Dr Flucke's Top 6 Test Drives of 2021

I do quite a bit of endo in my practice and for years I’ve been looking for a great way to help keep all of my files together in a way that is organized and safe. One of the things about endo files is that they have a very sharp end and, as such, need to be treated with the same care one exercises with needles.

The EndoButler was developed by Paul Moore, BDS, who practices in Galway, Ireland. It consists of a thick rectangle of medical grade silicone rubber sitting atop a hollow plastic stand. The files are pushed through the silicone and the tips are protected by the stand. The stand also works as an endodontic ruler so lengths are easy to determine.

The device holds the files safely and allows for accurate file measurements, and because the files are pushed into the silicone they cannot be spilled—even if the EndoButler is dropped!

The device is genius in its simplicity, plus Dr Moore is one of the nicest guys you’ll ever meet. He also makes a full line of other “Butler” products all based on the idea of medical grade silicone (in a variety of fun colors) that can hold burs, indirect restorations, lab burs, CAD/CAM blocks, and more.

As engineers better understand the effects of heat on nickel titanium (NiTi), great progress is being made with the flexibility of endo files. Within the last few years we have seen NiTi files that can be curved and then return to their original shape by being autoclaved. That was a significant discovery, but now Medidenta has taken that 1 step further with the Genius Proflex line of files.

The files needed for the midpoint of canal instrumentation are created in a way to give them a good mixture of flexibility and strength. When the canals are still being fine-tuned, these files offer the best of both worlds.

I have been using the Genius system for a while now and I am impressed with the continued advancements. The brain behind all of this is Carlos Spironelli Ramos, DDS, MS. Not only is he an endodontist, but he also earned a PhD in endodontics in his home country of Brazil. He is constantly working, experimenting with, and testing the latest endodontic instruments he has created. He has 3 patents on endodontic devices and when he speaks, many experts in endodontics listen. Even though I’m not an endodontist, I listen as well. His latest creation is a game changer.

As I’ve said in the past, curing is the stepchild of adhesive dentistry. It’s always there, but no one ever pays any attention to it. We’ve seen some pretty dramatic improvements in our curing devices over the past decade, but AMD Lasers has leapfrogged the industry with the first laser that is the same size as the standard LED curing light.

A laser pushes all of its photons in 1 direction in a column of light. Because of this, every photon created goes to the process of curing the composite. The physics of LED lights means that as soon as the light leaves the LED, it begins to sort of “spray” in all directions. That means wasted photons, which do not help cure the composite. The Monet Curing Laser focuses all of those photons in a single column of light.

Because of the intensity of the beam, AMD’s internal testing shows a depth of cure of at least 4 mm. In my own independent testing, I have seen similar numbers.

The Monet also comes with some handy aperture attachments that can easily snap on over the curing lens. These little clip-on attachments reduce the diameter of the beam to create different aperture tacking tips or smaller beams for more precise curing.

The Monet has benefits for indirect restorations as well. The intensity of the beam assures the operator of a strong bond and effective photopolymerization even through thick restorations such as onlays. This means that the user can have confidence that the restoration has a strong bond and is not relying on autopolymerizing resins to complete their chemical curing process. Lasers are truly the next step in our curing armamentarium.

It is truly amazing how far composites have come. They now wear like iron, can match almost any color of tooth, and are simple to repair. I have not done an amalgam restoration in probably 20 years, and I don’t miss them at all. If anything, I’m grateful that I don’t have to place them.

However, the 1 drawback composites have is that they are technique sensitive. Manufacturers have done their best to create materials that can withstand the incredible environment of the human mouth, but there are still some times where things fall short. One of the toughest things about placing composites is adequately controlling the field. Even a small amount of water, saliva, or blood can reduce bond strengths especially along the margins. This leads to recurrent decay, which is the bane of the composite restoration’s existence. Current research is showing that the average composite has a life span of a little over 5 years.

Infinix contains a very special molecule: a quaternary ammonium molecule bonded to silica that is mixed into Infinix and actually becomes part of the composite. This molecule lyses the cell wall of the caries-causing bacteria and kills it. You read that right. This is a composite that can actually kill decay-causing bacteria.

The molecule is never used up or depleted and never needs to be recharged. It just stays there, in the material, killing the bacteria that come into contact with it. I was actually fortunate enough to be the first office in the United States to use Infinix and even though I have had time to place only a limited number of restorations, so far, I have been incredibly impressed. This material has the potential to change restorative dentistry as we know it.

Composite technology has become a bit like the automobile. I know that sounds strange but hear me out. Originally the idea of automobiles was simply a better form of transportation. While at first, they were for tinkerers, the devices had to grow and mature. They became safer and more reliable. The old adage of “Get a horse!” came from the fact that cars were not reliable and broke down far too often. However, as the vehicle category improved, cars became much, much more than simple transportation. In fact, today, everyone expects safety and reliability. The selling features are now what technologies they offer.

Adhesive dentistry is now entering a similar phase. Everyone expects a material to be strong and highly polishable.

A new entry into the bonding arena is Re-Gen from Vista Apex, the first dental adhesive to utilize Bioglass as an active ingredient. Bioglass has been around in medical applications for over 50 years and has even proven to form a hydroxyapatite like surface that can help propagate the actual regeneration of tooth structure. That’s right, not only can this bonding adhesive hold your restorations in place, but it can even help to regrow healthy tooth structure in areas where that structure is microscopically missing.

The product was developed by John Kanca, DMD, one of the founding fathers of the entire idea of “wet bonding” in dentistry. Over the years he has developed several products that have helped advance the world of adhesive dentistry and Re-Gen is his latest. The system has performed well in my hands.