courtesy
of Stephen P. Niemczyk, Drexel Hill.
Pa.)

Fig. 16a

Fig. 16b

Fig. 14b_Carrier shaft and GP are
severed at the orifice of the canal.
(Photo/Courtesy of Stephen P.
Niemczyk, Drexel Hill. Pa.)
Fig. 15_A second carrier is inserted
alongside the first carrier to enhance
compaction. (Photo/Courtesy of
Stephen P. Niemczyk, Drexel Hill. Pa.)
Fig. 16a_A PAX of the immediate
post-op (left) and two-year post-op
(right).

Fig. 17a

Fig. 17b

_Important consideration between using the entire canal first, so unknown anatomy more
coronally in the canal won’t be missed.
injection or carrier-based obturation
Essentially, there is one very significant difference
between the two techniques. The injection technique
fills the canal system from the apical to the coronal, whereas the carrier-based techniques fill from
coronal to the apical. This is important to take into
account, especially in cases in which the operator
does not want to fill the canal to the orifice or needs
to control the “depth” of the fill.
A good example would be in the case of treatment of a perforation repair. Using injection, the
“fill” can be accomplished rather easily, and both
the sealer and GP can be confined apical to the
perforation. MTA can then be added to the repair
in a very controlled manner (Figs. 10a–c). When a
post space is required, the GP can be injected to
any level in the canal, but it is better to obturate

_Injection of thermo-plasticized GP with
a Calamus or Obtura

Fig. 16b_A PAX of the immediate
post-op (left) and four-year post-op
(right).
Fig. 17a_Teeth #14 & 15 obturated
with Thermafil Plus. (Photo/Courtesy
of Stephen P. Niemczyk, Drexel Hill,
Pa.)
Fig. 17b_Tooth #3 after being
obturated using the Calamus.

After using the Obtura for more than a decade
for thermo-plasticized GP obturation, the author
switched to the Calamus when it was introduced
many years ago. After thousands of canals were
obturated using both of them, several advantages
were noted when comparing the two units (Table 1).
Both units are available as a single unit, or a dual
unit combined with a thermal handpiece for convenience (Figs. 11a,b). The consistent flow of the Calamus
unit does make the learning curve quicker and easier
to master than the Obtura, because the relatively
large muscle action of squeezing the trigger could
vary from patient to patient, or day to day. The much

roots
I 11
2
_ 2013

[12] =>

I C.E. article_ obturation

Fig. 18

Fig. 18_These four cases all have
excellent root canal treatment,
but only the third from left had the
entire canal system filled at the final
endodontic visit. Which one would
you bet on for predictability?

Table 1_ A comparison of

thermo-plasticized
GP obturation with
Calamus vs. Obtura.

12 I roots
2_ 2013

the collar is pressed until the initial GP is extruded and
then the collar is released. The slight amount of GP at
the tip is removed.
The needle is then placed into the canal apically,
just short of binding, and the collar is pressed to reactivate the plunger and initiate the flow of GP. It is
good practice to barely move the tip, in a very slight
apical-coronal direction as the GP is flowing. The moment there is a sensation of pushback, a momentary,
very slight apical resistance can be exerted, then
begin to slowly withdraw the needle until the GP fills
the canal to the orifice. Using an SOM, this is easily
observed and gives the operator confidence.
If there are two or more canals in the same root,
they must be injected in a special manner, especially
if they join or are connected by any variation in the
canal system (an isthmus, for example). Obturation
smaller muscle action of using a finger to press the is accomplished by filling both of the canals in rapid
collar of the Calamus is significantly less, and the re- succession to the desired level in the orifice. Then
sulting flow of the GP can be pre-set for consistency. immediately proceed to the first canal with a preThe size of the needle used in the Calamus or measured plugger to create more hydraulics (deep
Obtura (20 vs. 23 gauge) is generally a matter of pack) and start the compaction process. The GP will
preference and can also depend on what the canal remain soft for enough time so the operator can
wants. It does not make any difference, in the scheme accomplish the shepherding process in two or more
of things, how far apically into the canal the needle canals if done in a timely manner.
To insure complete adaptation to the walls of the
is placed, as long as it is non-binding.4 For example,
a straighter and larger canal will take a larger needle. canal, the warm GP needs to be compacted as it cools to
On some occasions, the 20-gauge needle will not overcome any shrinkage that will normally occur. Since
be far enough apical to the orifice of the canal before the softness of the GP is mass-dependent, the GP at the
binding. If the canal preparation is narrower, this is orifice level has the greatest mass and will stay softest
an indication to use the smaller, 23-gauge needle. As for the longest time in the canal, regardless of which
long as it is not binding and the canal has the cor- technique is utilized. Using the Calamus, a pre-fitted
rect shape, the GP will flow to the apex. Note: If the Schilder #9 plugger, well short of binding, is then used
canal is parallel in shape, the canal then becomes an to compact the GP to the pre-measured depth (Fig. 12).
CALAMUS
The plugger is firmly pushed into the soft GP and
extension of the needle and apical control is severely
1) Flow is consistent and can be preset
handicapped. Shape is of the utmost importance, held at the measured depth for just a few seconds to
2) GP & needles in single packaging
achieve compaction of the GP in the apical third. The
especially in these techniques.
3) Single needle use the norm
The settings on the Calamus are checked to assure plugger is now used to “shepherd” the GP from the
4) Barrier protection easy to place
the desired set temperature has been achieved (the walls of the canal into a “wad” and further compact
5) Less patient discomfort upon injection
author uses 160 C), and the flow rate is set correctly the GP. The operator works toward the orifice in
6) Easier to relate/teach proper use
(the author prefers 100 percent). When the unit approximately 2-mm steps as the plugger creates
7) Can easily be rotated for ergonomics
reaches the set temperature, it will stop blinking. “new wads” in the process. The shepherding of the
8) No hand fatigue during use
Note: As a safety feature, until the unit has achieved GP is continued until the desired depth in the orifice
9) No patient response during obturation
the pre-set parameters, the motorized plunger will is reached. The mistake often made when working
10) Generally, very clean to use
not initiate and GP is not ejected. When all is ready, with warm GP is the tendency to “bounce” off the GP
CALAMUS
1) Flow is consistent and can be preset
2) GP & needles in single packaging
3) Single needle use the norm
4) Barrier protection easy to place
5) Less patient discomfort upon injection
6) Easier to relate/teach proper use
7) Can easily be rotated for ergonomics
8) No hand fatigue during use
9) No patient response during obturation
10) Generally, very clean to use

OBTURA
1) Flow dependent on operatorʼs “squeeze”
2) GP pellets delivered several in a box
3) Multiple needle use the norm
4) Barrier protection more involved
5) Patient often felt a “flash of warmth”
6) Proper “squeeze” a longer learning curve
7) Unit difficult to turn to different angle
8) Hand fatigue can occur
9) Patients often felt apical pressure
10) More time consuming to clean

OBTURA
1) Flow dependent on operatorʼs “squeeze”
2) GP pellets delivered several in a box

[13] =>

C.E. article_ obturation

Fig. 19a

while compacting, instead of giving the GP time to
compact. Just a few seconds are needed for the newly
compacted “wad” to cool.

_Obturation with carrier-based GP
(Thermafil)
Carrier-based GP (Thermafil) was first conceived by
Dr. Ben Johnson of Tulsa, Okla., in 1975; published in
1978; and made commercially available to the dental
profession in 1988 (Tulsa Dental).5 It has become one of
the most popular and respected techniques in the world.
Today there are many forms of the Thermafil concept
on the market that conform to the design of various
rotary burs (Dentsply Tulsa) (Fig. 13). The technique
saves the operator a significant amount of time during
the obturation process, and excellent results have been
supported by numerous studies over the years.
After shaping, cleaning and disinfection is complete
and the canal is still filled with fluid (NaOCl, CHOH, etc.),
a NiTi verifier the same size as the maximum apical file
(MAF) is selected. Using just the fingers, it is spun into
the canal to working length. The verifier has to be passive
when doing this step. Depending on the canal anatomy
(straight vs. curved), if there is significant resistance with
the selected verifier, such as traversing a curve of sufficiently sharp radius, then the carrier of the same size will
meet the same resistance when it is placed.
Therefore, you would then drop down one size,
test-spin that verifier to length, and it should encounter less resistance. This then would be the correct size carrier to choose, regardless of what the final
apical size was that you machined. Note: The verifier
is not verifying the apical size of the preparation, but
it is a dress rehearsal for how the carrier is going to
behave when it is inserted into the space. It is verifying the ease of insertion of the eventual carrier core.
For example, if you instrumented to a MAF size
30/0.06 in a significantly curved canal (less than
25 degrees), a #30 size verifier may not spin easily
to length; you would try a #25 size verifier instead.
In all likelihood, the #25 will go to length without
significant resistance.

Fig. 19b

Fig. 19c

The resistance it encounters is a function of the file/
carrierbeingdistortedbythecurvatureofthecanalspace;
the greater the curvature, the greater the distortion and
resistance (and the greater the chance of contacting the
carrier on two opposing sides during insertion, possibly
stripping the GP from the core). Dropping down one size
eases that impingement without compromising the
carrier’s ability to transport the softened gutta-percha
to length. The use of the size verifier is critical to the successful placement of the eventual carrier, but is often
done improperly, or not at all.
Once the appropriate carriers are chosen, the
canal spaces are dried completely with paper points,
the “FIRE technique,” etc. A small amount of sealer
is applied to the canal walls with a paper point (pinhead drop) into the shaped canal. If the canal is not
dry, the excess moisture will prematurely cool the
advancing wave of GP, resulting in a “pig-tail” of GP
extruded into the PA area. The same will occur with
excess sealer, and it will extrude along with the GP.
The carriers are placed singly into the oven, the correct
time chosen, and the cores allowed to heat to the proper
temperature. The small plastic, and all Gutta-Core carriers, are heated on the first setting (20 to 22 seconds); size
30 to 60 Thermafil Plus heated with the second setting
(40 to 42 seconds); and size 70 or larger, the third setting
(44 to 46 seconds). The carriers can be reheated, if necessary, and the time setting for the larger carriers is not
critical, as long as they are heated for at least 40 seconds.
Insertion of the heated carrier is slow and deliberate; you need to allow the excess material to be
vented coronally. Insertion rates are 2 to 3 mm per
second, which would translate to an average time
of seven to 10 seconds for most canals from orifice
to working length. With the larger carriers, you may
experience a “rebound” effect after the carrier is
inserted a few millimeters into the canal. Release the
carrier and it will “rise” slightly from the canal space.
This is the GP venting and pushing the carrier back
out of the canal slightly as it vents. Once the rebound
is stopped, you can continue the insertion, stopping
every few millimeters to check for rebound until the
carrier is inserted to length. Pushing through the

Fig. 19a_CaOH injected to fill canal
system and covered with a sterile
cotton pellet.
Fig. 19b_Core paste is placed to seal
the access opening.
Fig. 19c_A bonded temporary that
has been in place for three months
without leakage.

roots
I 13
2
_ 2013

[14] =>

I C.E. article_ obturation
Fig. 20_The FibreKor posts have a
wide selection of posts with good
retention and are easy to use.

Fig. 20

rebound and not allowing the GP to vent coronally
will precipitate significant extrusions.
Depending on which type of carrier is used, the
handle is cut at the orifice level using either a Prepi bur,
or a thermal tip (Figs. 14a,b). Removal of the handle
is essential when placing more than one carrier in the
access, as multiple handles in the access will obscure
the view for the succeeding placements. A radiograph
is taken to confirm placement, and any adjustments
are easily made by engaging the core with a file and
removing from the canal. Using a high-speed round
bur, the remaining carrier “stubs” are trimmed to the
desired level. If a post space is desired, it can be prepared immediately with an end-cutting ProPost drill
(Dentsply) that will not displace the carrier.
Compaction of warm GP using Thermafil for
carrier-based obturation is slightly different. A simple technique is to segment a GP cone into approximately 5 mm sections prior to the obturation process.
Immediately after the Thermafil carrier is separated
with a Prepi bur (Dentsply), the GP at the orifice is
still soft and can be readily compacted. To facilitate
thorough adaptation, a small and lubricated plugger
(about a size 8 to 8.5 Schilder) can be used to apically
compact the warm GP alongside the carrier.
Push apically to a predetermined distance, hold
briefly and remove the plugger. Then, using one of
the pre-cut segments of GP, place it into the void
created by the plugger, and compact it into place.
More segments of GP may be necessary depending
on the size of the canal. In cases when the canal may
be ribbon-shaped and large in the M-D or B-L direction, the apical third of the canal is obturated in the
conventional manner. Then an accessory carrier can
be inserted alongside the initial carrier (Fig. 15).
The second core of the second carrier functions as
a gentle spreader to assist in the lateral compaction
and spread of the softened GP. The warm GP from the
first and second carriers fuse together so any voids are
eliminated.

_Excess filling material
Historically, any time a case was obturated, there
was much concern when anything was extruded

14 I roots
2_ 2013

beyond the apical terminus. Many endodontic failures were blamed on vertical over-extension, but in
reality the culprit was an “under-filled” canal system.
As Schilder stated, “You can only fill a canal 100
percent.” If the canal is filled 100 percent, any excess
material extruded would be of no consequence.
In fact, if the author obturated a canal system and
there was no excess filling material, the GP would be
routinely removed and re-obturated until there was.
The point was, “How else could you be sure the canal
system was obturated 100 percent unless there was
some excess filling material present at the apex?”
Cases that have a significant amount of excess filling
material but are properly shaped, cleaned and packed
do heal. Over time, the excess material will slowly be
resorbed (Figs. 16a,b).
The biggest fear of the new user of injection or
carrier-based GP is, “There will be a great amount of
excess filling material at the terminus.” The opposite
is generally true. At first, the most common problem
for the new user was the inability to get to the terminus and completely fill/obturate the canal system.
The usual reason for this was either an improper
shape, the absence of patency or fear of the operator to use enough pressure during the injection and
compaction process.
A good way to imagine what is happening, while
using thermo-plasticized GP in a properly shaped
and patent canal, is to envision everyone in a theater
rushing to get out the same door in a big hurry. The
GP molecules are relatively large and warm, so the
continually tapering shape is, in itself, a limiting factor for the amount of sealer, or filling material, that
will be extruded beyond the apex.
If the apical terminus of the canal is kept as small as
practical, about the size of a 20KF, it is hard to obtain
more than a small “puff” at the apex, no matter how
hard the operator compacts the thermo-plasticized
GP (Figs. 17a,b). However, it makes sense that the
larger the apical opening, the larger the amount of
excess material might be extruded. In a short period
the operator develops the necessary “feel” to be very
predictable with the obturation and compaction.
This is the essence of the learning curve when beginning to use a thermo-plasticized technique. Also,
since the softness of thermo-plasticized GP is maintained for a longer time in a larger mass size (volume),
the apical extent is the first to become solid since it
has the smallest volume of mass. These techniques
are easy, fast and predictable for achieving excellent
obturation, if all is done as described.

_Now for the rest of the seal
The final step of the System “S” protocol is to fill
the entire canal system. It is self-defeating to do a
beautiful job in the apical half of the canal system
and turn the case over to another person to complete

[15] =>

C.E. article_ obturation

Fig. 21a

the coronal half of the obturation. As endodontists,
we are generally concerned with “the fill” and forget
the importance of sealing “the rest of the system.”6 To
illustrate this concept, look at the four cases depicted
in Figure 18, and then decide which one would have
the most predictable chance of success. They all have
well-done endodontic treatment, but only one case
has had the entire canal system sealed.
A survey taken not too long ago showed that 95 percent of general/restorative dentists did not use a rubber
dam while placing a foundation restoration in an endodontically treated tooth. To maximize the predictability
of success and avoid possible post-op complications,
the “endo-doer” must be responsible for the seal of the
entire canal system. Here are just a few reasons to do
the foundation restoration at the same visit:
1) Patient is “in the chair.”
2) Patient is anesthetized.
3) Rubber dam is in place.
4) Access is sterile for placement of the foundation
restoration.
5) All previous restorative materials are easily
removed.
6) The “endo-doer” has microscopically enhanced
vision.
7) The “endo-doer” knows correct angle, size and
depth of the canal system.
8) There is no chance of contamination of the
canal system.
9) Inadvertent perforations are eliminated.
10) The tooth can be “roughed prepped” with dam
in place.
11) The patient has more time to plan for the final
restoration.
12) After RCT, doctor knows, within two minutes,
the time to schedule for crown prep.
13) On anterior teeth, appointments can be coordinated for placement of a provisional.
It has been shown that coronal leakage is the major
cause of root canal treatment failure.7 Therefore, it
behooves us to do all that is possible to prevent it. If
multiple visits are required, the doctor should not rely
on “cotton and Cavit” to maintain sterility. With the current bonding and composite technology, the temporary
placed between visits should be a bonded composite.

Fig. 21b

Fig. 21c

A good example of an easy-to-use temporary is
auto-cure Tenure Uni-Bond and Core Paste (Denmat).
CaOH (Ultracal by Ultradent) is injected into the canal
system and covered with a sterile cotton pellet (Fig.
19a). Then Tenure Uni-Bond is used to condition the
access opening (Fig. 19b). After just a few minutes, the
auto cure Core Paste is set completely, the occlusion is
ready for any adjustments, to make sure there are no
interferences left to irritate the tooth between visits.
On occasion, a patient is unable to keep the appointed return visit and may have to delay his or her
return visit for weeks or months (Fig. 19c). There may
be an important change of events in his or her life, or
the doctor may also have to change the scheduled
visit. If a temporary is placed, such as Cavit, IRM or
Tempit, all control of the bacterial environment in the
canal system is lost in a relatively short period if the
patient does not return in a timely fashion.
Who would be better to control the coronal aspect of the tooth following endodontic obturation
than the “endo-doer,” while the case isolated with a
rubber dam in place? As Dr. Denny Southard of Tulsa,
Okla., commented almost 15 years ago, “When we
slap in Cavit and turn our heads, the case is destined
for contamination or worse [perforation, for example].” However, if a more definitive seal is maintained,
that part of the equation becomes a non-issue.6

Figs. 21a–c_The canal systems
have been filled 100 percent and are
ready for restorations without any
concern for micro-leakage until they
are more permanently restored.

_An easy foundation restoration
technique
After the obturation of all canals, the guttapercha is removed to the proper depth in the orifice
as required for retention. This is quickly and easily
done using a Munce Bur at approximately 5,000 rpm.
If a post space is required using carrier-based GP, a
ProPost drill can be used to remove a little GP at a
time, until the desired depth is reached. Using the
co-observer tube of the SOM and a precise flow of
air from the Stropko Irrigator, the chairside assistant
can aid in the removal of all bits of sealer and GP to
maintain vision while final cleaning of the access/
post space is done.
After the mechanical cleansing of the access is
accomplished, it is flooded with 95 percent ethanol
to remove any remaining sealer and scrubbed with a

roots
I 15
2
_ 2013

[16] =>

I C.E. article_ obturation
micro-applicator (SybronEndo). Another application
may be necessary to achieve a clean surface. If there
is a post space, it can be cleaned the same way, but
after flooding the space with 95 percent ethanol, use
a Versa-brush (Vista) turning at approximately 500
rpm to be assured of getting the post space walls free
of sealer. After this step, the post used can be tried in
to be sure it fits passively.
The FibreKor post kit (Pentron) has a very good
selection of sizes (Fig. 20). The 1.125 mm (lavender
colored lid on tube) fits most of the post spaces passively. If the fit of the post is not passive but is the
desired size, a very fine, tapered diamond is used to
taper the apical end until it does fit passively into the
space. Note: A post space should never be enlarged
to fit the post. The post should always be adjusted to
fit the post space. A post should only be used for retention of the core buildup and does not strengthen
the tooth.
Rinse and air dry the access, and then flood it with
37 percent phosphoric acid gel (Ultradent), letting it
remain for approximately 20 seconds to accomplish
the proper etch of the walls. Rinse very thoroughly
and air dry, being careful not to desiccate the dentinal
surface. Apply two coats of Tenure A&B (Den Mat) for
conditioning of the dentin, air drying between each
and inject Core Paste (Den Mat) to fill the access completely. If needed, the FibreKor post can be cemented
with the initial application of Core Paste.
It is a good idea to also coat the fiber post with the
Tenure A&B before insertion into the newly injected,
soft Core Paste. Note: Do not use the Tenure UniBond for this step, as it is thicker in consistency and
may affect the passive fit of the post.
Core Paste is one of the most forgiving and
easy-to-use materials. It is auto-cure, has adequate
working time and can be “stacked” or added onto, so
enough bulk is easy to achieve for the desired buildup,
and it always sets up in two to three minutes. The
tooth can then be rough prepped and returned to the
referring doctor (Figs. 21a–c). At any rate, the endodontically treated tooth is ready for the final crown
prep and impression if the doctor wishes to do it at
the same appointment.

_Respect for the endo-pros relationship
Current technology has allowed endodontic
treatment to achieve a very high degree of success
when the coronal seal has been accomplished. Weine
has stated that more endodontically treated teeth are
lost due to improper restoration than to endodontic
failure.8 More recently, it was shown that in 1.5 million people over an eight-year period, there was a
97 percent success rate for endodontically treated
teeth. Of the 3 percent that failed, 85 percent of those
had no coronal coverage.9 It is necessary to appreciate some basic restorative/prosthodontic principles

16 I roots
2_ 2013

to establish a degree of predictability we want to
achieve with the System “S” protocol of treatment.
It has been shown that teeth do flex during normal
function. The less radicular structure present, the
weaker the tooth will be. And the weaker the tooth,
the more it flexes. The more it flexes, the more micro
leakage occurs, and it becomes only a matter of time
before the tooth fails. The canal system can be contaminated due to micro leakage, by fracture due to
lack of radicular strength, or the crown/post/core can
break or come out. If a restoration is placed, entirely
based on the retention of the foundation restoration,
it is not an issue of whether the restoration will fail; it
is a matter of when it will fail.10
It is critical that a minimal circumferential ferrule of 1 to 2 mm be established for retention of the
restoration. A biological width of approximately 2
to 3 mm is required between the osseous crest and
the cervical margin of the restoration.11 Therefore, a
minimum total of 3.5 mm is necessary between the
intended cervical margin of the restoration and the
osseous crest.
Another important consideration for conserving
root structure is the necessity of a post for retention. It is worth repeating, “A post is only indicated
if retention of the core is inadequate without it.
Posts are only indicated when needed for retention.
The post space must never be shaped to fit the post.
Instead, the post must be shaped to fit the existing
post space.” The more radicular substance removed,
the weaker the tooth. Posts never strengthen a tooth.
Conservation of the radicular structure also needs
to be considered when accessing and shaping the
canal system. Only enough tooth substance should
be removed to achieve vision and desired shape
needed to completely disinfect, clean and obturate
the entire canal system. If the access is compromised,
the correct shape may be difficult if not impossible to
achieve. Likewise, if we compromise the shape, the
cleaning and obturation will also not be as complete
as desired for predictability. The author is amused by
anyone willing to compromise access and shaping in
the name of tooth conservation. What good does all
that tooth structure do if the tooth is lost to disease?
Once the referring doctors are made aware of the
favorable benefits that will be derived, it becomes
difficult for a conscientious person to object to this
concept of eliminating untoward possibilities that
can lead to failure of treatment.

_Conclusion
The System “S” protocol demands thoroughness
in treatment of the entire canal system. The author
uses a Calamus for obturation, but carrier-based
techniques of using warm GP can be used with the
same degree of success, as long as they are done
correctly. System “S” requires a commitment to

[17] =>

C.E. article_ obturation

complete all six steps to avoid the many pitfalls that
present themselves during treatment of the entire
endodontic canal system.
A survey of endodontists taken about nine years
ago stated that 38 percent always used an SOM, 30
percent sometimes used it, and 32 percent never used
it.12 Hopefully, things have changed. The use of an
SOM is essential for us, as “endo-doers,” to achieve
the high level of predictability our current technology
allows us to deliver. We only know what we see, and
if we don’t see it we don’t know it. A good example
is the high percentage of fourth canals (93 percent)
that can be found in the maxillary molar segment.
The clinical use of the SOM significantly increased
the number of canals that were discovered.13 If these
canals are not found, and the operator doesn’t take
the time to locate and treat them, the predictability
of success will be far less. It behooves all of us to do
everything humanly possible to give our patients
dental treatment that will create the health they
expect from our profession.
In general, our current endodontic vision has been
directed to treatment of the apical half of the root canal system. It should not be a problem integrating the
basic principles of bonding technology, restorative
principles and post core placement into our normal
endodontic treatment protocol. We, as a specialty,
should be thinking in terms of being responsible
for the entire canal system and doing everything
humanly possible to increase the predictability of
our treatment. When endodontic treatment fails, it
seems like everyone “stands around in a circle and
points at one another.” Adhering to proven principles
eliminates the probability of contamination of the
canal system by providing a solid foundation for the
restorative aspect of the patient treatment.
Obviously, those who are so concerned with the
endodontic lack of respect for radicular structure have
not witnessed what often happens to that same tooth
when preparing it for a crown. It is imperative for the
endodontic and restorative to be a team, working together for predictability, in the interest of the patient.
Our job as “endo-doers” is to learn, become teachers
and educate the patients, staff and doctors we work
with, so we can achieve dental health as a team. Let’s
not “cave into” the demands of public convenience or
political pressure, but rather be governed by proven
dental principles, so we can achieve predictable endodontic success, saving the teeth our patients are born
with. Isn’t that what endodontics is all about?_

_References
1.
2.

Schilder H. Filling root canals in three dimensions. Dent Clin
North Am 1967;11(7).
Weller RN, Kimbrough WF, Anderson RW. A comparison
of thermoplastic obturation techniques: adaptation to the
canal walls. J Endod 1997;23(11):703–706.

Schilder, H. Cleaning and Shaping the Root Canal. Dent Clin
North Am 1974;18(2):269–296.
4. Veis A, Lamianidis T, Molyvdas I, Zervas P. Sealing
ability of sectional injection thermoplasticized gutta-percha
technique with varying distance between needle tip and
apical foramen. Endod Dent Traumatol. 1992;8 (2):63-66.
5. Johnson WB. A new gutta-percha technique. J Endod
1978;4(6):184–188.
6. Southard DW. Immediate Core Buildup of Endodontically
Treated Teeth: The Rest of the Seal. Pract Periodontics &
Aesthet Dent. 1999;11 (4): 519–526.
7. Heling I, Gorfil C, Slutzky H, Kopolovic K, Zalkind
M, Slutzky-Goldberg I. Endodontic failure caused by
inadequate restorative procedures: review and treatment
recommendations. J Prosthet Dent. 2002;87(6):674–678.
8. Weine FS. In: Endodontic Therapy. 5th Ed. St. Louis,
MO:Mosby, 1996:4.
9. Salehrabi R, Rotstein I. Endodontic treatment outcomes in
a large patient population in the USA: an epidemiological
study. J Endod. 2004;30(12):846-850.
10. Kois J. Implants — Restorative Heroics vs. Replacement
Antics, 47th Annual Meeting American Equilibration
Society, Feb 21, 2002, Chicago.
11. Goldberg PV, Higginbottom FL, Wilson TG. Periodontal
considerations in restorative and implant therapy.
Periodontol 2000. 2001;25:100–109.
12. Dental Products Report Survey: Endo Survey to Dentists.
Dental Products Report. July 2004, p.20.
13. Stropko J. Canal Morphology of Maxillary Molars: Clinical
Observation of Canal J of Endo, 1999;25(6):446–450.

_about the author

roots

John J. Stropko received his
DDS from Indiana University
in 1964. For 24 years he
practiced restorative dentistry. In 1989 he received
a certificate for endodontics
from Boston University and
has recently retired from
the private practice of endodontics in Scottsdale, Ariz.
Stropko is an internationally recognized authority on
microendodontics and has performed numerous live microendodontic and microsurgical demonstrations. He has
been a visiting clinical instructor at the Pacific Endodontic
Research Foundation (PERF); an adjunct assistant professor at Boston University; an assistant professor of graduate
clinical endodontics at Loma Linda University; a member of
the endodontic faculty at the Scottsdale Center for Dentistry
in Scottsdale, Ariz., as an instructor of microsurgery; and is
a co-founder of Clinical Endodontic Seminars. His research
on in-vivo root canal morphology has been published in the
Journal of Endodontics. He is the inventor of the Stropko
Irrigator, has published in several journals and texts and
is an internationally known speaker. Stropko and his wife,
Barbara, currently reside in Prescott, Ariz. You may contact
him at docstropko@gmail.com.

roots
I 17
2
_ 2013

[18] =>

I instrumentation_ MounceFiles

MounceFiles: A safe,
economical and efficient
option for canal preparation
Author_Rich Mounce, DDS
_Opinions vary as to the best means to achieve
three dimensional cleansing, shaping and obturation of the root canal system. Emerging technology,
literature research and proven clinical success all
provide clinicians with options, evidence and methods for their clinical techniques. Presently, there is
no commercial consensus on the optimal methods
for canal preparation, especially when considered
across the wide range of clinical cases encountered. The options in the marketplace are myriad
— Dentsply, Coltene Whaledent, SpecializedEndo,
Brasseler, Ultradent.
Taking into account the present state of the art in
nickel-titanium science and manufacture, literature
evidence and extensive clinical experience, what follows are the author’s chosen materials and methods
of shaping root canal systems, i.e., the MounceFile. This
article was written both to introduce the MounceFile
and suggest that the reader compare his or her present
systems and treatment strategies for achieving the
goals of canal preparation.

The goals of canal preparation are to:
• Maintain the original position of the canal.
• Maintain the original position and size of the
apical foramen.
• Prepare a tapering funnel with narrowing
cross-sectional diameters (in essence, to
mimic the shape of a tornado).
• Prepare a taper that is proportional to the external dimensions of the root that does not predispose the root to subsequent vertical fracture.
• Prepare a taper that allows cone fit with tugback and ideal obturation hydraulics during
down pack with warm vertical obturation
techniques (and warm techniques of all types).
• Prepare a taper that optimizes the necessary
volume and space for activation of irrigants.
Among other valid and clinically proven marketplace choices, MounceFiles represent a literaturebased, clinically valid, safe, efficient and economical
option for canal preparation.

_Universal application
It is a personal bias that not every instrumentation
system is applicable to all canal anatomy encountered.
Anatomy is infinite in its diversity (three-rooted lower
molars, etc.), variety (length, curvature, etc.), clinical challenge (resorption, immature apices, etc.) and the environment in which these canals are treated (limited opening,

Figs. 1a, b_The MounceFile SNT
Assorted Pack. (Photos/Provided by
Rich Mounce, DDS)

18 I roots
2_ 2013

Fig. 1a

Fig. 1b

[19] =>

[20] =>

I instrumentation_ MounceFiles

Fig. 2a

Fig. 2c

Fig. 2d

Fig. 2b

Fig. 2a_Mani D finders.
Fig. 2b_Mani K files.
Fig. 2c_Safe-ended Mani hand SEC
O K file.
Fig. 2d_Synea W&H WA-62, a
reciprocating hand piece.

20 I roots
2_ 2013

excessive swallowing by patients, etc.). “One size fits all”
algorithms work some or most of the time, but given the
above variables, in the wrong clinical situation, otherwise
typical clinical actions can lead to iatrogenic events.
MounceFiles come in two forms of nickel titanium, Controlled Memory© (CM) and standard nickel
titanium (SNT). CM nickel-titanium files result from a
proprietary thermomechanical treatment of nickeltitanium whereby once curved, the files remain curved.
Clinically, this means that as a CM instrument rotates
through a curvature, the file remains curved, a valuable
attribute in a complex canal. SNT files are superelastic,
meaning they spring back to their original shape after
being stressed (used clinically). CM instruments have
shown increased resistance to cyclic fatigue and other
attributes relative to their superelastic counterparts.1–5
MounceFiles are square in cross section, nonlanded and of constant taper throughout their cutting
flutes. The square cross-section provides added fracture resistance relative to triangular cross sections due
to the increased metal mass in this dimension.
The MounceFile Assorted Pack is designed more for
the general dentist and the typical endodontic case.
Specifically, this pack is ideal for teeth that are 18–23
mm, have roots of moderate curvature and canals that
are located with relative ease and negotiable with hand
files. The MounceFile CM Assorted Pack and MounceFile SNT Assorted Pack are configured (from left to right
in the box) from larger tapers to smaller: .08/25; .06/25;
.04/25; .03/25; .02/25, .03/30 (Fig. 1).
The MounceFile system was developed to give
endodontists a virtually unlimited choice of tapers and
tip sizes to custom assemble their file configurations
and handle virtually any clinical case. If the endodontist
(or general dentist handling complex cases) wants to
customize his or her selection of MounceFiles, there are
75 combinations of taper and tip size available in both
CM and SNT files. Tapers include .01 in addition to the

tapers present in the assorted packs. Tip sizes among
the tapers range from 20–60, depending on the taper.
The breadth of this product line gives an unlimited
set of options for clinicians of any experience level
(from dental school graduates to veteran endodontists)
to treat virtually any canal (from a straightforward #8
to a more complex 25 mm C shaped #18 with multiplanar curvature and a relatively open apex in proximity to
the inferior alveolar nerve).

_Clinical technique
The following directions for use and FAQs have been
adapted from PDFs on the www.MounceEndo.com
website. These directions reference the MounceFile CM
Assorted Pack. The directions for the MounceFile SNT
Assorted Pack are identical to those below.
Specifically, the MounceFile CM Assorted Pack is used
within the context of the following treatment steps:
Step No. 1: Estimate the true working length
Before making access, the clinician should estimate
the true working length (TWL) from the initial preoperative radiographs. This is the estimated working length
(EWL). The EWL is used later to help confirm the TWL,
which is determined radiographically or electronically
(Foramatron-Parkell, Elements Diagnostic Unit-Axis/
Sybron, Root ZX II-J Morita).
Step No. 2: Prepare straight-line access
Straight-line access is achieved when all of the
canals can be seen in one mirror view and hand and
rotary files can be inserted without deflection off the
axial walls of the preparation.
Step No. 3: Remove the cervical dentinal triangle
The .08/25 MounceFile CM is inserted 2–3 mm below
the orifice and removed with a brushing motion up

[21] =>

instrumentation_ MounceFiles

Fig. 3a_The MounceFile .08/25
rotary nickel-titanium orifice opener
in Controlled Memory (retains its
shape once a curve is placed upon it).
Fig. 3b_The MounceFile .08/25
rotary nickel-titanium orifice opener
in Standard NiTi (SNT) (superelastic,
returns to its original shape upon
being curved/stressed).
Fig. 4a
Figs. 4a, b_Clinical cases treated
with the MounceFile CM and SNT
Assorted pack (.08/25, .06/25,
.04/25, .03/25, .02/25, .03/30)
utilizing the techniques discussed.

Fig. 3a

Fig. 3b

and away from the furcation (against the canal wall of
greatest thickness). After removal of the CDT, the pulp
chamber and canal orifice is irrigated copiously.
Step No. 4: Shape the coronal third
After CDT removal, using light pressure, the .08/25
MounceFile CM is gently inserted to the point of first canal curvature. Insertion is gentle and should ideally take
about three seconds. The file is not used with a pecking
motion. If the file will advance easily and shape the
coronal third or advance to the point of first curvature,
then it can be taken to this level.
If the .08/25 MounceFile CM file will not easily reach
the point of first curvature (or shape the coronal third)
after several insertions, do not force the file to reach
length. Move to Step No. 5. Irrigate copiously after every
insertion of the orifice opener.
Step No. 5: Establish and/or confirm apical patency
Stainless-steel K files are used to establish and/or
confirm apical patency (Mani K files, Mani D Finders,
Mani Flexile K files). Using the EWL determined from
the pre-operative radiographs, pre-curved hand K
files (#6, #8, #10; whatever size is appropriate to the
canal treated) are inserted successively until the EWL is
reached. Now the clinician should verify he or she has
reached the apex of the root with an electronic apex locator and/or a radiograph. The EWL and the TWL should
be relatively close if not identical.
Step No. 6: Prepare a glide path
Once a hand file reaches the apex and TWL is established, the canal should be enlarged to the diameter of

Fig. 4b

a #20 hand file, i.e., prepare a glide path. One proven
method to prepare a glide path is with #6, #8, #10, #15
and #20 hand K files used in succession. A reciprocating handpiece can be immensely helpful in preparing
a glide path, especially using a safe-ended hand K file
(Mani SEC O K file) (Figs. 2a–d).
Step No. 7: Prepare the canal ‘crown down’
The .06/25, .04/25, .03/25, .02/25, .03/30 files are
used successively until the desired taper and tip size
is achieved. In the majority of clinical cases, a .06 taper
is prepared to the apex (i.e., to the TWL). Using the
MounceFile CM Assorted Pack, this means the .06/25
instrument will be taken to the TWL before preparation
of the master apical diameter.
If any given file in the MounceFile CM Assorted Pack
does not advance apically without undue pressure,
move to the next smaller file in the sequence (from left
to right in the pack, i.e., crown down) and continue to
use them in succession (from larger tapers to smaller)
until the desired taper is prepared to the apex.
As with the .08/25 MounceFile CM file, the insertion
should be gentle, to resistance and take approximately
three seconds. Such file engagement should remove approximately 4–6 mm of dentin with each insertion. Do not
use a pecking motion or force the files apically. After each
insertion, irrigate the canal and recapitulate with a small
(#8, for example) hand K file to assure patency (Figs 3a, b).
Step No. 8: Prepare the master apical diameter
Once the final taper is prepared (generally .06 taper),
the .03/30 MounceFile CM file is taken to the TWL to prepare the master apical diameter (MAD). If the clinician

roots
2

_ 2013

I 21

[22] =>

I instrumentation_ MounceFiles
•
•

Figs. 5a, b_Clinical case re-treated
with MounceFiles. Figure 5A is the
pre-operative view. Figure 5B is
the completed case with the MB2
located and treated.

•
•

Fig. 5a

•
•
•

Fig. 5b

wishes to prepare a larger MAD, he or she can do so by
whatever means is desired.
Important supplementary information
• Use an electric torque control endodontic motor (TCM III-Axis/Sybron).
• 500 rpm is recommended. Rotational speed
can be modified depending on clinician experience and preference from 500-900 rpm.
• A gentle and feather touch insertion of the
file is recommended. Insertion should seek
to minimize engagement of the instrument
to 4-6 mm of canal wall per insertion, which
generally will take about three seconds. Files
should be rotating when inserted. Files should
be inserted or removed but never left stationary while in use. Do not use a pecking motion
or insert the file repeatedly in order to progress
apically. If the canal resists apical advancement while using minimal pressure, remove
the instrument and chose the next smaller file.
• After insertion, the flutes are wiped of debris,
the canal irrigated and the canal recapitulated
with a small hand K file (Mani K file #8 or #10).
• To minimize risk of canal transportation and/or
file separation, each file should be taken to the
true working length only once for one to two
seconds, then removed.
• Irrigation and recapitulation should be performed after every insertion.
• If the file is inserted as per the instructions above,
using torque control with the auto reverse function engaged is a matter of clinician preference.

22 I roots
2_ 2013

Single use is recommended.
Discard files in an appropriate biohazard
sharps container.
Straight-line access and removal of the cervical dentinal triangle are recommended.
While a step back approach to instrumentation
is feasible and possible in many canal anatomies, the MounceFile CM and SNT instruments
are used most efficiently in a “crown down”
(CD) sequence, shaping the coronal third first,
middle third second and apical third last. Clinically, this means that larger taper and tip-sized
instruments are used first followed by smaller.
Rubber stopper colors on the MounceFiles
indicate taper size: .01 Purple, .02 White, .03
Black, .04 Red, .06 Yellow, .08 Light Blue.
The .08/25 mm orifice opener in the 21 and 25
mm MounceFile CM and MounceFile SNT Assorted Packs is 21 mm long.
No set of instructions or precautions is comprehensive. Evaluation of risks is essential. Treatment
algorithms and clinical strategies must often
be revised in the face of anatomical challenges
(severe calcification, curvature, open apices, etc.).
Clinical judgment and caution are advised.

_FAQs
What is “Controlled Memory” (CM) and how do these
files differ from standard nickel-titanium files?
Controlled Memory instruments have been subjected
to a proprietary thermomechanical treatment that provides significant resistance to cyclic fatigue relative to
nickel-titanium (NT) instruments without this treatment. When a CM instrument curves during treatment,
it retains its shape. CM treatment reduces the effects of
NT shape memory, minimizing transportation. Use of CM
instruments versus the MounceFile SNT (standard nickel
titanium) files is a matter of personal preference with the
limitation that SNT instruments are less resistant to cyclic
fatigue relative to the CM variety.
How many times can I use the MounceFile CM and
SNT files?
Single use of the MounceFile CM and SNT instruments is recommended.
How do I sterilize new packs of files?
With a steam autoclave, sterilize the instruments at
136 degrees C for 20 minutes.
Can I use MounceFile CM and SNT files to remove
gutta-percha?
Yes, appropriately sized MounceFile CM and SNT files
can be used to remove gutta-percha in retreatment.
Is torque control recommended?
If the file is inserted as per the instructions below,

[23] =>

[24] =>

I instrumentation_ MounceFiles
using torque control with the auto reverse function
engaged is a matter of clinician preference.
Why is the .03/30 MounceFile CM instrument at the
end of the sequence?
The .03/30 MounceFile CM instrument (at the far
right of file box) allows the clinician to prepare the apical diameter to a #30 tip size.
How do I obturate a canal prepared by the MounceFile CM Assorted Pack?
Canals can be obturated in whatever manner the
clinician chooses. Using vertical compaction and lateral
condensation techniques, it is efficient to learn to trim
cones. Specifically, a .06/25 cone trimmed 1 mm from its
tip is approximately equivalent to a #30 ISO instrument.
If the clinician is using carrier-based obturation, he or
she can use a size verifier and place the carrier as desired.
What if I want to prepare a larger apical diameter
than a #30 tip size?
The clinician can use whatever means he or she desires to prepare an apical diameter larger than a #30. In
the MounceFile CM file system, the .03-tapered instrument is available (among other tip sizes) in a #40 tip size.
What is “crown down” instrumentation and what
are the advantages of this approach in canal shaping?
After straight-line access is prepared, the orifice
shaped, the canals negotiated to the apical foramen
and a glide path prepared, crown down instrumentation
means that the coronal third is prepared first, the middle
third prepared second and the apical third last. In essence, the clinician is preparing the root from the crown
of the tooth to the root apex, so crown down (CD).
The advantages of CD instrumentation outweigh any
relative disadvantages. A CD approach removes restrictive dentin, especially in the coronal third, and facilitates
its removal by allowing early and copious irrigation prior
to enlargement of the middle and apical thirds. Removal
of restrictive dentin and its evacuation from the root
minimizes the possibility that this debris will be pushed
apically. Alternatively, leaving this debris risks canal
blockage, an outcome correlated with uncleaned and
unfilled canal space and canal transportation.
Are there any contraindications to crown down
instrumentation?
There are no absolute contraindications to the CD
technique. There are several clinical situations where a
CD approach might be less efficient. Specifically, cases
of severe curvature, with or without severe calcification, might argue for a step back (SB) approach or a
combination CD and SB approach. Such severe cases
are not what the MounceFile CM Assorted Pack were
designed to treat and these cases generally require a
combination of specialized techniques (Figs. 4, 5).

24 I roots
2_ 2013

What pre-operative considerations are correlated
with endodontic success (among other factors)?
• Optimal visualization (ideally a surgical operating microscope, most certainly loupes,
Global Surgical, Zeiss, Orascoptic).
• Copious irrigation.
• Use of the rubber dam for every case, without
exception.
• Use of a bite block where possible.
• Profound anesthesia (STA-Milestone Scientific).
• Pre-operative assessment of risks (number of
roots, curvature, calcification, risk of perforation,
open apices, presence of root resorption, etc.)
• Diagnostic radiographs (taken from different
angles) and a cone beam where indicated to
fully illustrate the anatomy (Planmeca, Sirona).
• Referral when in the best interest of the patient.
• Staff training and education (if the staff knows
what each step of the treatment process is
intended to accomplish, they can provide the
needed support more efficiently).
• Having the needed instruments available in
the sizes required and having them organized
in a fashion that makes them easy to access
and store while not in use.
• Detailed informed consent.
This clinical article has introduced the MounceFiles,
a new, literature-based, clinically valid, safe, economical and efficient rotary nickel-titanium option for canal
preparation. Emphasis has been placed on blending
proven clinical principles with the instruments discussed. Readers are encouraged to compare their
present systems and treatment strategies to those
presented here. I welcome your feedback._
Editorial note: A complete list of references is
available from the publisher.

_about the author

roots

Rich Mounce, DDS, is in
full-time endodontic practice in Rapid City, S.D. He
has lectured and written
globally in the specialty.
He owns MounceEndo
LLC, marketing the rotary
nickel-titanium MounceFile in Controlled Memory
and Standard NiTi. MounceEndo is an authorized
dealer of Mani stainlesssteel hand files and burs.
Mounce can be reached at
richardmounce@mounceendo.com, www.mounceendo.
com and on Twitter at @MounceEndo.

[25] =>

[26] =>

I education_ training replicas

No more supremely
stinky teeth
Author_L. Stephen Buchanan, DDS, FICD, FACD
_Extracted human teeth have been a blessing and
a curse for endodontic educators.
The blessing? Teaching dental students and dentists new endo techniques in real human teeth
without the human attached. Awesome, no human!
The curse? Infected, supremely stinky teeth with
unknown anatomy, no relationship to educational
objectives, and no mulligans.
Let’s put aside the supremely stinky teeth part for
now and just look at the unknown anatomy issue, the
educational objectives issue, the testing issue and the
no mulligans issue.
The unknown anatomy issue doesn’t need much
explanation. Unknown anatomy is the fun part of
clinical endodontic practice, but it’s a nightmare
in procedural endodontic training. Think about it.
Teaching endo technique is limited by the random
nature of the root canal anatomy presented in the extracted teeth students procure. It’s not like you get to
choose the anatomic challenges that your students
work their way through, or ever know what’s in those
teeth they brought to your course.
The educational objectives issue is very simple.

Fig. 1_TrueTooth procedural
training replica. Note the fine detail
of internal root canal anatomy,
including fins, webs, and loops,
lateral and accessory canals — the
full Monty. (Photo/Provided by
Dr. L. Stephen Buchanan)

26 I roots
2_ 2013

Fig. 1

There are a number of procedural endodontic challenges — abrupt apical curves, “S” curves, cervical
curves, mid-root bifurcations, apical confluencies,
etc. How do you find a number of extracted teeth
with the same anatomic challenge you want to teach
your students to handle? Not possible with extracted
teeth; they aren’t designed to answer a specific procedural training objective.
The testing issue? Extracted teeth for board exams
are neither fair to the examined nor defendable as fair
by examiners. No consistency, no defense, case closed.
The no mulligans issue? Being denied another
attempt after you’ve just screwed the pooch working
through a given anatomic challenge? That’s rough,
and that’s why becoming competent in endo therapy
has been a random walk through endo anatomy only
overcome by a large number of cases treated.
Up until now, endodontic procedural training
has been hamstrung by the random nature of the
anatomy encountered by students when working in
extracted teeth (not to mention the smell). When we
attempt a procedure in a given root canal space and,
for instance, come upon an impediment in the canal

[27] =>

[28] =>

I education_ training replicas
but ledge it before we know better, we don’t get a
second attempt. We are left to hopefully deconstruct
the error correctly, and then just wait for another
tooth having similar anatomy.
So what would it be like to repeat — in exactly the
same anatomic form — a procedure over and over
(and over, if necessary), until you get it?
Flash back to more than 20 years ago …
I treat a physics professor from UCSB who explains how he invented a method to print, in three
dimensions, any computer-generated CAD model —
a process he called Stereo-lithography. The machine
he invented had a 10-inch cubed vat — with a plate
that moved up and down in it — filled with photopolymerizing resin. Above that a laser traces the
surface of the solution, polymerizing, layer-by-layer,
the cross-sectional geometry of the object to be
fabricated. The plate then drops by a precise amount,
and the laser traces the next layer. When the object
has been completely printed, the plate rises out of the
resin bath with the object revealed.
This blew my mind completely. Everything was
different now. Research, prototyping, testing, training, manufacturing, engineering, product design and
pretty much everything else was, or was going to be,
different now. My first question?
Could we print replicas of teeth?
I had spent the previous five years working out
how to CT scan extracted teeth and reconstruct them
in 3D computer space as virtual replicas,1 so replicating, in 3D, the incredible anatomy we were seeing in
our reconstructed models was very fun to consider.
He said no, not yet — the technology was in early
development so the resolution was too large to work
for RCT training and the cost of printing at that point
could only be borne by aerospace firms. So I waited
for 10 years, and had a tooth replica printed at the
resolution possible at that time but found it was
not yet ready for prime time in dentistry (Fig. 1). Last
year, the inflection points of resolution, polymer
chemistry and cost intersected for dentistry’s use of
stereo-lithography, and this year Dental Education
Laboratories, after completing our development,
introduced as TrueTooth™ training replicas.

_It’s here now
These replicas are printed in clear and opaque
versions for training and testing, and the polymers
used are heat-resistant so high speed burs don’t
gum up when cutting access cavities and the replica’s canal walls don’t melt when obturating with
warm gutta-percha methods. Inside the replicas, in
all the root canal spaces, is a gel-like material that
is red in color and dissolves in sodium hypochlorite,
immediately showing students the efficacy of their
irrigation procedures. Inside the replicas, are the

28 I roots
2_ 2013

phenomenal intricacies of endodontic anatomy in
all of its natural glory.
Negotiating through the canals gives tactile feedback
that there is still “pulp” medium present, that the file tip
has engaged a lateral fin or accessory canal — in other
words, almost as good as the real thing. Cutting shapes in
clear TrueTooth roots reveals what aggressive file tips are
actually doing when they destroy apical anatomy during
preparation procedures. Obturation procedures in these
replicas are a “thrill of the fill” experience.
Summary? All boxes are ticked:
1) No unknown anatomy. All the anatomy of every
replica is known.
2) Replicas can be chosen for teaching specific
endodontic procedural skills.
3) Replicas are exactly the same so they are a fair
test between board applicants.
4) 3D printed replicas can be worked with — over
and over — the same challenge every time.
5) They are less expensive than the oversimplified
training models available.
6) No more stinky teeth.
Endodontic procedural training will never be the
same._

_Reference
1.

Buchanan, L.S., and Hebert, J.P.: 3-D computer
reconstructions of CT Scans of extracted human teeth,
Unpublished, 1987.

_about the author

roots

L. Stephen Buchanan, DDS,
FICD, FACD, was valedictorian of his class at the
University of the Pacific
School of Dentistry, and he
completed the endodontic
graduate program at Temple
University in Philadelphia in
1980. He began pursuing
3-D anatomy research early
in his career, and in 1986
he became the first person in dentistry to use micro
CT technology to show the intricacies of root structure.
In 1989 he established Dental Education Laboratories, through which he has lectured and conducted
participation courses around the world. Buchanan
holds a number of patents for dental instruments
and techniques, including variably tapered shaping
instruments for use in endodontics. He pioneered a
system-based approach to treating root canals. He is
a diplomate of the American Board of Endodontics.
He maintains a private practice limited to endodontics
and implant surgery in Santa Barbara, Calif. Contact
him at 1515 State St., Suite 16, Santa Barbara, Calif.
93101, (800) 528-1590 or (805) 899-4529, info@
endobuchanan.com, www.delendo.com.

[29] =>

[30] =>

I industry_ Technology4Medicine

PIPS Laser Endo
harnesses the power
of the Lightwalker
Dual wavelength, all-tissue Er:YAG & Nd:YAG laser cleanses canals
Fig. 1_ The Lightwalker dual wavelength, all
tissue Er:YAG & Nd:YAG laser. (Photos/Provided
by Technology4Medicine)
Fig. 2_Internal surface after conventional
instrumentation, without PIPS.
Fig. 3_Clean dentin surface achieved with the
PIPS root canal treatment.
Fig. 4_Higher magnification after PIPS. Collagen
fibers are intact, with no thermal damage.
Fig. 5_Clean dentinal tubules
after PIPS.

_PHAST™ Laser Endo (PIPS™) harnesses the
power of the proprietary Lightwalker Er:YAG
laser, both exclusively available from Technology4Medicine (www.T4Med.com), to create
photoacoustic shock waves within the cleaning
and debriding solutions in the canal.
The containment of the shockwaves thoroughly streams these solutions three-dimensionally through the entire canal system, enhancing their effectiveness. The canals and
subcanals are left clean and the dentinal tubules
are free of smear layer. It is a well-established
fact that different dental procedures require
different laser wavelengths. Wavelength is
important to clinical outcomes because specific
body tissues interact in different ways depending on the particular laser source.
The Lightwalker is a true dual wavelength
system. With the choice of two complementary
wavelengths, LightWalker is the “universal”
laser. Practically all laser-assisted dental treatments can be performed with either the most
highly absorbed Er:YAG laser wavelength or
the selectively absorbed, deeper penetrating
Nd:YAG laser wavelength.
There are many advantages to using the
Lightwalker and its proprietary PHAST (Photo

Active Systems Technology) and PIPS for endodontic procedures:
• First is the entire root canal and subcanal
system is more effectively cleaned and debrided than with traditional instrument-only
techniques, reducing the risk of re-infection.
• The minimally invasive nature of PIPS
preserves more tooth endoskeleton than
traditional instrument techniques because
filing can be limited to as small as ISO #20
or 25, maintaining more post-restoration
tooth strength.
• Sub-ablative power levels eliminate the
risks of thermal damage, ledging and demineralization inherent to other laser endodontic
methods.
• Because the PIPS tip is inserted only into
the coronal opening and not into the canal,
there is no risk of tip breakage from curved
canals or unwanted apical extrusion of chemical irrigants, as is possible with standard laser
endodontic methods.
• Less filing time and less soaking time for
chemical agents can significantly reduce treatment time while being more effective.
The SEM images below demonstrate the effectiveness of PHAST Laser Endo._

Fig. 1

Fig. 2

Fig. 3

30 I roots
2_ 2013

Fig. 4

Fig. 5

[31] =>

[32] =>

I industry_ Wykle Research

Wykle Research
expands its
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 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 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

32 I roots
2_ 2013

[33] =>

[34] =>

I industry_ Seiler

Plasma light source
from Seiler
Latest advance is designed to offer clearer, crisper images
_Have you seen the light? Seiler’s new Plasma
light source, that is!
It’s even brighter than 180 W Xenon and
three times as bright as an LED, with over
100,000 LUX and it has a bulb life of more than
10,000 hours.
See clearer, crisper images through the use of
live video and/or a digital camera.
The Plasma can be retrofitted to an existing
scope or equipped on any new operating microscope.
Seiler continues to stay at the forefront
of fine optics and stands behind its products
with a lifetime warranty on the optics and
mechanics.
To experience the Seiler advantage, call
(800) 489-2282 to schedule a free demonstration, or visit www.seilermicro.com for more
information._

Fig. 1_Seiler has a new Plasma light source.
(Photos/Provided by Seiler)
Fig. 2_A close-up view.

Fig. 1

Fig. 2

34 I roots
2_ 2013

[35] =>

[36] =>

I about the publisher_ submissions

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
space between paragraphs. We also ask that
you forego any special formatting beyond the
use of italics and boldface, and make sure that
all text is left justified.
If you would like to emphasize certain
words within the text, please only use italics
(do not use underlining or a larger font size).

36 I roots
2_ 2013

Boldface should be reserved for article headlines, headers and subheads please.
Please do not “center” text on the page,
add special tab stops or use underlines in your
text as all of this must be removed manually
before layout. If you require a special layout,
please let the word processing program you
are using help you to do this formatting
automatically rather than doing it manually.
If you need to make a list or add footnotes
or endnotes, please let the word processing
program do it for you automatically.
There are menus in every program that
will help you apply all sorts of special formatting.
_Image requirements
Please number images consecutively by
using a new number for each image. If it is
imperative that certain images are grouped
together, then use lowercase letters to designate the images in a group (i.e., Fig. 2a, Fig.
2b, Fig. 2c).
Insert figure references in your article
wherever they are appropriate, whether that
is in the middle or end of a sentence, but
before the period rather than after. Our
preference is to have figure references noted
in the appropriate place within the text, as it
helps the readers to orient themselves when
moving through the article. In addition,
please note:
• We require images in TIF or JPEG format
• These images must be no smaller than
4 x 4 inches in size at 300 DPI
• Images should be 1 MB in size each
If you have an image that is greater than
1 MB, please do not bother “sizing it down”
to meet our requirements, but send us the
largest file size available. The larger the
starting image is in terms of bytes, the more
leeway the designer has in terms of resizing
the image to fill up more space should there
be room available).
Also, please remember that you should
not embed the images into the body of the

text document you submit. Images must
be submitted separately from the textual
submission.
You may submit images through a
zipped file via e-mail, unzipped individual
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
them from).
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 Robin Goodman
r.goodman@dental-tribune.com
Roots Managing Editor Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor Sierra Rendon
s.rendon@dental-tribune.com

[37] =>

[38] =>

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
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com

Managing Editor
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor
Robert Selleck
r.selleck@dental-tribune.com
Designer
Kristine Colker
k.colker@dental-tribune.com
Education Director
Christiane Ferret
c.ferret@dtstudyclub.com

Marketing Director
Anna Wlodarczyk-Kataoka
Group Editor
a.wlodarczyk@dental-tribune.
Robin Goodman
r.goodman@dental-tribune.com com
Roots Managing Editor
Fred Michmershuizen
f.michmershuizen
@dental-tribune.com

Product/Account Manager
Humberto Estrada
h.estrada@dental-tribune.com

Product/Account Manager
Mara Zimmerman
m.zimmerman@dental-tribune.
com
Product/Account Manager
Will Kenyon
w.kenyon@dental-tribune.com
Product/Account Manager
Charles Serra
c.serra@dental-tribune.com
International Product/Account
Manager
Jan Agostaro
j.agostaro@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 Robin Goodman at r.goodman@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
assume responsibility for product names or statements made by advertisers.
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.

38 I roots
2_ 2013

[39] =>

[40] =>

) [page_count] => 40 [pdf_ping_data] => Array ( [page_count] => 40 [format] => PDF [width] => 594 [height] => 837 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => roots C.E. No. 2, 2013

[toc] => Array ( [0] => Array ( [title] => Cover [page] => 01 ) [1] => Array ( [title] => Editorial [page] => 03 ) [2] => Array ( [title] => Content [page] => 04 ) [3] => Array ( [title] => Predictable Endo 102: Why warm and soft is so good [page] => 06 ) [4] => Array ( [title] => MounceFiles: A safe - economical and efficient option for canal preparation [page] => 18 ) [5] => Array ( [title] => No more supremely stinky teeth [page] => 26 ) [6] => Array ( [title] => Industry [page] => 30 ) [7] => Array ( [title] => Submissions [page] => 36 ) [8] => Array ( [title] => Imprint [page] => 38 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

[cached] => true )