Getting to the Root of the Problem

As someone who loves the practice of dentistry, I have a confession to make: I flat-out love endodontics. Now, don’t get me wrong; I love composites, I love fixed prosthetics, I love treating sleep apnea, and I love improving patients’ smiles. The great thing about being a general dentist is that I get to do all those things, but my favorite procedure is endo.

I’m willing to bet that a lot of you just groaned at that last sentence, but bear with me on this. Quite a few years back, I injured my right elbow—not severely, but enough that the process of performing extractions became painful. So I chose to stop doing them. I began to look for another procedure that I could be as passionate about that would save my patients from a referral.

I always had interest in endodontics, but after I was forced to give up on performing extractions, I decided to devote some time to learn. I consider myself fortunate because I became friends with an endodontist who loved tech as much as I do and who also happened to be a great teacher.

We would get together frequently and with practice blocks and extracted teeth, he taught me the art and science of endodontics. I basically got a miniature residency from all the work we did together, and I became confident in my endo skills. I owe my friend Jerry a debt of gratitude.

That confidence allowed me to do more cases, and also allowed me to better evaluate products and techniques. As new, superior products and methods were introduced, I extrapolated what I had learned to help me incorporate those products into my cases.

Also, some of my time is spent evaluating products in different phases of development, so I often get a chance to see things well before they hit the market. That sometimes gives me months of experience with a product before it is even released.

Efficiency in endodontics is important. I look upon making the procedure faster while achieving better outcomes as critical. Patients do not want endo to take longer. In all my years of practice, no patient has ever asked me to leave the rubber dam on for 15 or 30 more minutes because they enjoy it so much. The procedure should take as little time as possible while providing the best outcomes we can deliver. These are products currently on the market that can make your endo life easier and less stressful.

Septodont Paroject Intraligamental Syringe

Although not strictly an endo product, this beauty can make a tremendous difference when an infected tooth won’t get numb. Sometimes teeth simply don’t cooperate, and a periodontal ligament injection is a great way to get anesthetic right where you need it.

The device is simple, sleek, and effective. We also routinely use it for restoring a single lower molar instead of delivering a block. You can check it out at https://www.septodontusa.com/products/paroject

SybronEndo M4 Safety Handpiece

One of the most important parts of endo is creating the “glide path.” This is the initial part of shaping that prepares the canal for rotary files. Often this is done with hand files, which can be a slow and difficult process. Some current instrumentation techniques allow for reciprocation and rotation with the same type of file. Other systems require the creation of a glide path with the time-tested process of using hand files. Of course, filing by hand is frequently a slow and arduous process.

But what if you could take that hand filing and convert it to engine driven? That is the beauty of the M4 Safety Handpiece. This device is a contra angle that fits on a standard E speed motor attachment (usually the one on your endo motor). The head has a push button chuck that will accept the handle of almost any type of hand file. Once the file has been gripped by the M4, it moves in a 60º “watch-winding” oscillation when you step on the rheostat, turning 30º in each direction. This makes the hand files efficient, allowing the operator to finish with a file in less than 30 seconds.

The M4 has become a vital part of my endo setups. My glide path steps are efficient and predictable. It truly is one of those devices I do not want to work without. Find it by going to https://www.kerrdental.com/kerr-endodontics/m4-safety-handpiece-endodontic-contra-angle-shape

EndoUltra from Vista Apex

If you follow the endodontic literature, you understand that mechanical debridement, even with the very best instruments in the hands of the very best operator, will not completely clean the canal system. There are too many oddities in its shape for a file to reach and adequately clean them. We need to use our irrigation chemistry to reach those areas for us.

Of course, the standard and most popular way of removing pulpal remnants and bacteria is to use sodium hypochlorite. Yet with all those little nooks and crannies in the canal system, how can we ensure that the irrigant is adequately reaching those areas and working its magic? The best way to do this is to agitate the irrigants with ultrasonic energy.

This can be done by using a piezo unit, but those devices are a bit pricey and also occupy a pretty large footprint. Instead, how about a small, light, and cordless unit designed specifically for endo? That is what you get with the EndoUltra from the folks at Vista Apex. The EndoUltra is the only cordless activator unit capable of generating the tip frequency (40,000 Hz) required to create sufficient acoustical streaming and the cavitation necessary to effectively clean, penetrate, and remove vapor lock. It uses titanium tips that can be bent to accommodate easy access to any tooth. It also has a white LED that helps illuminate the field during use.

One other thing that makes it so great is that, in addition to all its benefits, it is also affordable. Check it out by going to https://vistaapex.com/product/endoultra-cordless-ultrasonic-activator/

Medidenta Advanced Cordless Endo (ACE) Motor

I owe a great deal to my friend Dr Carlos S. Ramos. He is an endodontist as well as a tremendous endodontic researcher, teacher, and inventor. He has taught me and explained countless endodontic secrets of success. His outside-the-box thinking is inspiring, and one of his latest inventions deserves mention.

Two of the most important changes in endo in the past couple of decades involve the development of the electronic apex locator (EAL) and the electric torque-controlled endo motor. Achieving clinical success without an EAL is difficult, and knowing the location of the apex is critical. Knowing its exact length and then moving your instrument to it exactly is more difficult than it sounds. One must first determine the canal length, then translate the determined distance to a file in a handpiece. After that, getting it to precisely the right spot is challenging.

The solution is to have the EAL built into the electric torque-controlled motor so that the 2 devices work simultaneously. Being able to know the location of the file in the canal at any moment as you are working is powerful and helps ensure clinical success in instrumentation.

One of the more recent improvements in instrumentation is the concept of using a file system that allows for the files to be used in reciprocation as well as rotation. The ACE motor is one of a few motors on the market that will do just that. Dr Ramos has also invented the Endo-Eze™Genius® file system, which uses both reciprocation and rotation in instrumentation. To enable that, he has designed the ACE motor to perform those critical functions well.

However, it’s not simply that this motor (which he designed) works great with the Genius files (which he also designed). The other truly great aspect of this device is that it is designed with fully open architecture. By that I mean the motor is totally programmable by the end user. In a nutshell, that means the doctor can tell the motor precisely how to perform.

The ACE is far and away the most comprehensive and all-encompassing endo motor I have ever seen. The device is so impressive, I could easily have devoted this entire article to it. However, you can learn everything about it by watching an 11-minute video. Head over to YouTube and prepare to be amazed.https://www.youtube.com/watch?app=desktop&v=Wd-4-8Fo7aQ

Labomed Dental Microscopes

Almost every endodontist has a surgical microscope these days. However, although more than 80% of general dentists work with surgical telescopes, only a very small percentage actually work with microscopes. The main reason they have not embraced the concept of microscopes is the cost. Although microscopes aid in endo, most doctors feel that working in 3.0× to 5.0× is perfectly acceptable for quality restorative work.

The expense of a surgical microscope is hard to justify when endo is not the only procedure on your daily schedule. Enter Labomed, with their line of affordable surgical microscopes. The company currently offers 3 models, and they are more affordable than those from other companies in the dental space.

The products offer features such as the ability to connect a DSL camera for taking photos, connections for monitors, and even a splitter that allows the assistant to see what the doctor sees. I have had one of their microscopes in my office for the past few years and have been very happy with its performance. Give them a look at https://www.laboamerica.com/category/dental-microscopes/

Wrapping Up

If you noticed that I failed to mention a file system, I have a good explanation. File systems are a bit like cars. Each system has advantages and disadvantages. It really comes down to what works best in your hands. The products mentioned here will improve your clinical outcomes no matter which file system you use.

The important thing to remember is that endodontics is a constantly changing landscape. Like walking up the down escalator, if you are not pushing to move forward you will be moving backward. This constant push to be our best is one of the things I love most about what I do. I hope you feel the same way. I sincerely hope that this column has given you some nuggets to improve your patient outcomes.