Cover / Editorial / Content / A review of bioceramic technology in endodontics / Using hand files to their full capabilities: A new look at an old yet emerging technology / The real state of endodontic instrumentation / ADA holds meeting in San Francisco and offers plenty for endodontists / Wykle Research expands its Calasept Endo line / Submissions / Imprint
Cover
01 - 01 viewEditorial
03 - 03 viewContent
04 - 04 viewA review of bioceramic technology in endodontics
06 - 12 viewUsing hand files to their full capabilities: A new look at an old yet emerging technology
13 - 20 viewThe real state of endodontic instrumentation
22 - 26 viewADA holds meeting in San Francisco and offers plenty for endodontists
28 - 30 viewWykle Research expands its Calasept Endo line
32 - 32 viewSubmissions
33 - 33 viewImprint
34 - 34 viewArray
(
[post_data] => WP_Post Object
(
[ID] => 58750
[post_author] => 0
[post_date] => 2012-12-06 13:49:15
[post_date_gmt] => 2012-12-06 13:49:15
[post_content] =>
[post_title] => roots C.E. No. 4, 2012
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => roots-c-e-no-4-2012-0412
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-22 00:59:40
[post_modified_gmt] => 2024-10-22 00:59:40
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/epaper/rootsce0412/
[menu_order] => 0
[post_type] => epaper
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 58750
[id_hash] => d0f43faf3ea83ce6c87d2adb40b34e3503e9ca20b883839af812ca1edfe3b24e
[post_type] => epaper
[post_date] => 2012-12-06 13:49:15
[fields] => Array
(
[pdf] => Array
(
[ID] => 58751
[id] => 58751
[title] => rootsCE0412.pdf
[filename] => rootsCE0412.pdf
[filesize] => 0
[url] => https://e.dental-tribune.com/wp-content/uploads/rootsCE0412.pdf
[link] => https://e.dental-tribune.com/epaper/roots-c-e-no-4-2012-0412/rootsce0412-pdf-2/
[alt] =>
[author] => 0
[description] =>
[caption] =>
[name] => rootsce0412-pdf-2
[status] => inherit
[uploaded_to] => 58750
[date] => 2024-10-22 00:59:34
[modified] => 2024-10-22 00:59:34
[menu_order] => 0
[mime_type] => application/pdf
[type] => application
[subtype] => pdf
[icon] => https://e.dental-tribune.com/wp-includes/images/media/document.png
)
[cf_issue_name] => roots C.E. No. 4, 2012
[contents] => Array
(
[0] => Array
(
[from] => 01
[to] => 01
[title] => Cover
[description] => Cover
)
[1] => Array
(
[from] => 03
[to] => 03
[title] => Editorial
[description] => Editorial
)
[2] => Array
(
[from] => 04
[to] => 04
[title] => Content
[description] => Content
)
[3] => Array
(
[from] => 06
[to] => 12
[title] => A review of bioceramic technology in endodontics
[description] => A review of bioceramic technology in endodontics
)
[4] => Array
(
[from] => 13
[to] => 20
[title] => Using hand files to their full capabilities: A new look at an old yet emerging technology
[description] => Using hand files to their full capabilities: A new look at an old yet emerging technology
)
[5] => Array
(
[from] => 22
[to] => 26
[title] => The real state of endodontic instrumentation
[description] => The real state of endodontic instrumentation
)
[6] => Array
(
[from] => 28
[to] => 30
[title] => ADA holds meeting in San Francisco and offers plenty for endodontists
[description] => ADA holds meeting in San Francisco and offers plenty for endodontists
)
[7] => Array
(
[from] => 32
[to] => 32
[title] => Wykle Research expands its Calasept Endo line
[description] => Wykle Research expands its Calasept Endo line
)
[8] => Array
(
[from] => 33
[to] => 33
[title] => Submissions
[description] => Submissions
)
[9] => Array
(
[from] => 34
[to] => 34
[title] => Imprint
[description] => Imprint
)
)
)
[permalink] => https://e.dental-tribune.com/epaper/roots-c-e-no-4-2012-0412/
[post_title] => roots C.E. No. 4, 2012
[client] =>
[client_slug] =>
[pages_generated] =>
[pages] => Array
(
[1] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-0.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-0.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-0.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-0.jpg
[1000] => 58750-3d955ee1/1000/page-0.jpg
[200] => 58750-3d955ee1/200/page-0.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[2] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-1.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-1.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-1.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-1.jpg
[1000] => 58750-3d955ee1/1000/page-1.jpg
[200] => 58750-3d955ee1/200/page-1.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[3] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-2.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-2.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-2.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-2.jpg
[1000] => 58750-3d955ee1/1000/page-2.jpg
[200] => 58750-3d955ee1/200/page-2.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[4] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-3.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-3.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-3.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-3.jpg
[1000] => 58750-3d955ee1/1000/page-3.jpg
[200] => 58750-3d955ee1/200/page-3.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[5] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-4.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-4.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-4.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-4.jpg
[1000] => 58750-3d955ee1/1000/page-4.jpg
[200] => 58750-3d955ee1/200/page-4.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[6] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-5.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-5.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-5.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-5.jpg
[1000] => 58750-3d955ee1/1000/page-5.jpg
[200] => 58750-3d955ee1/200/page-5.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[7] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-6.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-6.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-6.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-6.jpg
[1000] => 58750-3d955ee1/1000/page-6.jpg
[200] => 58750-3d955ee1/200/page-6.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[8] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-7.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-7.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-7.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-7.jpg
[1000] => 58750-3d955ee1/1000/page-7.jpg
[200] => 58750-3d955ee1/200/page-7.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[9] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-8.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-8.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-8.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-8.jpg
[1000] => 58750-3d955ee1/1000/page-8.jpg
[200] => 58750-3d955ee1/200/page-8.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[10] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-9.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-9.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-9.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-9.jpg
[1000] => 58750-3d955ee1/1000/page-9.jpg
[200] => 58750-3d955ee1/200/page-9.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[11] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-10.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-10.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-10.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-10.jpg
[1000] => 58750-3d955ee1/1000/page-10.jpg
[200] => 58750-3d955ee1/200/page-10.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[12] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-11.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-11.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-11.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-11.jpg
[1000] => 58750-3d955ee1/1000/page-11.jpg
[200] => 58750-3d955ee1/200/page-11.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[13] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-12.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-12.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-12.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-12.jpg
[1000] => 58750-3d955ee1/1000/page-12.jpg
[200] => 58750-3d955ee1/200/page-12.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[14] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-13.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-13.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-13.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-13.jpg
[1000] => 58750-3d955ee1/1000/page-13.jpg
[200] => 58750-3d955ee1/200/page-13.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[15] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-14.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-14.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-14.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-14.jpg
[1000] => 58750-3d955ee1/1000/page-14.jpg
[200] => 58750-3d955ee1/200/page-14.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[16] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-15.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-15.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-15.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-15.jpg
[1000] => 58750-3d955ee1/1000/page-15.jpg
[200] => 58750-3d955ee1/200/page-15.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[17] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-16.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-16.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-16.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-16.jpg
[1000] => 58750-3d955ee1/1000/page-16.jpg
[200] => 58750-3d955ee1/200/page-16.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[18] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-17.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-17.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-17.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-17.jpg
[1000] => 58750-3d955ee1/1000/page-17.jpg
[200] => 58750-3d955ee1/200/page-17.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[19] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-18.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-18.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-18.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-18.jpg
[1000] => 58750-3d955ee1/1000/page-18.jpg
[200] => 58750-3d955ee1/200/page-18.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 58752
[post_author] => 0
[post_date] => 2024-10-22 00:59:34
[post_date_gmt] => 2024-10-22 00:59:34
[post_content] =>
[post_title] => epaper-58750-page-19-ad-58752
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-58750-page-19-ad-58752
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-22 00:59:34
[post_modified_gmt] => 2024-10-22 00:59:34
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-58750-page-19-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 58752
[id_hash] => a44825cd8058a0eb1cfe95179c2d28fe688ed2cd1742dc5f418728e66a9a856d
[post_type] => ad
[post_date] => 2024-10-22 00:59:34
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies_3594_dt_study_club_international.html
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-58750-page-19-ad-58752/
[post_title] => epaper-58750-page-19-ad-58752
[post_status] => publish
[position] => 0.1,0,92.47,100
[belongs_to_epaper] => 58750
[page] => 19
[cached] => false
)
)
[html_content] =>
)
[20] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-19.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-19.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-19.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-19.jpg
[1000] => 58750-3d955ee1/1000/page-19.jpg
[200] => 58750-3d955ee1/200/page-19.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[21] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-20.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-20.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-20.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-20.jpg
[1000] => 58750-3d955ee1/1000/page-20.jpg
[200] => 58750-3d955ee1/200/page-20.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[22] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-21.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-21.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-21.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-21.jpg
[1000] => 58750-3d955ee1/1000/page-21.jpg
[200] => 58750-3d955ee1/200/page-21.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[23] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-22.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-22.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-22.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-22.jpg
[1000] => 58750-3d955ee1/1000/page-22.jpg
[200] => 58750-3d955ee1/200/page-22.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[24] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-23.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-23.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-23.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-23.jpg
[1000] => 58750-3d955ee1/1000/page-23.jpg
[200] => 58750-3d955ee1/200/page-23.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[25] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-24.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-24.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-24.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-24.jpg
[1000] => 58750-3d955ee1/1000/page-24.jpg
[200] => 58750-3d955ee1/200/page-24.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 58753
[post_author] => 0
[post_date] => 2024-10-22 00:59:34
[post_date_gmt] => 2024-10-22 00:59:34
[post_content] =>
[post_title] => epaper-58750-page-25-ad-58753
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-58750-page-25-ad-58753
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-22 00:59:34
[post_modified_gmt] => 2024-10-22 00:59:34
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-58750-page-25-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 58753
[id_hash] => 5b492ce11d22e72a3c23cb4184667ce7ced8a7c4d1ff5960a3f7d457648d4eca
[post_type] => ad
[post_date] => 2024-10-22 00:59:34
[fields] => Array
(
[url] => http://www.tribunecme.com/
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-58750-page-25-ad-58753/
[post_title] => epaper-58750-page-25-ad-58753
[post_status] => publish
[position] => -0.29,-0.27,91.72,100.54
[belongs_to_epaper] => 58750
[page] => 25
[cached] => false
)
)
[html_content] =>
)
[26] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-25.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-25.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-25.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-25.jpg
[1000] => 58750-3d955ee1/1000/page-25.jpg
[200] => 58750-3d955ee1/200/page-25.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[27] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-26.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-26.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-26.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-26.jpg
[1000] => 58750-3d955ee1/1000/page-26.jpg
[200] => 58750-3d955ee1/200/page-26.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[28] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-27.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-27.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-27.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-27.jpg
[1000] => 58750-3d955ee1/1000/page-27.jpg
[200] => 58750-3d955ee1/200/page-27.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[29] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-28.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-28.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-28.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-28.jpg
[1000] => 58750-3d955ee1/1000/page-28.jpg
[200] => 58750-3d955ee1/200/page-28.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[30] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-29.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-29.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-29.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-29.jpg
[1000] => 58750-3d955ee1/1000/page-29.jpg
[200] => 58750-3d955ee1/200/page-29.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[31] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-30.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-30.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-30.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-30.jpg
[1000] => 58750-3d955ee1/1000/page-30.jpg
[200] => 58750-3d955ee1/200/page-30.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[32] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-31.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-31.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-31.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-31.jpg
[1000] => 58750-3d955ee1/1000/page-31.jpg
[200] => 58750-3d955ee1/200/page-31.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[33] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-32.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-32.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-32.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-32.jpg
[1000] => 58750-3d955ee1/1000/page-32.jpg
[200] => 58750-3d955ee1/200/page-32.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[34] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-33.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-33.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-33.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-33.jpg
[1000] => 58750-3d955ee1/1000/page-33.jpg
[200] => 58750-3d955ee1/200/page-33.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[35] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-34.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-34.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-34.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-34.jpg
[1000] => 58750-3d955ee1/1000/page-34.jpg
[200] => 58750-3d955ee1/200/page-34.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 58754
[post_author] => 0
[post_date] => 2024-10-22 00:59:34
[post_date_gmt] => 2024-10-22 00:59:34
[post_content] =>
[post_title] => epaper-58750-page-35-ad-58754
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-58750-page-35-ad-58754
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-22 00:59:34
[post_modified_gmt] => 2024-10-22 00:59:34
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-58750-page-35-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 58754
[id_hash] => 8cafb0ca17ecc9ebc6f5432cfbf4903b6c6be48c3629634af8825c582a08a7e9
[post_type] => ad
[post_date] => 2024-10-22 00:59:34
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies_994_greater_new_york_dental_meeting.html
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-58750-page-35-ad-58754/
[post_title] => epaper-58750-page-35-ad-58754
[post_status] => publish
[position] => 0.1,0,99.79,99.73
[belongs_to_epaper] => 58750
[page] => 35
[cached] => false
)
)
[html_content] =>
)
[36] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/2000/page-35.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/1000/page-35.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/200/page-35.jpg
)
[key] => Array
(
[2000] => 58750-3d955ee1/2000/page-35.jpg
[1000] => 58750-3d955ee1/1000/page-35.jpg
[200] => 58750-3d955ee1/200/page-35.jpg
)
[ads] => Array
(
)
[html_content] =>
)
)
[pdf_filetime] => 1729558774
[s3_key] => 58750-3d955ee1
[pdf] => rootsCE0412.pdf
[pdf_location_url] => https://e.dental-tribune.com/tmp/dental-tribune-com/58750/rootsCE0412.pdf
[pdf_location_local] => /var/www/vhosts/e.dental-tribune.com/httpdocs/tmp/dental-tribune-com/58750/rootsCE0412.pdf
[should_regen_pages] => 1
[pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/58750-3d955ee1/epaper.pdf
[pages_text] => Array
(
[1] =>
roots
issn 2161-6558
the international C.E. magazine of
4
2012
_C.E. article
A review of bioceramic
technology in endodontics
_technique
Using hand files to their
full capabilities
_trends
The real state
of endodontic
instrumentation
North America Edition • Vol. 3 • Issue 4/2012
endodontics
[2] =>
[3] =>
editorial _ roots
Stay up on the
latest information
with roots
I
Fred Weinstein, DMD, MRCD(C),
FICD, FACD
Thanks to ever expanding technology, dental professionals are able to treat patients in new and innovative ways. But staying on the cutting edge can be a challenge. That’s what makes the publication you
are holding right now so valuable.
For this issue of roots, we’ve assembled a collection of articles from some of the most respected names
in endodontics. These expert clinicians are sharing their knowledge and expertise with you.
Within this issue you can read reports on using hand files to their full capabilities by Dr. Rich Mounce,
and the real state of endodontic instrumentation by Dr. Barry Lee Musikant. In addition, Managing Editor
Fred Michmershuizen has written a report on the many offerings for endodontists that were available at
the recent ADA meeting in San Francisco.
But there’s even more.
Every issue of roots magazine also contains a C.E. component. By reading the article on bioceramic
technology by Dr. Ken Koch, then taking a short online quiz about this 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.
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 on page 6.
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 enjoy this issue and that you get the most out of it.
Sincerely,
Fred Weinstein, DMD, MRCD(C), FICD, FACD
Editor in Chief
roots
I 03
4
_ 2012
[4] =>
I content_ roots
page 13
page 06
page 22
I C.E. article
06 A review of bioceramic technology in
endodontics
_Ken Koch, DMD; Dennis Brave, DDS; and
Allen Ali Nasseh, DDS, MMSc
I technique
13 Using hand files to their full capabilities:
A new look at an old yet emerging technology
_Rich Mounce, DDS
I trends
roots
North America Edition • Vol. 3 • Issue 4/2012
issn 2161-6558
the international C.E. magazine of
22 The real state of endodontic instrumentation
_Barry Lee Musikant, DMD
endodontics
4
2012
_C.E. article
Bioceramic
technology
I events
_technique
28 ADA meeting in San Francisco offers plenty
for endodontists
Canal shaping
_trends
The state of
instrumentation
_Fred Michmershuizen, Managing Editor
I industry
32 Wykle Research expands its Calasept Endo line
Roots2012_04_DIFFERENT COVER.indd 1
11/12/12 11:30 AM
I about the publisher
I on the cover
page 22
page 28
33
34
_submissions
_imprint
04 I roots
4_ 2012
Image courtesy of Real World Endo.
Research performed by Dr. Adam Lloyd.
page 32
[5] =>
[6] =>
I C.E. article_ bioceramic technology
A review of
bioceramic technology
in endodontics
Authors_ Ken Koch, DMD; Dennis Brave, DDS; and Allen Ali Nasseh, DDS, MMSc
_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 Dec. 2.
06 I roots
4_ 2012
_Since bioceramic technology was introduced
to endodontics, the response has been exceptional. As more and more practitioners have thought
through the process, they have been able to see not
only the clear benefits of this technology in endodontics, but they are now asking how this technology can
be applied to other aspects of dentistry. The application of bioceramic technology has not only changed
endodontics both surgically and non surgically, it
has also begun to change the way we treatment
plan our patients. As a result of bioceramic technology, we now have the ability to save more teeth in
a predictable fashion, while, in addition, improving
their long-term prognosis. The option of “saving the
natural dentition” is now back on the table.
However, before we investigate specific techniques, we must first ask ourselves, “What are bioceramics?” Bioceramics are ceramic materials specifically designed for use in medicine and dentistry. They
include alumina and zirconia, bioactive glass, glass
ceramics, coatings and composites, hydroxyapatite
and resorbable calcium phosphates.1,2
There are numerous bioceramics currently in use
in both dentistry and medicine, although more so
in medicine. Alumina and zirconia are among the
bioinert ceramics used for prosthetic devices. Bioactive glasses and glass ceramics are available for use
in dentistry under various trade names. Additionally,
porous ceramics such as calcium phosphate-based
materials have been used for filling bone defects.
Even some basic calcium silicates such as ProRoot
MTA (Dentsply) have been used in dentistry as root
repair materials and for apical retrofills.
It is important to understand the specific advantages
of bioceramics in dentistry and why they have become
so popular. Clearly the first reason is related to physical
properties. Bioceramics are exceedingly biocompatible, non–toxic, do not shrink, and are chemically stable
within the biological environment. Additionally, and this
is very important in endodontics, bioceramics will not
result in a significant inflammatory response if an over fill
occurs during the obturation process or in a root repair.
A further advantage of the material itself is its
ability (during the setting process) to form hydroxyapatite and ultimately create a bond between
dentin and the filling material. A significant component of improving this adaptation to the canal wall is
the hydrophilic nature of the material. In essence, it
is a bonded restoration. However, to fully appreciate
the properties associated with the use of bioceramic
technology, we must understand the hydration reactions involved in the setting of the material.
_EndoSequence BC sealer setting reactions
The calcium silicates in the powder hydrate to
produce a calcium silicate hydrate gel and calcium
hydroxide. The calcium hydroxide reacts with the
phosphate ions to precipitate hydroxyapatite and
water. The water continues to react with the calcium
silicates to precipitate additional gel-like calcium silicate hydrate. The water supplied through this reaction
is an important factor in controlling the hydration rate
and the setting time in the following equations.
The hydration reactions (A, B) of calcium silicates can
be approximated as foloows:
2[3CaO ⋅ SiO2 ]+ 6 H 2 O → 3CaO ⋅ 2 SiO2 ⋅ 3H 2 O + 3Ca (OH ) 2
(A)
2[2CaO ⋅ SiO2 ]+ 4 H 2 O → 3CaO ⋅ 2 SiO2 ⋅ 3H 2 O + Ca (OH ) 2
(B)
(A)
2[3CaO ⋅ SiO2 ]+ 6 H 2 O → 3CaO ⋅ 2 SiO2 ⋅ 3H 2 O + 3Ca (OH ) 2
The
reaction
calcium
phos7Ca
(OHprecipitation
) 2 + 3Ca ( H 2 PO4 ) 2 →
Ca10 ( PO4 ) 6(C)
(OHof
) 2 + 12
H 2O
(C)
2[2CaO
⋅ SiO ]+ 4is
H as
O→
3CaO ⋅ 2 SiO ⋅ 3H O + Ca (OH )
phate
apatite
follows:
2
2
2
2
2
(B)
7Ca (OH ) 2 + 3Ca ( H 2 PO4 ) 2 → Ca10 ( PO4 ) 6 (OH ) 2 + 12 H 2O
(C)
[7] =>
C.E. article_ bioceramic technology
For clinical purposes (in endodontics), the advantages
of a premixed sealer should be obvious. In addition to a
significant saving of time and convenience, one of the
major issues associated with the mixing of any cement,
or sealer, is an insufficient and non-homogenous mix.
Such a mix may ultimately compromise the benefits
associated with the material. Keeping this in mind, a
new premixed bioceramic sealer has been designed that
hardens only when exposed to a moist environment,
such as that produced by the dentinal tubules.3
But, what is it specifically about bioceramics that
make them so well suited to act as an endodontic
sealer? From our perspective as endodontists, some
of the advantages are: high pH (12.8) during the initial
24 hours of the setting process (which is strongly antibacterial); they are hydrophilic, not hydrophobic; they
have enhanced biocompatibility; they do not shrink or
resorb (which is critical for a sealer-based technique);
they have excellent sealing ability; they set quickly
(three to four hours); and they are easy to use (particle
size is so small it can be used in a syringe).
The introduction of a bioceramic sealer (EndoSequence BC Sealer, Brasseler USA) allows us, for
the first time, to take advantage of all the benefits
associated with bioceramics but to not limit its use
to merely root repairs and apical retrofills. This is
possible only because of recent nanotechnology
developments; the particle size of BC Sealer is so fine
(less than two microns), it can actually be delivered
with a 0.012 capillary tip (Fig. 1).
This material has been specifically designed as a
non-toxic calcium silicate cement that is easy to use
as an endodontic sealer. This is a key point. In addition to its excellent physical properties, the purpose
of BC Sealer is to improve the convenience and delivery method of an excellent root canal sealer, while
simultaneously taking advantage of its bioactive
characteristics (it utilizes the water inherent in the
dentinal tubules to drive the hydration reaction of
the material, thereby shortening the setting time).
As we know, dentin is composed of approximately
20 percent (by volume) water, and it is this water that
initiates the setting of the material and ultimately results in the formation of hydroxyapatite.4 Therefore, if
any residual moisture remains in the canal after drying,
it will not adversely affect the seal established by the
bioceramic cement. This is very important in obturation and is a major improvement over previous sealers.
Furthermore, its hydrophilicity, small particle size and
chemical bonding to the canal walls also contribute to its
excellent hydraulics. But there is another aspect to sealer
hydraulics. That is the shape of the prepared canal itself.
Actually, it all begins with the file. To be more specific,
it all begins with the specific preparation created by the
file — a constant taper preparation. When using the
EndoSequence technique, we can create either a 0.04
constant taper preparation or a 0.06 taper. The real key
I
Fig. 1_The particle size of BC Sealer
is so fine (less than two microns),
it can actually be delivered with a
0.012 capillary tip. (Photos/Provided
by Real World Endo)
Fig. 1
is the constant taper preparation, because when accomplished it now gives us the ability to create predictable,
reproducible shapes. A variable taper preparation is not
recommended because its lack of shaping predictability
(and its corresponding lack of reproducibility) will lead to
a less than ideal master cone fit. This lack of endodontic
synchronicity is why all variable taper preparations are
associated with the overly expensive and more time
consuming thermoplastic techniques.
Knowing in advance what the final shape (constant
taper preparation) will be is a tremendous advantage
in creating superior hydraulics. Then add in the feature
of laser-verified paper points and gutta-percha cones,
and we now start to develop a system where everything
matches (true endodontic synchronicity).
This concept of having everything match is so important because it allows us, for the first time, to perform
rotary endodontics in a truly conservative fashion and to
be able to use a hydraulic condensation technique.
Furthermore, when used in conjunction with the EndoSequence filing system, this becomes a synchronized
hydraulic condensation technique. This has tremendous
implications for the tooth as evidenced by a recent study
published in the Journal of Endodontics.5 The purpose
of this study was to evaluate and compare the fracture
resistance of roots obturated with various contemporary
filling systems. The investigators (Ghoneim, et al.) instrumented 40 single-canal premolars using 0.06 taper
EndoSequence files. The teeth were then obturated using four different techniques. Group I used a bioceramic
sealer iRoot SP (IRoot SP is BC Sealer in Europe) in combination with ActiV GP cones (Brasseler USA) while Group
II used the bioceramic sealer with regular gutta-percha.
Group III utilized ActiV GP sealer plus ActiV GP cones and
Group IV employed ActiV G sealer with conventional
gutta-percha cones. All four groups were obturated
using a single cone technique. Ten teeth were left unprepared and these acted as a negative control for the study.
Following preparation and obturation, all the teeth
were embedded in acrylic molds and then subjected to
a fracture resistance test in which a compressive load
(0.5 mm/min) was applied until fracture. Subsequently,
all data was statistically analyzed using the analysis of
variance model and the Turkey post hoc test.
The results generated were quite remarkable. It was
demonstrated that the significantly highest fracture
roots
I 07
4
_ 2012
[8] =>
I C.E. article_ bioceramic technology
Fig. 2a
Fig. 2b
Fig. 2a_This image shows the
excellent adaption of the bioceramic
sealer (and gutta-percha) to the true
shape of the prepared canal.
Fig. 2b_A composite image
demonstrating the true excellence of
the technique.
resistance was recorded for both the negative control
and Group I (bioceramic sealer /Activ GP cone) with
no statistical difference between them. The lowest reported value was in Group IV, which employed ActiV GP
sealer in combination with regular gutta-percha cones.
The conclusion of this study was that employing a bioceramic sealer (such as BC Sealer) is very
promising in terms of strengthening the residual
root and increasing the in vitro fracture resistance of
endodontically treated teeth. This is a very significant
finding, especially regarding the long-term retention
of an endodontically treated tooth.
In this particular study, the bioceramic sealer performed best when combined with ActiV GP cones. In
fact, bonding will occur between the bioceramic sealer
and the ceramic particles in the ActiV GP cones as
well as to the bioceramic particles present in the new
bioceramic coated cones (BC cones). The technique of
achieving a true bond between the root canal wall and
the master cone (as a result of creating endodontic
synchronicity and advanced material science) is known
as synchronized hydraulic condensation.
_Synchronized hydraulic condensation
The technique with this material is quite
straightforward. Simply remove the syringe cap
from the EndoSequence BC Sealer syringe. Then
attach an Intra Canal Tip of your choice to the hub
of the syringe. The Intra Canal Tip is flexible and can
be bent to facilitate access to the root canal. Also,
because the particle size has been milled to such a
fine size (less than 2 microns), a capillary tip (such
as a 0.012) can be used to place the sealer.
Following this procedure, insert the tip of the syringe into the canal no deeper than the coronal one
third. Slowly and smoothly dispense a small amount
of EndoSequence BC Sealer into the root canal. Then
remove the disposable tip from the syringe and
proceed to coat the master gutta-percha cone with
a thin layer of sealer. After the cone has been lightly
coated, slowly insert it into the canal all the way to
the final working length. The synchronized master
08 I roots
4_ 2012
gutta-percha cone will carry sufficient material to
seal the apex.6
The precise fit of the EndoSequence gutta-percha
master cone (in combination with a constant taper
preparation) creates excellent hydraulics and, for that
reason, it is recommended that the practitioner use
only a small amount of sealer. Furthermore, as with
all obturation techniques, it is important to insert the
master cone slowly to its final working length. Moreover, the EndoSequence System is now available with
bioceramic coated gutta-percha cones. So in essence,
what we can now achieve with this technique is a
chemical bond to the canal wall, as a result of the hydroxyapatite that is created during the setting reaction
of the bioceramic material and we also have a chemical
bond between the ceramic particles in the sealer and
the ceramic particles on the bioceramic coated cone.
Think about what we have just accomplished. We
are now doing root canals in a manner that truly is
easier, faster and better. As further evidence of this
technique, we asked Dr. Adam Lloyd, the chairman
of the Department of Endodontics at the University
of Tennessee, to share the results of a study recently
conducted at the University of Tennessee.7
_Materials and methods
Sixteen recently extracted human molars were
mounted on individual stubs and underwent an initial
high spatial resolution CT scan prior to any treatment.
Following biomechanical crown-down canal preparation to an apical matrix of 35/0.04 and ultrasonic irrigation with 6 percent sodium hypochlorite, each sample
was scanned a second time. Obturation was completed
using a single matched gutta-percha cone and EndoSequence BC sealer. The coronal 4 mm of the gutta-percha
was thermo-softened and compacted vertically. Subsequent to canal obturation, a third scan was made.
Scanning of the specimens was performed (Actis
150/130, Varian Medical Systems, Palo Alto, Calif.) with a
180-degree rotation around the vertical axis and a single
rotation step of 0.9 degree with a cross-sectional pixel
size of approximately 24 μm. All three backscatter pro-
[9] =>
C.E. article_ bioceramic technology
Fig. 3a
Fig. 3b
Fig. 3c
I
Fig. 3d
Figs. 3a–5c_Cases treated with
bioceramics. (Clinical X-rays/Provided
by Allen Ali Nasseh, DDS, MMSc)
Fig. 4a
Fig. 4b
Fig. 4c
Fig. 5a
Fig. 5b
Fig. 5c
jections were aligned post-processing with sub-voxel
accuracy at 92 percent CI in VG Studio Max 2.1 (Volume
Graphics GmbH, Heidelberg, Germany) and manipulated
to create regions of interest for each of the scans.
upon setting (it actually expands 0.002 percent) and
once it is fully set, the material will not resorb.
The cases pictured in Figures 3a through 5c demonstrate the excellence of this technique.
_Results
_Retreatment of bioceramics
Analysis of volume occupied by sealer in relation to total original canal volumes was found to
be extremely high with a mean of 97 percent ± 2.8,
much higher than reported previously using studies
on canal surface area occupancy of material, with 75
percent of samples occupied at the ≥ 95 percent level
(Figs. 2a, 2b).
While the properties associated with bioceramics
make them very attractive to dentistry, in general,
what would be their specific advantage if used as an
endodontic sealer? From our perspective as endodontists, some of the advantages are: enhanced biocompatibility; possible increased strength of the root
following obturation; high pH (12.8) during the setting process, which is strongly anti-bacterial; sealing
ability related to its hydophilicity; and ease of use.8
Furthermore, the bioceramic sealer does not shrink
Bioceramic sealer cases are definitely retreatable
yet the issue of retreating these cases (and all the
associated misinformation) is not unlike that of glass
ionomer. Historically there has been confusion about
retreating glass ionomer endodontic cases (glass
ionomer sealer is definitely retreatable when used as
a sealer) and, similarly, there has been confusion concerning the retreatability of bioceramics.8 The key is
using bioceramics as a sealer, not as a complete filler.
This is why endodontic synchronicity is so important
and again, why the use of constant tapers makes so
much sense (it minimizes the amount of endodontic
sealer thereby facilitating retreatment).
The technique itself is relatively straightforward. The
key in retreating bioceramic cases is to use an ultrasonic
with a copious amount of water. This is particularly important at the start of the procedure in the coronal third
roots
I 09
4
_ 2012
[10] =>
I C.E. article_ bioceramic technology
Fig. 6a
Fig. 6b
Fig. 6c
Fig. 6d
Figs. 6a–6d_A case demonstrating
retreatment of BC Sealer. (Clinical
X-rays/Provided by Allen Ali
Nasseh, DDS MMSc)
Fig. 7_EndoSequence Root Repair
Material. (Photos/Provided by
Real World Endo)
Fig. 8_A section of material ready
for delievery.
Fig. 7
Fig. 8
of the tooth. Work the ultrasonic (with lots of water)
down the canal to approximately half its length. At this
point, add a solvent to the canal (chloroform or xylol)
and switch over to an EndoSequence file (#30 or 35/0.04
taper) run at an increased rate of speed (1,000 RPM). Proceed with this file, all the way to the working length, using
solvent when indicated. An alternative is to use hand files
for the final 2-3 mm and then follow the gutta-percha
removal with a rotary file to ensure synchronicity.
The case pictured in Figures 6a through 6d demonstrates the retreatment of BC Sealer.
a serious upgrade. This allows many clinicians, not just
specialists, to take advantage of its properties.
EndoSequence Root Repair material specifically has
been created as a white premixed cement for both
permanent root canal repairs and apico retrofillings. As
a true bioceramic cement, the advantages of this new
repair material are its high pH (pH >12.5), high resistance to washout, no-shrinkage during setting, excellent
biocompatibility, and superb physical properties. In fact,
it has a compressive strength of 50-70 MPa, which is
similar to that of current root canal repair materials,
ProRoot MTA (Dentsply) and BioAggregate (Diadent).
However, a significant upgrade with this material is its
particle size, which allows the premixed material to be extruded through a syringe rather than inconsistent mixing
by hand and then placement with a hand instrument.
The Clinicians Report (November 2011) published
findings on EndoSequence Root Repair Material. Some
of its noted advantages as a root repair material were:
• Easier to use and place than previous similar
products.
• Good dispenser (tip/syringe) for easy dispensing.
• Radiopaque.
• Mulitple uses for a variety of clinical conditions.
• No mixing required.
_Bioceramics as a root repair material
We are all familiar with the success of MTA (mineral trioxide aggregate) as a root repair and apico
retrofilling material. Furthermore, we realize that
because MTA is a modified Portland cement, it has
some limitations in terms of handling characteristics.
It does not come premixed (and therefore must be
mixed by hand), is difficult to use on retrofills, and
has such a large particle size that it cannot be extruded through a small syringe. Yet it has a number
of favorable characteristics, including a pH of 12.5,
which is significantly anti-bacterial. However, in lieu
of a Portand cement-based material, we now have
available a medical grade bioceramic repair material.
This new repair material is, in fact, the EndoSequence
Root Repair material, which comes either premixed in
a syringe (just like BC Sealer) or as a premixed putty
(Fig. 7). This is a tremendous help not just in terms of
assuring a proper mix but also in terms of ease of use.
We now have a root repair material with an easy and
efficient delivery system. This is a key development and
10 I roots
4_ 2012
Furthermore, their final conclusion was that 95
percent of 19 CR Evaluators stated that they would
incorporate EndoSequence Root Repair Material into
their practice. Ninety-five percent rated it excellent
or good and worthy of trial by colleagues.
Another significant piece of research was published
in the Journal of Endodontics, where a research team
investigated the antibacterial activity of EndoSequence
[11] =>
C.E. article_ bioceramic technology
Fig. 9a
Fig. 9b
Fig. 9c
I
Fig. 9d
Figs. 6a–10c_Cases demonstrate
healing and bone fill in less than six
months. (Clinical X-rays/Provided by
Allen Ali Nasseh, DDS MMSc)
Fig. 10a
Fig. 10b
Root Repair material against Enterococcus faecalis. The
aim of this study was to determine whether EndoSequence Root Repair material either in its putty form or
as a syringeable paste possessed antibacterial properties
against a collection of Enterococcus faecalis strains. As a
standard, they compared the ESRRM to MTA. Their conclusion was, ESRRM, both putty and syringeable forms
and white ProRoot MTA demonstrated similar antibacterial efficacy against clinical strains of E. faecalis.9
This research again validated earlier studies that
found ESRRM (putty) and ESSRM (paste) displayed similar in vitro biocompatiblity to MTA. Additionally, other
studies found that the ESRRM had cell viability similar to
Gray and White MTA in both set and fresh conditions.10
Even more significant research was published
(January 2012) concerning bioceramics in general. In
a comparison of endodontic sealers, it was demonstrated that in various moisture conditions within a
root canal, iRoot SP (EndoSequence BC Sealer) outperformed all the other sealers. The conclusion of the
study was, “Within the experimental conditions of
this in vitro study, it can be concluded that the bond
strength of iRoot SP to root dentin was higher than
that of other sealers in all moisture conditions.”11
As mentioned previously, the bioceramic material to
use in surgical cases is the EndoSequence Root Repair
Material (RRM). The ESRRM is available in two different
modes. There is a syringeable RRM (very similar to the
basic BC Sealer in its mode of delivery) and there is also
an RRM putty that is both stronger and malleable. The
consistency of the putty is similar to Cavit G. The RRM
in a syringe is obviously delivered by a syringe tip but the
technique associated with the putty is different.
When using the putty, simply remove a small
amount from the room-temperature jar and knead
it for a few seconds with a spatula or in your gloved
hands. Then start to roll it into a hotdog shape. This
is very similar to creating similar shapes with desic-
Fig. 10c
cated ZOE or SuperEBA (Bosworth). Once you have
created an oblong shape, you can pick up a section
of it with a sterile instrument and use this to deliver
it where needed (Fig. 8). This is an easy technique
for apico retro fills, perforation repairs, and even
for resorption defects. After placing the putty into
the apical preparation (or defect) simply wipe with a
moist cotton ball and finish the procedure.
The cases pictured in Figures 9a to 10c are
evidence of how beautifully this technique works.
These cases are so significant because they clearly
demonstrate the extraordinary healing capability
of bioceramics, when used as a repair material. The
X-rays display amazing healing and bone fill in the
mandible in less than six months.
_Pulp capping with bioceramics
One of the other significant benefits of having bioceramics come premixed in a syringe (EndoSequence Root Repair Material) is the ability
for all dentists to now easily treat young patients
in need of pulp caps or other pulpal therapies
(e.g., pulpotomies). Previously, many specialists
considered MTA to be the ideal material for a direct pulp cap because it did not seem to engender
a significant inflammatory response in the pulp.
Unfortunately, due to price concerns and the
difficulty of placement, this methodology was not
universally accepted. However, we now have a true
bioceramic material (ESRRM) that not only works well,
but is easier to use. It is much easier. Hopefully, this will
lead to an increased use of bioceramics in our pediatric
patients and help these patients save their teeth. All
dentists can benefit from this upgrade in technique.
The technique itself for a direct pulp cap with the
bioceramic root repair material is as follows: Isolate
the tooth under a rubber dam and disinfect the expo-
roots
I 11
4
_ 2012
[12] =>
I C.E. article_ bioceramic technology
sure site with a cotton ball and NaOCl. Apply a small
amount of the RRM from the syringe or, take a small
amount of the RRM putty from the jar, and place this
over the exposure area.
Then, cover the bioceramic repair material with a
compomer or glass ionomer restoration. Following
the placement of this material, proceed with the final
restoration, including etching if required. Single-visit
direct pulp capping is now here.
_Future directions and prosthodontic
applications
The future promises to be even more exciting in
the world of bioceramics. There will be new fast-set
(eight to 10 minutes) repair materials introduced, as
well as a special bioceramic putty for pediatric use
(primary teeth). We have also seen the melding of
bioceramic technology into the world of prosthodontic cements, with the introduction of Ceramir
Crown & Bridge (Doxa Dental). It is easy to predict
that we will see more applications of this technology
in different aspects of dental medicine.
In this article, we have introduced a new bioceramic sealer (EndoSequence BC Sealer) that when
combined with coated cones offers an exciting new
obturation technique (Synchronized Hydraulic Condensation).
The properties associated with the new bioceramic sealer also allow us to be more conservative
in our endodontic shaping which ultimately leads
to the preservation of natural tooth structure.
Surgical applications have also been introduced,
and cases shown, which demonstrate the remarkable ability of bioceramics. The future is bright for
bioceramic technology and even more exciting for
dental medicine._
References
1.
2.
3.
4.
5.
6.
7.
12 I roots
4_ 2012
Best S.M., Porter A.E., Thian E.S., Huang J., Bioceramics:
Past, Present and for the Future, Journal of the European
Ceramic Society 28 (2008) 1319–1913.
Hench L., Bioceramics: From Concept to Clinic, Journal
Amer. Ceram. Soc., 74(7) 1487–1510 (1991).
Koch K., Brave D., Bioceramic technology-the game changer
in endodontics. Endodontic Practice US.2009;12:7–11.
Koch KA, Brave DG, Nasseh AA, Bioceramic Technology:
closing the endo-restorative circle, Part I, Dent. Today,
2010;29:100–105.
Ghoneim Ag, Lutfy RA, Sabet NE, et al. Resistance to
fracture of roots obturated with novel canal-filling system.
J Endod,2011;37:1590–1592.
Koch, K., Brave D., Bioceramic technology — the
game changer in endodontics. Endodontic Practice
US.2009;12:7–11.
Lloyd A, Personal communication.
8.
Friedman S., Moshonov J., Trope M., Residue of gutta
percha and a glass ionomer sealer following root canal
retreatment, Intl. Endo. Jour., Vol. 26, Issue 3, pgs.
169–172, (May 1993).
9. Lovato KF, Sedgley CM, Antibacterial activity of
EndoSequence root repair material and ProRoot MTA
against clinical isolates of Enterococcus faecalis. J Endod,
2011;37:1542–1546.
10. Alanezi AZ, Jiang J, Safavi KE, et al. Cytotoxicity
evaluation of EndoSequence root repair material.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2010;1109:e122–e125.
11. Nagas E, Uyanik MO, Eymirli A et al. Dentin moisture
conditions affect the adhesion of root canal sealers. J
Endod, 2012;38(2):240–244.
_about the authors
roots
Dennis Brave, DDS,
left, a diplomate of the
American Board of Endodontics and a member of
the College of Diplomates,
received his DDS degree
from the Baltimore College
of Dental Surgery, University of Maryland and his
certificate in endodontics from the University of Pennsylvania.
In endodontic practice for over 25 years, he has lectured
extensively throughout the world and holds multiple patents,
including the VisiFrame. Formerly an associate clinical professor at the University of Pennsylvania, Brave currently holds
a staff position at The Johns Hopkins Hospital. Along with
having authored numerous articles on endodontics, Brave is
a co-founder of Real World Endo.
Allen Ali Nasseh, DDS, MMSc, center, received
his MMSc degree and Certificate in Endodontics from the
Harvard School of Dental Medicine in 1997. He received his
DDS degree in 1994 from Northwestern University Dental
School. He maintains a private endodontic practice in Boston
(Microsurgicalendo.com) and holds a staff position at the
Harvard’s postdoctoral endodontic program. Nasseh is the
endodontic editor for several dental journals and periodicals
and serves as the Alumni Editor of the “Harvard Dental Bulletin.” He serves as the Clinical Director of Real World Endo.
Ken Koch, DMD, received both his DMD and certificate
in endodontics from the University of Pennsylvania School of
Dental Medicine. He is the founder and past director of the New
Program in Postdoctoral Endodontics at the Harvard School of
Dental Medicine. Prior to his dndodontic career, Koch spent 10
years in the Air Force and held, among various positions, that
of chief of prosthodontics at Osan Air Force Base and chief of
prosthodontics at McGuire Air Force Base. In addition to having
maintained a private practice, limited to endodontics, Koch has
lectured extensively in both the United States and abroad. He is
also the author of numerous articles on endodontics. Koch is a
co-founder of Real World Endo.
The authors may be contacted via thier website, www.
RealWorldEndo.com, or via email at info@realworldendo.com.
[13] =>
technique_ canal shaping
I
Using hand files to
their full capabilities:
A new look at an old yet
emerging technology
Author_Rich Mounce, DDS
_Despite wide global acceptance of rotary
nickel-titanium (RNT) canal enlargement, hand
files remain central to endodontic practice. It
can be argued persuasively that proper canal negotiation and glide path creation are key ingredients
to successful long-term treatment, along with adequate and appropriate irrigation, canal preparation,
coronal seal, etc. Simply stated, after the preparatory
steps of straight-line access and removal of the cervical dentinal triangle with orifice openers, if the canal
is not properly negotiated and a glide path prepared
prior to RNT enlargement, cleaning and shaping procedures cannot be optimal.
This article was written primarily for the general
dentist. It describes stainless-steel (and, to a lesser
degree, nickel titanium) hand files, reciprocation and
their clinical application. This article is intended to
be a clinical “how to” article, not a literature review,
hence a lack of extensive references. The endodontist
is encouraged to compare their treatment methods
with those described here. The Mani product line of
files is described primarily because these files are
used daily by the author. Examples of equivalent files
are provided alongside of Mani products throughout
the article for comparison.
There are myriad hand-file designs, applications,
materials and manufacturing methods. In recent
years, multiaxis grinding machines have provided
advancements of true clinical consequence, especially with regard to file flexibility and cutting ability.
Given the wide diversity of available designs and
features, it is impossible to discuss the design, clinical
use or precautions required for every hand file on the
market. Neither barbed broaches nor balanced force
technique will be discussed.1
_Introduction: Appreciating the unseen
dimension
Hand files allow the clinician to manually “feel”
the unseen dimension in canal anatomy beyond
what radiographs alone can illustrate. Specifically,
by virtue of hand-file resistance to apical advancement, the clinician can, by tactile feel, determine
Fig. 1_Mani D Finders (Photos/
Provided by Rich Mounce, DDS)
Fig. 1
roots
4
_ 2012
I 13
[14] =>
I technique_ canal shaping
the curvature, calcification, length, the anatomy of
the MC, and if iatrogenic events may have occurred.
Only cone-beam technology comes close to providing the tactile information provided by hand files
(Planmeca).
Such tactile information helps determine treatment strategies prior to shaping. Astute RNT use has,
as its foundation, intimate canal knowledge first by
hand files. Forcing RNT files to length without adequate hand-file negotiation and a glide path is the
harbinger of file fracture, canal transportation and
inadequate cleaning and shaping.
_Hand-file applications, differentiation
and general use principles
Hand files differ based on the following (among
other attributes):
1) Material of manufacture (carbon steel, stainless steel, nickel titanium, among several other less
common materials).
2) Taper (0.02 tapered, variable tapered, greater
tapered).
3) Initial cross-sectional design before manufacture (triangular, square, rhomboid, among other
initial shapes).
4) Final cross-sectional design.
5) Corrosion resistance.
6) Handle design and material used for the hand file.
7) Tip sizes (of the individual instrument).
8) Progression of tip sizes across the spectrum of
a given set of instruments.
9) How the cutting flutes are produced (twisting,
grinding, among other manufacturing methods).
10) Tip design (active, non cutting, partially cutting).
11) Whether the file is reciprocated, watchwound (K files), rotated (K reamers), or used with a
pull stroke (H files).
12) Helix angle, rake angle, cutting angle (if different from the rake angle) number of flutes (as well as
flute width, depth and number).
13) Possible variability of the cutting angle along
the length of the file.
14) Linear length of the cutting flutes.
15) In addition to the attributes above, hand files
are designed to be stiff versus flexible, aggressive cutting versus less aggressive, finishing files versus bulk
shaping files, among other general classifications.
_Principles for maximizing hand file
effectiveness
The use of hand files is based on several universal
assumptions. These assumptions are:
A) Optimal visualization of the access preparation, ideally through the surgical microscope (Zeiss,
Global Surgical).
14 I roots
4_ 2012
B) Optimal radiographic evaluation of the tooth
prior to access preparation including where necessary, cone-beam visualization. For those without
CBCT technology, having two or optimally three different pre-operative radiographic angles will provide
the best possible visualization of canal anatomy short
of a CBCT scan.
C) Straight line access.
D) Removal of the cervical dentinal triangle prior
to hand-file exploration.
E) Copious irrigation at every stage in the procedure, especially rinsing debris from the access
preparation before hand files are inserted.
F) Pre-operative evaluation of the estimated and
expected true working length, final taper and master
apical diameter.
G) Curved files negotiate curved canals more effectively than straight ones. The EndoBender pliers
(Axis/Sybron) are an effective instrument to place the
needed curvature onto hand files. Generally, in canals
that have been ledged or transported, placing an acute,
3- to 5-mm curve onto the apical portion of the hand
file is beneficial. Multiple insertions of curved hand files
to bypass blocked and transported canals (especially
ledges) are the rule, not the exception. Alternatively, if
no transportation has occurred (the canal is untouched
or easily negotiable) the clinician can curve the file in
their fingers without an EndoBender.
H) Canals should always be negotiated with hand
files prior to using RNT files. Even if the clinician uses
a RNT glide path creator (PathFile, Dentsply Tulsa or
PreShapers, SpecializedEndo), the canal should be
first negotiated by hand to assure patency. Clinician
preference dictates whether a glide path should be
created by hand files or RNT files.
I) In the view of the author, hand files are single
use disposable instruments as they dull rapidly during clinical function.
J) The use of nickel-titanium hand files is a matter
of personal preference. While some clinicians desire
the flexibility and shape memory of nickel-titanium
hand files, others do not. It should be noted that
nickel-titanium hand files are available with controlled memory, a proprietary thermo mechanical
process in which nickel-titanium hand files lose their
shape memory yet retain their flexibility.2–4
K) The principles of canal preparation must be observed, irrespective of the methods utilized to achieve
these principles (i.e., hand-file canal enlargement
and/or RNT enlargement or a combination of these
methods). These principles are to:
1) leave the canal in its original position (simply
enlarge it as described here);
2) leave the minor constriction (MC) of the apical
foramen at its original position and size;
3) create a tapering funnel with narrowing crosssectional diameters from orifice to apex;
[15] =>
[16] =>
I technique_ canal shaping
K Reamers
Mani K Reamers are three-sided and contain
fewer spirals than K files. Smaller reamers are generally square in cross section. Larger reamer sizes are
generally triangular. The angle between the cutting
flutes and long axis of a reamer is most often in the
10- to 30-degree range.5
Reamers are used in rotation, unlike K files. Handfile rotation is associated with less canal transportation than K-file watch winding.
The use of K reamers versus K files is a matter of
personal preference. K-type instruments of both types
(reamers versus K files) should be manipulated carefully
when used counterclockwise due to the risk of instrument fracture. Lexicon K Reamers are an additional
example of a commercially available K reamer (Dentsply
Tulsa) — these are triangular in cross section.
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 2_Mani K and H Files, and Mani
Reamers.
Fig. 3_Mani Flexile Files.
Fig. 4_Mani RT Files.
4) create a master apical taper that optimizes irrigation and obturation hydraulics, and yet causes no
iatrogenic events (strip perforation, canal transportation unnecessary dentin removal — and does not
leave the tooth at risk of long-term vertical fracture).
_General classes of hand files
Fig. 5_Mani SEC O K and H Files.
Files primarily designed for canal negotiation
In calcified canals, hand-file stiffness is an attribute. Mani D Finder files are representative of this
class and are especially useful for early negotiation
of calcified canals. The D finders have a D-shaped
cross section. Some files utilize carbon steel in manufacture and/or possess atypical tip sizes to facilitate
negotiation. Stiffness can be attributed to either the
file’s design (Mani D Finders) or the use of carbon steel
and/or a combination of carbon steel and a modified
design (Pathfinder CS, Axis/SybronEndo) (Fig. 1).
K files
Generally, K files have a three- or four-sided configuration with more spirals than a K reamer. Mani
K Files are four-sided. Overall, K files are the most
“universal” hand files covering the greatest number
of clinical indications.
K files are not as flexible as hand files designed
specifically for flexibility (such as the Mani Flexile
files discussed below) or nickel-titanium hand files. K
files are used with a watch-winding hand motion and
can be reciprocated (as described below). The angle
between the cutting flutes and long axis of a K file is
generally in the 25- to 40-degree range.5 Lexicon K
Files are an additional example of another commercially available K file (Dentsply Tulsa).
16 I roots
4_ 2012
H files
H files (Mani H Files as well) have conical spirals
ground into them. They are used on the pull stroke for
gross removal of canal contents in the coronal third
and in retreatment. H files should not be rotated due
to fracture risk inherent in their design. The angle
between the cutting flutes and long axis of an H file
is generally in the 60- to 65-degree range.5
It is not advisable to use H files near the MC. The
MC can be transported easily if H files are used at
or beyond the MC. Clinically, aside from transportation, such an action leads to significant apical
bleeding (Fig. 2).
Hand files of accentuated and variable taper
Mani Flare Files are more tapered than standard hand files — 0.05 taper compared to 0.02 taper.
They are used to prepare tapered canals for doctors who hand file the entire preparation among
other more specialized uses such as verifying
taper before cone fit.
Accentuated taper is also available with nickeltitanium GT Hand Files. ProFile 0.04 Hand Files are
0.04 tapered and come in a variety of tip sizes, again
in nickel titanium. ProTaper Universal Hand Files
feature the ProTaper variable taper design in shaping
and finishing files in various lengths (all of the above
are manufactured by Dentsply Tulsa).
Flexible Files
Mani Flexile Files are triangular in cross section.
Files with a triangular cross section are more flexible than those with square cross sections. Flexible
stainless steel hand files are generally used in easily negotiated canals. Clinician preference dictates
whether to use flexible stainless steel files relative to
nickel titanium hand instruments (Fig. 3).
Additional files in this class are Lexicon FlexSSK
Files (Dentsply Tulsa). These files are also available in
medium sizes (12, 17, 22, etc.).
[17] =>
[18] =>
I technique_ canal shaping
Fig. 6_The Synea W&H WA-62 A
reciprocating handpiece attachment.
Fig. 7_The MounceFile Controlled
Memory nickel-titanium files.
Fig. 6
Fig. 7
Aggressive cutting files
Mani RT files (possessing a parallelogram cross
section) and a 71-degree cutting angle, making
them more aggressive relative to many of the other
files included here. RT files would be used primarily
by doctors who are hand filing the entire canal in
conjunction with other hand files (Fig. 4).
Nickel titanium files
GT Hand Files (made of nickel titanium) are available in various tapers and tip sizes (Dentsply Tulsa).
Lexicon FlexNTK Files are made of nickel titanium and
come in various tip sizes while maintaining a constant taper. As mentioned above, clinician preference
dictates whether a flexible stainless steel file is more
desirable than a nickel titanium hand file.
Medium sizes, K, H and reamers
Mani provides K Files, H Files and stainless-steel
reamers in medium sizes (12, 17, 22, 27, etc.). ProFile
Series 29 Stainless Steel 0.02 Hand Files have a constant 29 percent increase in tip size in 0.02 taper. Use
of medium sizes avoids the dramatic increase in tip
diameter with increasing tip sizes, especially between
a #10 an #15 hand file (a 50 percent increase in size
of the #15 relative to the #10 hand file).
Safe-ended hand files and reciprocation
Mani SEC O files are available in an H and K file
variety. Both are “safe-ended,” as they do not cut on
their tips. The Mani SEC O K File is ideal for reciprocation. SEC O H files (and H files in general) are not
reciprocated (Figs. 5,6).
Reciprocation is a very safe technique, whereby
the clinician can use a reciprocating handpiece attachment to replicate manual hand file watch winding. Clinically, reciprocation is used after the canal
has been negotiated to the TWL and reciprocation
proceeds with the first file that binds at TWL. In this
18 I roots
4_ 2012
article, the terms TWL and MC are synonymous. The
purpose of reciprocation is to save time, reduce hand
fatigue and prepare a space into which RNT files
can subsequently be inserted with minimal torque
stresses (prepare a glide path).
Reciprocation is inherently safe. It is difficult
to fracture hand files when this technique is used
appropriately. Fracture or iatrogenic misadventure
generally occurs when the files are inappropriately
placed (well beyond the MC), the wrong type of hand
file is reciprocated (H) and/or the speed is grossly
exaggerated above the recommended levels.
Reciprocating handpiece attachments fit onto an
E-type coupling and can be powered at 900 rpm, for
example at the 18:1 setting on an electric endodontic
motor.
To initiate reciprocation, the file is left in the canal
at the TWL and the reciprocating handpiece is placed
over the file (the file is inserted into the head of the
reciprocating handpiece and is held there while
reciprocating). The attachment reciprocates the file
clockwise and counter clockwise — for example, with
a 30-degree clockwise and 30-degree counterclockwise movement. These attachments do not rotate
the file a full 360 degrees — in contrast to how RNT
files are powered. Different reciprocating handpieces
may have variations on the degree of clockwise or
counterclockwise rotation and possibly include a
vertical amplitude.
The Synea W&H-62A is an example of a reciprocating handpiece (MounceEndo) attachment with a
30-degree clockwise and 30-degree counterclockwise motion. Reciprocation is the technique and file
motion utilized in the Wave One canal preparation
system (Dentsply Tulsa).
Clinically, using the SEC O K File as an example,
the SEC O K File is placed to the TWL, the attachment
placed over the file and reciprocation commences
as described above. The file is reciprocated for 15 to
[19] =>
[20] =>
I technique_ canal shaping
Fig. 8_Clinical case treated using the
reciprocating technique described
and the MounceFile in Controlled
Memory©.
Fig. 8
30 seconds, using a 1- to 3-mm vertical amplitude
movement. Clinically, the file will become less tightly
bound as the canal is enlarged.
If, for example, a #08 SEC O K file is the first file
that binds in the canal at TWL, this file is reciprocated.
Once the #08 SEC O K File is reciprocated, the canal
will now accept a #10 SEC O K File to TWL. The #10 SEC
O K File is reciprocated. Once reciprocation is complete, the canal will allow a #15 SEC O K File to reach
the TWL. Once the canal is enlarged to approximately
the size of a #15 or #20 hand file, the canal is ready
for RNT enlargement.
Aside from glide path creation, this technique is especially helpful in early enlargement of calcified canals,
especially the MB2 canal of upper molars. Reciprocation is also valuable for rubbing out iatrogenic ledges.
Once the hand file can negotiate around the ledge, it is
left in place and reciprocated as suggested above.
It is not advised to place a hand file in a reciprocating
handpiece attachment and try to move the file apically
while powering the file. While such a motion will work
some of the time, it can accentuate ledges and other canal transportations and increase the risk of file fracture.
path preparation, regardless of whether the glide
path was made with reciprocation or with a nickel
titanium instrument, using a relatively smaller taper
and tip size RNT file (for example, a 0.02/20, 0.03/20,
or 0.04/20 file such as the MounceFile CM (controlled memory) can minimize the risk of subsequent
fracture that may otherwise result in moving directly
to a strict crown down approach around such a curvature. Fracture risk is minimized with the removal of
restrictive dentin along the curvature through use of
the instruments above (Figs. 7,8).
Alternatively, instead of using the MounceFile,
the clinician can make an equivalent enlargement
through the curvature using a 0.04/25 Twisted File
(Axis/Sybron) or similarly sized RNT file.
This article, written for the general dentist, has
described common attributes of hand files, their
clinical use, reciprocation, and integration of glide
path preparation with initial shaping procedures.
Emphasis has been placed on interpreting tactile
feedback and avoidance of iatrogenic events. Your
feedback is welcome._
_References
1.
2.
3.
4.
_Integration of the glide path with early
RNT shaping
5.
If the clinician is using RNT shaping methods, the
decision must be made to move either crown down,
step back or possibly use a hybrid of the two strategies.
While a comprehensive discussion of such RNT strategies is beyond the scope of this article, it has value to
mention that judicious initial removal of restrictive
dentin at the point of greatest root curvature (especially
in complex cases) is essential to minimize subsequent
iatrogenic events. Caution is advised. RNT fracture is a
risk when the wrong taper and tip size RNT is inserted
into an acute curvature (immediately after glide path
creation) with unnecessary force. In essence, a strict
crown down sequence may not be indicated.
Anatomically, the aforementioned greatest curvature tends to be in either the middle root third or
at the junction of the middle and apical thirds. Clinically, in complex multiplanar curvatures, after glide
20 I roots
4_ 2012
Roane JB, et al. The balanced force concept for
instrumentation of curved canals. Journal of Endodontics,
1985; 11:203–211
Shen Y, Qian W, Abtin H, Gao Y, Haapasalo M. Fatigue
testing of controlled memory wire nickel-titanium rotary
instruments. J Endod 2011;37:997–1001.
Shen Y, Qian W, Abtin H, Gao Y, Haapasalo M. Effect
of environment on fatigue failure of controlled memory
wire nickel-titanium rotary instruments. J Endod. 2012
Mar;38(3):376–380.
Shen Y, Zhou HM, Zheng YF, Campbell L, Peng B,
Haapasalo M. Metallurgical characterization of controlled
memory wire nickel-titanium rotary instruments. J Endod.
2011 Nov;37(11):1566–1571.
Schäfer E. Root canal instruments for manual use: a review.
Endod Dent Traumatol. 1997 Apr;13(2):51–64.
_about the author
roots
Rich Mounce, DDS, is in
full time endodontic practice
in Rapid City, S.D. He is
the owner of MounceEndo
LLC and an endodontic
supply company marketing
the MounceFile in Controlled Memory© and Standard Nickel Titanium (SNT).
MounceEndo is an authorized dealer of Mani Inc.
products and W&H reciprocating handpiece attachments.
He can be reached at richardmounce@mounceendo.com,
Mounceendo.com, Twitter: @MounceEndo.
[21] =>
[22] =>
I trends_ instrumentation
The real state
of endodontic
instrumentation
Author_Barry Lee Musikant, DMD
_While the quality of endodontic instrumentation and obturation are generally based on our final
mesio-distal X-rays, we must not believe for a moment
that such an X-ray is necessarily a predictable or even accurate reflection of a job well done even when the results
look excellent. I say this today because research over the
past several years has clearly established that canals are
often quite oval, deviating significantly from the conical
shapes we most often associate with thorough instrumentation and obturation (Figs. 1,2).
In this regard, the inadequacy of rotary NiTi in
shaping such canal configurations is established by
a plethora of research articles.1,2 The use of rotary
NiTi aggravates incomplete shaping by its need to
stay centered at all times within the canal. It takes
little imagination to realize that an instrumentation
system that requires constant centering lest it be
more prone to separation, is not going to cleanse
what are often the buccal and lingual extensions of
highly oval canals.1,2 To further compound inadequate
debridement, single instrument NiTi instrumentation
systems have been introduced that have also been
clearly shown via micro CT scans to miss removing
more than 50 percent of the tissue in the canals (Fig. 3).
Knowing that NiTi instruments of greater tip size
and taper are more prone to separation, rotary NiTi
Fig. 1
Figs. 1,2_CT scan of a mandibular
central incisor. Note the irregular
canal shape. (Images/Provided by
www.rootcanalanatomy.
blogspot.com)
Fig. 3_The green areas of this CT
photograph show areas missed
during the root canal procedure.
22 I roots
4_ 2012
Fig. 2
Fig. 3
[23] =>
[24] =>
I trends_ instrumentation
Fig. 4_A photograph showing
a relieved K-reamer. Note the
horizontal orientation of the flute
design and flat side. (Photos/Provided
by Barry Lee Musikant, DMD)
Figs. 5–7_Radiographs of a maxillary
molar instrumented with a relieved
reamer.
24 I roots
4_ 2012
Fig. 4
and to a lesser extent asymmetric NiTi reciprocation
creates an incentive in the dentist to prepare canals
conservatively with an increased incidence of debris
left behind. Recent research has now demonstrated
an increased occurrence of dentinal micro-fractures
when the canal walls are exposed to NiTi instruments
generating full arcs of motion.3–6 It should also be
noted at this time that both hand instrumentation
and engine-generated movement not resulting in
full arcs of motion are not associated with the development of micro-fractures.
In short, 20 plus years after the introduction of
rotary NiTi and its close cousin asymmetric reciprocation, we are becoming more aware of the limitations
imposed by these systems including modification of
technique to prevent separation, non-deviation from
centered canal preparations leaving debris in the wider
extensions of oval canals to again prevent separation,
the understanding that NiTi instruments of increasing
tip size and taper are not only more prone to breakage,
but are more likely to create dentinal micro-fractures.
Given the aggressive marketing of these instruments and their universal adoption by our dental educational institutes, it is imperative that we understand
what these instruments cannot predictably and safely
do and what alternatives exist that can produce a safer
and more thorough result. The research has clearly
established that apical canal preparations must be to
at least a 30 and preferably a 35 to provide sufficient
space for effective irrigation. Given the insecurities of
the present NiTi systems such apical preparations will
be a rarity particularly in curved canals of molars.
The first improvement in instrumentation must
be the elimination of instrument breakage as a
source of concern. If breakage can be eliminated,
the challenges to the dentist doing endodontics is
now limited to negotiating and widening the canal
without distortion, a far easier task when separation
is no longer a worry.
It’s one thing to talk about the benefits of non-separation, but exactly how is this accomplished when
it is common wisdom that breakage is something
that anyone doing endodontics must contend with?
The fact is that if the movement of the instruments
are limited to a tight arc of motion manually and do
not exceed a 30-degree arc of motion when enginegenerated, the elastic limit of the instruments will not
be exceeded and the instruments will remain intact.
The twin factors that lead to the separation of NiTi instruments are torsional stress and cyclic fatigue, both
generated by high degrees of rotation. Substitute
30-degree reciprocation for full arcs of rotation and
Fig. 5
Fig. 6
Fig. 7
the instruments will remain intact even when used at
3,000–4,000 cycles per minute.
The consequences of no longer needing to be
concerned about instrument separation are several:
1) The earliest instruments can be used aggressively against all the walls of the canals including the
thin isthmuses that may be present either between
canals or the extensions of oval canals.
2) The instruments can be used several times until
they become dulled. They need not be replaced after
one use because the downside to over usage is dullness not breakage, a fact that relieves a good deal of
gastric distress while dramatically reducing the cost.
3) The canals are widened to a minimum of 35 in
accordance with the research that shows how such
preparations correlate to superior irrigation.
What we have not mentioned up to now is just
what design is optimal. Here we deviate from the
traditional use of K-files, substituting K-reamers
through a 10 and then relieved K-reamers (Fig. 4)
starting with the 15 and continuing on with instruments of this design for the complete shaping proce-
[25] =>
[26] =>
I trends_ instrumentation
dure. The advantages of reamers both unrelieved and
relieved are superior to K-files and eliminate the need
for either rotary or asymmetric reciprocating NiTi’s
subsequent use for the following reasons:
1) K-reamers have half the number of flutes with
a flute orientation that is twice as vertical producing
less engagement along length.
2) Used with the same watch-winding motion as
K-files, the reamers will immediately shave dentin
away from the canal walls because the more vertical
orientation of the flutes puts them more or less at
right angles to the plane of motion, similar to what
occurs when shaving with a safety razor that is on a
T. The same way a blade at right angles to the plane of
motion produces smooth skin, it will effectively shave
dentin away from the canal walls. The traditional use
of K-files results in the engagement, not the removal
of dentin, until the pull stroke is employed. Yet these
same horizontally oriented flutes on a K-file have a
high potential to impact dentinal debris when being
introduced into the canal.
3) Having half the number of flutes compared to
a K-file, the reamer is less work hardened making it
more flexible. The incorporation of a flat along its
entire working length makes it still more flexible. That
along with its reduced engagement along length allows it to negotiate curved and tortuous canals with
far less resistance than a K-file will encounter, allowing the canal to be shaped to the proper dimensions in
significantly less time. It should also be noted that the
creation of the glide path is where blockages, ledges
and loss of length most frequently occur, a direct
result of the poor K-file design. This is far less likely to
happen when using the reamers both unrelieved and
relieved either manually or in the 30 -degree reciprocating handpiece.
4) A system based on the design of a relieved
reamer and utilized in a way that minimizes the amplitude of motion is best made of stainless steel. NiTi
requires only a small extension of distortion beyond
the elastic limit to produce a breakage. Stainless
steel will work under far more distortion before it
separates, making it a more practical metal than NiTi.
5) Stainless steel can be pre-bent to adapt to any canal
configuration. NiTi, in most preparations snaps back to
the straight position with a tendency to shape curved
canals to the outer wall. Those preparations of NiTi that
can record a bend are so flexible that they can easily lock
apically while rotating or reciprocating coronally. There
is a downside to being too flexible.
6) The greater stiffness of stainless steel means it
must not be used in rotation, but has no limitations
when used with a short arc of motion either generated
manually or in the reciprocating handpiece. The greater
hardness of stainless steel means the instruments will
retain their cutting edge far longer than NiTi. Considering the fact that these instruments should be used at
least six times before replacement, the retention of a
sharp blade is a decided advantage.
26 I roots
4_ 2012
It is an easy task to enumerate the advantages of the
reamers over that of K-files and the subsequent use of
NiTi. The proof, however, is in the pudding and a recent
example of the work that we produced in our office will
illustrate the advantages gained from their usage.
Figures 5–7 show a maxillary molar that was prepared apically to a minimum of 35, 1 mm back to a 40
and the implementation of the single NiTi instrument
we use in reciprocation, the 25/06 to blend in the middle and apical thirds. The dimensions of the preparation
were in accordance with the research that recommended a 35 for effective irrigation.
From the outset, using the thinnest 06 reamers,
all the walls of the canals were shaped by the reamers’ vertically oriented blades. If we are serious about
removing the tissue in the thin isthmus extensions that
often exist, we must address them at the very beginning
of instrumentation when instruments are the thinnest.
The reamers far more easily negotiate curved canals
than K-files and if increasing resistance is encountered
are pre-bent and negotiated manually around any tortuous canal present. A combination of superior dentinal
shaving, less initial engagement and increased flexibility
give the reamers the ability to provide the dentist with
excellent tactile perception, letting him know exactly
when an instrument may require pre-bending.
With the ability to be pre-bent and limited to a
short arc of motion, the stainless-steel reamers both
unrelieved and relieved can adapt to any situation
that may be encountered. The result is not only one
that looks good in the mesio-distal plane, but is
cleansed three dimensionally to a degree that assures
cleaner canals and superior obturation while leaving
the walls of the canal defect free._
Editorial note: A complete list of references is
available from the publisher.
_about the author
roots
Barry Lee Musikant, DMD,
is a member of the American Dental Association,
American Association of
Endodontists, Academy of
General Dentistry, the
Dental Society of New
York, First District Dental
Society, Academy of Oral
Medicine, Alpha Omega
Dental Fraternity and the
American Society of Dental Aesthetics. He is also a
fellow of the American College of Dentistry (FACD)
and International College of Dentists (ICD). He is a
partner in the largest endodontic practice in Manhattan. Musikant’s 35-plus years of practice experience
have established him as one of the top authorities in
endodontics. To find more information, visit www.
essentialseminars.org, email info@essentialseminars.
org or call (888) 542-6376.
[27] =>
[28] =>
I events_ ADA San Francisco
ADA holds meeting
in San Francisco and
offers plenty for
endodontists
Author_Fred Michmershuizen, Managing Editor
Fig. 1_Tom Bender, left, and Gunnar
Wallin of Wykle Research had
plenty to talk about at the recent
ADA meeting in San Francisco: new
products for endodontic treatment.
(Photos/Fred Michmershuizen,
Dental Tribune)
Fig. 2_Dave Lage of Essential Dental
Systems.
Fig. 1
_The American Dental Association held its 153rd
Annual Session and World Marketplace Exhibition
in San Francisco in October. For endodontists, the
meeting offered an opportunity to learn from leaders in
clinical practice, research, academia and industry. There
was also plenty of new technology to discover.
In the lecture halls, Dr. L. Stephen Buchanan, one of
the featured speakers at the meeting, presented an allday lecture and a hands-on course. In the lecture, “The
Art of Endodontics: Everything Has Changed but the
Anatomy,” attendees were able to see fresh clinical footage shot with a state-of-the-art HD1080p video camera.
The images were painted onto a screen at a resolution
that resembled looking through a microscope. Attendees
were able to see new procedures, such as rotary negotiation, guided-bur access preps, single-file GTX shaping,
single-cone backfilling and many more. Most of the
video clips were chosen from recent clinical cases.
In Buchanan’s hands-on course, attendees were
able to use the new TrueTooth™ 3–D printed training
Fig. 2
28 I roots
4_ 2012
[29] =>
[30] =>
I events_ ADA San Francisco
Fig. 3
Fig. 4
Fig. 3_Nick Snow, left, and Sarah
Tzdepski of Coltene show off some
of the company’s products for
endodontic treatment.
Fig. 4_Meeting attendees crowd
the aisles of the ADA exhibit hall in
San Francisco.
Fig. 5_Dr. L. Stephen Buchanan’s
new TrueTooth 3-D printed training
replicas, available from Dental
Education Laboratories, were used
in a hands-on course.
Fig. 5
replicas, available from Dental Education Laboratories. The replicas allow dentists to practice again and
again until they get consistently good results with a
given technique in a given anatomic challenge. There
is also a patent-pending process for these TrueTooth
replicas to have simulated pulp tissue that dissolves
with sodium hypochlorite irrigating solutions.
On the exhibit hall floor, many companies offered
products and resources of value to endodontists.
Wykle Research offered new products for endodontic treatment. Calasept irrigation needles
are dual-side-vented, luer-lock irrigation needles
that are designed to provide for safe and effective
irrigation. The dual side vents optimize cleansing of
canals, creating a “swirl” effect. The closed tip safely
protects the apex. Also available from Wykle are
new Calasept color-coded irrigation syringes that
are designed to eliminate risk when using multiple
irrigation liquids.
Jordco, a company that continues to refine its
product line, offered a wide range of products for
treatment, diagnosis, organizing, storage, safety
and convenience. For treatment, the Endoring II
hand-held endodontic assistant, EndoGel endodontic lubricating gel, e-Ruler endodontic file measuring
30 I roots
4_ 2012
instrument and Pure Bond Dispensers bonding agent
and composite dispenser were available. Also popular
was the Jordco e-Foam endodontic foam and the
FileCaddy bulk file storage system.
Taken together, the offerings comprise what the
company calls the Jordco System. The system works
on the premise that Jordco products complement
each other and work in concert from diagnosis
through all phases of treatment.
Coltene Endo showcased its HyFlex CM NiTi files
with Controlled Memory, which the company says
are up to 300 percent more resistant to cyclical
fatigue compared with other NiTi files, which substantially helps reduce the incidence of file separation. According to Coltene Endo, HyFlex CM NiTi files
have been manufactured utilizing a unique process
that controls the material’s memory, making the files
extremely flexible but without the shape memory of
other NiTi files.
For those who prefer not to use rotary files, Essential Dental Systems (EDS) offered its Endo-Express
reciprocating handpiece and its SafeSiders, designed
to eliminate the fear of fracture associated with
crown-down systems and the typical shortcomings
of the step-back process._
[31] =>
[32] =>
I industry_ Wykle Research
Wykle Research
expands its
Calasept Endo line
Fig. 1_Calasept Irrigation Needles
(Photographs/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, which is 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
4_ 2012
[33] =>
about the publisher_ submissions
I
submissions
formatting requirements
Please note that all the textual elements
of your submission:
• complete article
• figure captions
• literature list
• contact info (email address please)
• author bio
must be combined into one Microsoft Word
document. Please do not submit multiple files
for each of these items. In addition, images
(tables, charts, photographs, etc.) must not
be embedded in the text document. All images
must be submitted separately, and details
about how to do this appear below.
If you are interested in submitting a C.E.
article, please contact us for additional instructions before you make your submission.
_Text length
Article lengths can vary greatly — from a
mere 1,500 to 5,500 words — depending on
the subject matter. Our approach is that if
you need more or less words to do the topic
justice, then please make the article as long or
as short as necessary.
We can run an extra long article in multiple parts, but this is usually discussing a subject matter where each part can stand alone
because it contains so much information. In
addition, we do run multi-part series on various topics. In short, we do not want to limit
you in terms of article length, so please use
the word count above as a general guideline
and if you have specific questions, please do
not hesitate to contact us.
_Text formatting
Please use single spacing and do not put extra
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).
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:
•W
e 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
roots
I 33
4
_ 2012
[34] =>
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
Account Manager
Mara Zimmerman
m.zimmerman@dental-tribune.
com
Designer
Kristine Colker
k.colker@dental-tribune.com
Account Manager
Humberto Estrada
e.estrada@dental-tribune.com
C.E. Director
Christiane Ferret
c.ferret@dtstudyclub.com
Account Manager
Will Kenyon
w.kenyon@dental-tribune.com
Marketing Director
Group Editor
Anna Wlodarczyk-Kataoka
Robin Goodman
a.wlodarczyk@dental-tribune.
r.goodman@dental-tribune.com com
Roots Managing Editor
Fred Michmershuizen
f.michmershuizen
@dental-tribune.com
Feedback & General Inquiries
feedback@dental-tribune.com
Accounting
Nirmala Singh
n.singh@dental-tribune.com
Account Manager & Interactive
Charles Serra
c.serra@dental-tribune.com
International Account Manager
Jan Agostaro
j.agostaro@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.
34 I roots
4_ 2012
[35] =>
[36] =>
)
[page_count] => 36
[pdf_ping_data] => Array
(
[page_count] => 36
[format] => PDF
[width] => 594
[height] => 837
[colorspace] => COLORSPACE_UNDEFINED
)
[linked_companies] => Array
(
[ids] => Array
(
)
)
[cover_url] =>
[cover_three] =>
[cover] => ![roots C.E. No. 4, 2012]()
[toc] => Array
(
[0] => Array
(
[title] => Cover
[page] => 01
)
[1] => Array
(
[title] => Editorial
[page] => 03
)
[2] => Array
(
[title] => Content
[page] => 04
)
[3] => Array
(
[title] => A review of bioceramic technology in endodontics
[page] => 06
)
[4] => Array
(
[title] => Using hand files to their full capabilities: A new look at an old yet emerging technology
[page] => 13
)
[5] => Array
(
[title] => The real state of endodontic instrumentation
[page] => 22
)
[6] => Array
(
[title] => ADA holds meeting in San Francisco and offers plenty for endodontists
[page] => 28
)
[7] => Array
(
[title] => Wykle Research expands its Calasept Endo line
[page] => 32
)
[8] => Array
(
[title] => Submissions
[page] => 33
)
[9] => Array
(
[title] => Imprint
[page] => 34
)
)
[toc_html] =>
Table of contents
-
Cover
01 - 01
view
-
Editorial
03 - 03
view
-
Content
04 - 04
view
-
A review of bioceramic technology in endodontics
06 - 12
view
-
Using hand files to their full capabilities: A new look at an old yet emerging technology
13 - 20
view
-
The real state of endodontic instrumentation
22 - 26
view
-
ADA holds meeting in San Francisco and offers plenty for endodontists
28 - 30
view
-
Wykle Research expands its Calasept Endo line
32 - 32
view
-
Submissions
33 - 33
view
-
Imprint
34 - 34
view
[toc_titles] => Cover
/ Editorial
/ Content
/ A review of bioceramic technology in endodontics
/ Using hand files to their full capabilities: A new look at an old yet emerging technology
/ The real state of endodontic instrumentation
/ ADA holds meeting in San Francisco and offers plenty for endodontists
/ Wykle Research expands its Calasept Endo line
/ Submissions
/ Imprint
[cached] => true
)