The Value of Endodontic Workshop

One can listen to lectures for hours, be the recipient of recommendations by advocates of different systems of instrumentation, irrigation and obturation, digest research articles on the superiority of one system over another or be influenced by the endless advertisements in magazines and YouTube without experiencing their actual use. Nothing substitutes for actual hand-on experience, giving the dentist the opportunity?to make his/her own evaluations on the ease, safety, and effectiveness of the tools they are using.

Most important in measuring the validity of any hands-on workshop is its realistic simulation of the procedures the dentist will perform on patients. In that regard, plastic blocks with small conical spaces with a mild degree of curvature are poor renditions of reality and don’t consistently represent conditions that the dentist is likely to face. We know from micro-CT scanned teeth that typical pulpal anatomy varies widely from the conical shapes in simple plastic blocks, that curvatures can be quite abrupt?and the canal anatomy is often not one of a continuous taper from orifice to apex. To call a workshop that limits the shaping of canals to such simplistic models is misleading and undermines the ability to make an accurate assessment of a system's capabilities.

What would be ideal is to use natural teeth that have been rendered transparent that show the wide variety of pulpal anatomy that actually exists, thin flat elongated pulpal configurations, highly oval anatomy where the bucco-lingual dimensions are often far wider than the mesio-distal dimensions, canals that are quite wide and those that are so thin along length reflecting the secondary dentine that has been laid down as we age. This option no longer exists in the United States given OSHA rules that include teeth as body parts that can no longer be used to prevent the possibility of the transmission of disease. Furthermore,?rendering them transparent is an expensive procedure that would add to the cost of the treated teeth that are no longer available.

So what is the best option we have left? The technology present today gives the manufactures of 3D printed teeth the ability to duplicate the complex anatomy that is often present in pulpal configurations. The materials with which they are fabricated are close to the hardness of dentin and the pulp tissue to be removed is simulated throughout their length with a waxy substance. These 3D simulations also have the great advantage of being transparent?giving the dentist the ability to observe to what degree the instrumentation and irrigation techniques employed are effective as well as detecting any distortions that the instrumentation process is producing.

This is the approach we use in our workshops. The dentists have the opportunity to use the techniques we advocate to determine their ability to instrument, irrigate and obturate the canals. As many of you who have read my past posts know, we recommend the use of 30o oscillating reamers in a handpiece that generates frequencies of 3000-4000 cycles per minute. The most obvious observation of this form of instrumentation that we want the participants to recognize is the virtual elimination of instrument separation. We emphasize this fact by encouraging the dentists to attempt to separate an instrument in any of the canals by applying great force both apically and laterally, something that is impossible to achieve even in the instruments’ thinnest dimensions. Indeed, even after such over-the-top usage an examination of any of the reamers so employed shows neither unwinding or overwinding the forerunners of any separation that would occur with other systems.

With separation fully removed as a source of concern, the next step already alluded to is their ability to be used with vigorous application against all the walls of the canals. The transparency of the teeth gives the dentist the ability to observe the degree of such vigorous debridement. What is noted is the high degree of cleansing accomplished even with the thinnest reamers, those used first in the instrumentation process, a result of their being applied to all the canal walls and cleansing the canals through a process I call internal routing where instruments thinner than the dimensions of the canal have the ability to fully debride because of their aggressive application against all the canal walls. Dentists who have taken rotary courses have learned to stay centered when shaping canals to avoid the extra stresses that would result from aggressive lateral movement leaving tissue in oval canals, something extensively documented in the literature.?

A personal comment on hands-on rotary courses I have taken. I have yet to take one of these courses that includes simulations of oval canals with either thin buccal and lingual extensions or those with thin isthmus-like spaces connecting major canals, anatomy that is not inviting for rotary preparation lest it leads to a higher incidence of instrument separation.

To this point, the dentists taking our hands-on workshops learn that instrument separation is completely avoided with the techniques we advocate thereby giving them the freedom to rigorously apply them laterally against all the canal walls for three-dimensional debridement. The final major point we want the dentists to appreciate is the fact that confined to the short arcs of motion generated by the 30o oscillating handpiece, the stainless steel relieved twisted reamers do not induce distortions even in highly curved canals, a fact that was originally observed by Dr. James Roane in his paper on the balanced force technique.?

These three objectives of the workshop are the main goals of the course. Just reading this post is no better than reading an article or attending a lecture. Without the hands-on experience no one is capable of making an accurate assessment of the advantages or even seeking out any shortcomings one may be looking for. I also know that many who read these posts are in no position to come to NYC to take the hands-on course.?

While not ideal, here is what I suggest. If you can’t get your hands on relieved reamers. Get a 30o oscillating handpiece (such as an Endo-Express or M4). They will accept the plastic heads of the reamers you are going to use. Run the handpiece at approximately 3000 cycles per minute as noted by a slight siren sound. Use irrigants at all times. From a practical point of view all you need is water as the irritant since you are using plastic simulations of real teeth. If you would like more info regarding the endo system I use, please see use this contact form:??https://zfrmz.com/DLRYvPKZKRG2fj6YSxIy

In my opinion, the best 3D-printed teeth I know of are made by TrueTooth by Plan B Dental. They can be contacted internationally at 1(805) 899-4529.?

Their address is: 315 Bollay Drive 150 Goleta, Ca. 93117

Their Email address is:?[email protected]

For those of you who can attend our workshops, our address is:

60 East 56th St. NYC, NY 10022

Our phone number is: 212-880-2700

Our email is:?[email protected]

Regards, Barry