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Performance Refined a shift up in performance May/June 2013 – Vol No a shift up in performance New PROTAPER NEXT features the same variable tapered performance as the original PROTAPER, but is refined with: • New unique rotary motion that further enhances PROTAPER canal-shaping efficiency ã Proven M-Wiređ NiTi alloy for increased flexibility and resistance to cyclic fatigue • New rectangular cross-section design for greater strength Call 1-800-662-1202 now to experience PROTAPER NEXT performance Or learn more at www.TulsaDentalSpecialties.com NEW Scan the code to see the unique new motion of PROTAPER NEXT Performance Refined 1-800-662-1202 For the latest information consult www.TulsaDentalSpecialties.com Rx Only © DENTSPLY International, Inc ADPTN1 11/12 Images Courtesy Dr Cliff Ruddle Product Profile What’s next? PROTAPER NEXT™ “Endodontics is a clinical game You’re supposed to have fun.” –John West, DDS, MSD To me, it’s fun when you master a skill such as the mechanics of root canal shaping It’s fun when you have a plan and you know how to get there ProTaper NEXT (PTN) was produced with a plan in mind: an advanced technology that gives the clinician choices, confidence, competence, safety, efficiency, technique simplicity, and yes, fun! West 20% OFF UP TO * REGISTRATION EVENT What makes ProTaper NEXT, next? PTN is a convergence of: 1) ProTaper Universal progressively tapered design, 2) M-Wire® refinements for added resistance to cyclic fatigue and increased flexibility, and 3) offset axis of rotation.* The resulting NiTi “envelope of motion” allows a newfound level of shaping control With almost unanimity, these three critical distinctions have had many colleagues describing their shaping experience with words like: “sleek,” “smooth,” “enchanting,” and “magic.” However, the best endorsement in the world is your own The first step in successful endodontics is to decide which “tool” to use when, why, where, and how Your plan gets you to where you’re going The resulting artistry is the signature that sets you apart Your signature becomes your reputation and your reputation ultimately becomes your endodontic legacy Technique Sequence I Used to Treat These Two Patients Case A FIND SAVINGS AND MORE WHEN YOU REGISTER AT TulsaDentalSpecialties.com Case B *Following your online registration, a coupon code will be emailed to you for a 20% discount off one total online order, with a maximum discount of $200 This offer is good for one use only per qualified account and may not be combined with other promotions DENTSPLY Tulsa Dental Specialties reserves the right to end the promotion at any time Design unimpeded smooth-walled access while fully preserving essential ferrule Brush gently on the outward stroke with ProTaper Universal SX to remove dentin triangles and restrictive dentin when present FIND WHAT YOU NEED FAST Pretreatment #12 Pretreatment #15 Prepare manual Glidepath with at least half canal length amplitude “super loose” #10 file (confirm Glidepath with #15 file or mechanical file, if desired) BETTER ORGANIZATION Shop for products by procedure or brand Float, follow, and brush on the outstroke (“let it run and paint” are useful watchwords) with PTN X1 to length Usually 2-3 shaping waves are needed Float, follow, and brush on the outstroke with PTN X2 to length Usually 2-3 shaping waves are needed EASY, PERSONALIZED ORDERING Re-order in one click or create separate users within your practice for purchasing control Perpendicular downpack #12 Perpendicular posttreatment #15 If X2 flutes are visibly filled with dentin: irrigate, gauge, conefit or use a verifier to validate proper shape Follow irrigation protocol then obturate with a vertical compaction of warm gutta-percha technique ON-DEMAND CE COURSES Enroll in courses, webinars and more, with your Clinical Education credits tracked in your profile If X2 flutes are nude of dentin, proceed with X3 and larger if occasionally needed All shapes presented were finished with X2 or X3 Note: PTN preserves proper root canal “Flow” *Ruddle CJ, Machtou P, West JD, The Shaping movement: fifth-generation technology Dent Today 2013;32(4):94-99 Oblique downpack #12 Oblique posttreatment #15 © 2013 DENTSPLY International, Inc CWEP 4/13 s • technology reviews May/June 2013 – Vol No PROMOTING EXCELLENCE Endodontics in 3D Dr Richard Kahan Direct pulp capping with a bioactive dentin substitute Dr Markus Firia Corporate profile Ultradent Products, Inc IN ENDODONTICS Top Ten Tips # To determine length Dr Tony Druttman Endodontics in Jamaica: a fulfilling and challenging experience Dr Gary Glassman Practice profile Dr Nishan Odabashian PAYING SUBSCRIBERS EARN 24 CONTINUING EDUCATION CREDITS PER YEAR! S IT D ! E R E C SID E C IN ASSOCIATE EDITORS Julian Webber BDS, MS, DGDP, FICD Pierre Machtou DDS, FICD Richard Mounce DDS Clifford J Ruddle DDS EDITORIAL ADVISORS Paul Abbott BDSc, MDS, FRACDS, FPFA, FADI, FIVCD Professor Michael A Baumann Dennis G Brave DDS David C Brown BDS, MDS, MSD L Stephen Buchanan DDS, FICD, FACD Gary B Carr DDS Arnaldo Castellucci MD, DDS Gordon J Christensen DDS, MSD, PhD B David Cohen PhD, MSc, BDS, DGDP, LDS RCS Stephen Cohen MS, DDS, FACD, FICD Simon Cunnington BDS, LDS RCS, MS Samuel O Dorn DDS Josef Dovgan DDS, MS Tony Druttman MSc, BSc, BChD Chris Emery BDS, MSc MRD, MDGDS Luiz R Fava DDS Robert Fleisher DMD Stephen Frais BDS, MSc Marcela Fridland DDS Gerald N Glickman DDS, MS Kishor Gulabivala BDS, MSc, FDS, PhD Anthony E Hoskinson BDS, MSc Jeffrey W Hutter DMD, MEd Syngcuk Kim DDS, PhD Kenneth A Koch DMD Peter F Kurer LDS, MGDS, RCS Gregori M Kurtzman DDS, MAGD, FPFA, FACD, DICOI Howard Lloyd BDS, MSc, FDS RCS, MRD RCS Stephen Manning BDS, MDSc, FRACDS Joshua Moshonov DMD Carlos Murgel CD Yosef Nahmias DDS, MS Garry Nervo BDSc, LDS, MDSc, FRACDS, FICD, FPFA Wilhelm Pertot DCSD, DEA, PhD David L Pitts DDS, MDSD Alison Qualtrough BChD, MSc, PhD, FDS, MRD RCS John Regan BDentSc, MSC, DGDP Jeremy Rees BDS, MScD, FDS RCS, PhD Louis E Rossman DMD Stephen F Schwartz DDS, MS Ken Serota DDS, MMSc E Steve Senia DDS, MS, BS Michael Tagger DMD, MS Martin Trope, BDS, DMD Peter Velvart DMD Rick Walton DMD, MS John Whitworth BchD, PhD, FDS RCS PUBLISHER Lisa Moler Email: lmoler@endopracticeus.com Tel: (480) 403-1505 MANAGING EDITOR Mali Schantz-Feld Email: mali@medmarkaz.com Tel: (727) 515-5118 ASSISTANT EDITOR Kay Harwell Fernández Email: kay@medmarkaz.com PRODUCTION MANAGER/CLIENT RELATIONS Email: kmurphy@medmarkaz.com Kim Murphy NATIONAL SALES/MARKETING MANAGER Drew Thornley Email: drew@medmarkaz.com Tel: (619) 459-9595 NATIONAL SALES REPRESENTATIVE Sharon Conti Email: sharon@medmarkaz.com Tel: (724) 496-6820 E-MEDIA MANAGER/GRAPHIC DESIGN Greg McGuire Email: greg@medmarkaz.com PRODUCTION ASST./SUBSCRIPTION COORDINATOR Lauren Peyton Email: lauren@medmarkaz.com MedMark, LLC 15720 N Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Fax: (480) 629-4002 Tel: (480) 621-8955 Toll-free: (866) 579-9496 Web: www.endopracticeus.com SUBSCRIPTION RATES Individual subscription year (6 issues) years (18 issues) $99 $239 © FMC, Ltd 2013 All rights reserved FMC is part of the specialist publishing group Springer Science+Business Media The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it The views expressed herein are those of the author(s) and not necessarily the opinion of either Endodontic Practice or the publisher Volume Number Endoscopic microsurgery for predicable and successful procedures The specialty of endodontics has improved so dramatically over the last several years, thanks to technology and to so many new instruments and products now available to us Performing apical surgery has become such a predictable and successful procedure Whereas once a procedure with no greater than 70% success, with the implementation of the surgical operating microscope, microsurgical hand instruments, ultrasonics, biocompatible root-end filling materials, and bone regeneration materials, endodontic microsurgery can now boast a success rate of greater than 90% This author feels strongly that the “pendulum” is starting to swing back towards saving the natural dentition whenever possible, and therefore, one must include surgical endodontics into their armamentarium Apical surgery is NOT a substitute for excellent conservative endodontics, but in an era of teeth that are heavily restored, and parts of longstanding fixed prosthetic work, often a surgical approach is the safer and more conservative approach Many problems can occur during conventional endodontics, such as separated files, ledged, or apically perforated canals, canal transportation, etc., and a surgical approach can correct these issues Teeth that contain large posts, which put the tooth at great risk for fracture if accessed conventionally, can be saved by surgical endodontics Endodontic surgery prior to the microscope had fair success Excess bone was removed in order to be able to see the roots; excess root structure was removed to be able to fit the handpiece inside in order to prepare the root end for an amalgam, which could then corrode and cause reinfection Under the microscope, we are able to keep our osteotomies small; just large enough to gain access to be able to remove all the diseased tissue Forty-five degree handpieces are used for easier viewing and only allow sterile water to enter the surgical site, while the air exits out the back of the handpiece head Only mm of the root is removed, and then the surface is stained with methylene blue dye to look for missed canals, microfractures, isthmuses between canals, and much more The root ends are then prepared with ultrasonic tips, remaining in line with the long axis of the roots so as not to remove any unnecessary root structure, and then these apical preparations are filled with biocompatible filling materials such as mineral trioxide aggregate (MTA), or newer bioceramic materials These root-end filling materials have been shown to not only allow new bone and cementum to reform, but they help to induce the formation of new cementum and bone, right up to the root We also have the great advantage of incorporating 3D imaging into our treatment planning for endodontic surgery, thanks to the CBCT This is an irreplaceable tool to help us see periapical lesions not seen on films, to measure the amount of bone necessary to drill through to access the apical portion of roots, as well as the proximity of roots to significant anatomical landmarks, such as the mental foramen and the sinuses One can use the measuring tool on the CBCT to determine the distance between an MB and ML root, for example, on mandibular molars, or the B and P root on maxillary bicuspids, as well as the direction one has to go to find these sometimes elusive roots Also, as endodontic surgeons, we should be knowledgeable about the various bone grafting and guided tissue regeneration materials available for those cases where there is a combination of an endodontic and periodontal lesion Of course there are cases where the teeth are just not accessible surgically, such as the second molar region, where the bone is so dense on the mandible and the patient’s lip cannot be pulled back far enough, or those maxillary second molars that are completely in the sinuses For cases like these, we must consider extraction/reimplantation, which has a documented success rate of over 80% when performed using modern protocol, proper case selection, and a transport medium such as Hanks Balanced Salt Solution, to maintain the viability of the PDL while the tooth is repaired extraorally Unfortunately, as a practicing endodontist, approximately 25% of my cases are nonsurgical retreatments These cases take the most time, are the most unpredictable, and have the highest postoperative flare-up rate As a comparison, endodontic microsurgery is quicker, more predictable, especially in preserving the coronal restorations, and has a negligible flare-up rate Yes, implants are successful and popular and predictable, but in the words of a well-known periodontist and former Dean of the University of Pennsylvania Dental School, Jan Linde, “Implants replace missing teeth… not teeth.” Endodontists are in the business of saving teeth, and therefore endodontic microsurgery should be something that all patients should be offered as a viable alternative to maintaining their own teeth Samuel I Kratchman, DMD Exton Endodontics, Inc Exton, Pennsylvania Endodontic practice INTRODUCTION May/June 2013 - Volume Number TABLE OF CONTENTS Clinical Practice profile Dr Nishan Odabashian: A focus on patients, colleagues, and family Technology, attention to detail, and knowledgeable mentors combine to help Dr Odabashian provide a positive experience for patients Endodontics in 3D In the second in a clinical series, Dr Richard Kahan discusses targeted endodontics 12 Effects of smear layer and debris removal with irrigation assisted by the EndoActivator and the Endo Brush Drs Joseph M Morelli, Mark Sakamaki, Ricardo Caicedo, and Stephen J Clark compare debris and smear layer removal from instrumented root canals after irrigation 14 Case study Maxillary molar endodontic case Corporate profile 10 presentation Dr Rahul Bose presents the case report that won him the acclaimed title of Young Dentist Endodontic Award 2012 18 Ultradent Products, Inc Ultradent continues to lead the way through invention and innovation Endodontic practice Volume Number simple, adaptable endodontic solutions Files to fit your technique And make apex location easy TiLOS hand files work with your technique Don’t change your technique Make it easier with TiLOS hand files No two root canal treatments are alike Your techniques are tried and tested, and you perform them on the entire range of cases you see every day So why not use the hand files that make every procedure faster and easier? Available in stainless steel and NiTi, TiLOS hand files just that And they’re made to work with your technique Scan to watch a short video about TiLOS hand files 800.552.5512 ultradent.com The unique construction of the TiLOS hand files allows the apex locator to be attached to the top of the file rather than below the handle ©2013 Ultradent Products, Inc All Rights Reserved TiLOS ® TABLE OF CONTENTS Research The effect of different solvents on root canal sealers Drs Ane Poly, Juliana Brasil, Paula Marroig, Fabiola Ormiga, Patrícia de Andrade Risso, Marcos Cesar Arẳjo, and Helsa Gusman evaluate the ability of solvents used in endodontics to disintegrate different root canal sealers 41 Aspiring endodontists in Jamaica 46 Case report Detection and endodontic treatment of a three-rooted maxillary second premolar Dr Imran Cassim presents a case report detailing treatment of a multirooted maxillary second premolar .22 Endodontics in focus Top ten tips: Tip number – To determine length Continuing his series on endodontics, Dr Tony Druttman looks at the best ways to measure the length of a canal 26 Endodontic practice Filling a need Continuing education Preserving the natural smile by immediate reattachment of a fractured tooth Drs Ramesh Bharti, Deeksha Arya, Anil Chandra, Aseem Prakash Tikku, Rakesh Yadav, and Promila Verma present two case reports detailing the reattachment of a fractured tooth fragment for the restoration of function and esthetics 28 Endodontics in Jamaica: a fulfilling and challenging experience Dr Gary Glassman takes his endodontic experience on the road to help aspiring dentists 46 Product insight Barbed sutures Dr Michael Norton discusses the barbed suture and its use in oral surgery 50 Anatomy matters Direct pulp capping with a bioactive dentin substitute Dr Markus Firla discusses various solutions for pulp exposure 32 Do lateral canals really matter? Technology Diary 54 3D Apical Cork – Part In the second article of this series, Dr Wyatt Simons discusses the technologic breakthroughs that the Cork delivery device brings to obturation 36 Part Dr John West explores the significance of the lateral canal 52 Materials & equipment 55 Ruddle on the radar The NITI shaping movement Fifth generation technology 56 Volume Number ORTHOPHOS XG 3D The right solution for your diagnostic needs Implantologists Endodontists Orthodontists will benefit from highquality pan and ceph images for optimized therapy planning will enjoy instantly viewable 3D volumetric images for revealing and measuring canal shapes, depths and anatomies will appreciate the seamless clinical workflow from initial diagnostics, to treatment planning, to ordering surgical guides and final implant placement General Practitioners will achieve greater diagnostic accuracy for routine cases ORTHOPHOS XG 3D “With my Sirona 3D unit, I can see the anatomy of canals, calcification, extent of resorption, fractures, and sizes of periapical radiolucencies, all of which influence treatment plans for my patients Combine that with the metal artifact reduction software that reduces distortions from metal objects, my treatment process is a lot less stressful My patients benefit from the technology and my referrals appreciate the value.” ~ Dr Kathryn Stuart, Endodontist - Fishers, Indiana The advantages of 2D & 3D in one comprehensive unit ORTHOPHOS XG 3D is a hybrid system that provides clinical workflow advantages, along with the lowest possible effective dose for the patient Its 3D function provides diagnostic accuracy when you need it most: for implants, surgical procedures and volumetric imaging of the jaws, sinuses and other dental anatomy For more information, visit www.Sirona3D.com or call Sirona at: 800.659.5977 www.facebook.com/Sirona3D PRACTICE PROFILE Dr Nishan Odabashian A focus on patients, colleagues, and family What can you tell us about your background? I am the oldest son, second of four children, to parents of Christian Armenian descent whose families ended up in the Syrian Desert after the Armenian genocide of 1915 My father was the oldest son of five, of the oldest son of six My mother was the youngest of 12, who lost her father at months of age Although my parents had humble beginnings, my father worked hard to improve his children’s chances of making a better future for themselves His first major decision towards that goal was to leave Syria and immigrate to the U.S We arrived in the U.S from Damascus in 1977 to N Providence, Rhode Island I was 12 I quickly adapted to the American way of life by first picking up the English language, and soon becoming a Red Sox, Celtics, Bruins, and Patriots fan We moved to California after the 1978 snow blizzard I attended Hollywood High School, and then I realized my father’s dream by being the first from our extended family to attend a university at UCLA I continued to Tufts University School of Dental Medicine and graduated with a DMD degree in 1991 After years of general restorative dentistry, I went back to school and received a certificate of specialty and a Master’s Degree in Endodontics from Loma Linda University School of Dentistry (LLUSD) in 2001 under the leadership of two giants in the field of endodontics — Drs Leif Bakland and Mahmoud Torabinejad I have since had a practice in Las Vegas, Nevada and Bakersfield, California In 2008, I returned to Glendale, California where I had practiced general dentistry I run Glendale MicroEndodontics (GME) and work with a wonderful staff who all strive to provide a most positive experience for our patients My biggest accomplishment in my life is my family I am married to Lilit going into our tenth year of marriage Lilit and I are blessed with three children, Galia, 8, Sérge, 5, and Noah, 3, who is a special-needs boy wonder Is your practice limited to endodontics? GME’s practice is limited to the specialty of Endodontic practice (Left to right) Lillia, Office Manager; Ingrid, Assistant; Elizabeth, Clinical Manager; Laura, Assistant in GME’s reception area endodontics However, we try to distinguish our office by practicing microscope-aided restorative endodontics What this really means is that we recognize that endodontic treatment is only half of the treatment, and that the success of our treatment equally depends on the restorative treatment To ensure our efforts have the maximum chance for success, we provide the permanent coronal restoration Performing the coronal restoration protects our root canal treatment and reduces the likelihood of: 1.) recontamination of the root canal system, 2.) fracture of the tooth prior to the patient having the crown placed by the general dentist, 3.) procedural accidents during the removal of the temporary and post and core placement by the general dentist, and 4.) having appropriate post size and depth as needed I also fabricate acrylic temporaries when needed, and make sure the patient returns to the referring doctor almost ready for his/her crown impressions Why did you decide to focus on endodontics? I owe my interest in endodontics to two very well-known endodontists from Santa Barbara, California — Drs Cliff Ruddle and Stephen Buchanan They were very influential in my becoming an endodontist, as I am sure they have been for many like me When I graduated dental school, the Dr Odabashian’s children: Galia, 8, Sérge, 5, and Noah, during Christmas 2012 “endo” requirement to graduate was to have treated nine canals with a minimum of one molar tooth Needless to say, I felt inadequate with my root canal treatment abilities, and so I took several courses from Cliff and Steve, and began appreciating the complexity of root canal systems The more I treated teeth endodontically, the more I enjoyed the challenges that came with treating each tooth I was lucky enough to have been accepted to LLUSD’s Graduate Endodontics program (to a class of three residents) by Dr Torabinejad and the rest of the faculty there My program laid a solid foundation for being an endodontic clinician, an educator, researcher, and a critical thinker How long have you been practicing, and what systems you use? I have been a dentist for over 22 years, a restorative dentist from 1991-1999, and an endodontist from 2001 till the present I started my training using the Surgical Operating Microscope (SOM) in residency, and I continue to so on 100% of the cases, from start to finish I don’t know how it is possible to perform endodontic treatment at a high level without a SOM I have heard some endodontists who don’t use the SOM say, “It’s just a tool!” I say “You don’t know what you don’t know!” Imagine walking in a pitch dark tunnel Volume Number What training have you undertaken? As I mentioned earlier, I was fortunate to be accepted to my endodontic specialty training under the well-known Mahmoud Volume Number Torabinejad, the post-graduate program director at LLUSD Dr “T,” as he is known by his residents, is not only a program director, he is a clinician, a clinical and didactic instructor, a previous president of the American Association of Endodontists (AAE), inventor, and a father figure to his residents Dr T is the developer of Mineral Trioxide Aggregate (MTA), which has been a game-changing material that has allowed the successful repair of iatrogenic and resorptive inflammatory perforations during root canal treatment When I began the program at LLU, Dr Torabinejad advised me and the other two incoming residents to expect to spend 1618 hours a day in the program He was very demanding of his residents, demanding for them to be the best they can be For me, it was an honor to be one of his students Who has inspired you? Professionally, my inspiration comes from Dr Gary Carr, an endodontist, an author, a visionary, the developer of The Digital Office (TDO) endodontic software, an inventor, and a mentor to hundreds of endodontists who are interested in performing endodontics at a high level Dr Carr has always challenged me to be the best that I can be, to always question dogma, and go beyond what is acceptable I owe Dr Carr much for being the endodontist that I have developed into Personally, my inspiration comes from my children They have taught me much also — patience, humility, sympathy, and understanding, among many other things I am blessed to have them What is the most satisfying aspect of your practice? I am sure I am not alone when I say that the best satisfaction for a clinician is when the result of a treatment is positive, the patient is appreciative, and the referring dentist is glad that he/she is referring his/her patients to you It is a great feeling when a patient writes a positive review on Yelp, Google, or your website, out of the blue! It is also very satisfying when you receive positive comments from referring doctors about the level of treatment you are providing to their patients There is no greater professional reward for me Professionally, what are you most proud of? I am most proud of the fact that I have the privilege of helping people; that I have the trust of my patients to take care of their endodontic needs I am proud that I have built a reputation in my community of being very good in my chosen profession I am proud that I don’t measure success with the amount of wealth that I amass, rather by the number of people I help I am proud that I stand for what I believe in, and that I am not fearful of the consequences of doing so I am also proud of the fact that, in a small way, I am able to contribute to dental education and organized dentistry Whether it is at the local, state, national, or even the international level, I try to volunteer my time, knowledge, and expertise to help my chosen profession As the saying goes, “If you are not part of the solution, then you are part of the problem.” I have been a part-time faculty member at LLUSD Department of Graduate Endodontics for the past 10 years I currently have the privilege of serving as the President of the California State Association of Endodontists, as well as serving as the Chairman of the Bylaws Committee of the International Academy of Endodontics What you think is unique about your practice? What I think is unique about my practice, at least in my immediate community, is that I am not in a hurry to complete a treatment Also we use the latest technology to the patient’s advantage, whether it’s the microscope, cone beam CT, digital radiography, the Internet, or even social media If we allow patients to register online or have them receive a text reminder of their appointment, doesn’t that make their lives easier? My endodontic practice is 50% initial treatment and 50% retreatment Unfortunately, gone are the days where endodontists are referred routine cases Generally speaking, endodontists are referred failing root canal treated teeth, severely curved or calcified teeth, teeth that have had procedural accidents, or patients who are generally either hard to manage or can’t afford treatment It takes an office with an experienced doctor, and a knowledgeable and understanding staff to manage these types of referred patients, and at the same time to please the patient, the referring dentist, as well as oneself I believe that we are able to accomplish this at Glendale MicroEndodontics Endodontic practice PRACTICE PROFILE that has three-dimensional curves, where the goal is to reach the end of that tunnel; and now imagine projector lights turned on throughout the tunnel Which method would you prefer to reach the end of the tunnel? Which would our patients prefer if the tunnel is inside their tooth that needs treatment? Dentistry in general is a profession that requires attention to detail at every step of treatment One cannot pay attention to detail at a certain part of the treatment, and be sloppy, or even average at another part, and still provide high quality dentistry For high quality treatment, an endodontist has to be detail-oriented from medical history to dental history, to proper use of radiography (two-dimensional, or 3D if needed), to diagnosis to proper treatment planning to anesthesia, to isolation to cleaning and shaping, to obturation to restoration, to postoperative care There is not one step that is more important than the next to have a successful practice that is patient centered In my opinion, there are a few fundamental “musts” as far as instruments and equipment for practicing endodontics at a high level: The SOM, an electronic apex locator (EAL), and more recently a cone beam computed tomography (CBCT) machine (when needed) There are numerous cleaning, shaping, and obturation systems out in the market, and it seems that almost daily, a new file, a new metal, or a new system is introduced, and hailed as the next panacea These different systems all work if used in the manner in which they were designed To me, these are mostly secondary What is primary, in my opinion, is to take the time to listen to the patients and pick up clues about what is their chief complaint; to take the time and diagnose the culprit tooth; to understand that it takes time to perform quality and successful endodontics; to realize that the root canal system is very complex and cannot be dumbed down to three white stripes on a radiograph that can be achieved in 30 minutes; and to educate both patients and general dentists about what is possible with meticulous endodontic treatment ... fifth-generation technology Dent Today 20 13; 32 (4):94-99 Oblique downpack #12 Oblique posttreatment #15 © 20 13 DENTSPLY International, Inc CWEP 4/ 13 s • technology reviews May/June 20 13 – Vol No PROMOTING... 025 Hypothesis 090 045 Error 1 53 6. 041 025 Hypothesis 152 025 Error 3. 852 1 96 020 F Partial Eta Squared Sig 9.7 13 089 829 482 707 192 1. 766 249 36 9 1.2 93 262 038 Intercept Group Evaluator Group... *Adcock et al, J.Endod 2011; 37 (4) **Castelo-Baz et al, J Endod 2012; 38 (5) 235 Ascot Parkway | Cuyahoga Falls, OH 442 23 Tel USA & Canada 800.221 .30 46 | 33 0.9 16. 8800 | coltene.com PATENT PENDING