Endodontic Practic US Vol 9, Supplement 1

clinical articles • management advice • practice profiles • technology reviews Vol 9 Supplement 1

PROMOTING

EXCELLENCE

IN

ENDODONTICS

Turn on the lights of endodontics!

Dr. John West

CBCT provides clarity of prognosis Dr. Mark Anthony Limosani

Practice profile Dr. Brian Wells

Investing in a CBCT system — the must-haves, the nice-to-haves, and where to splurge Jordan Reiss

SEE BEYOND THE SURFACE

PRECISE IMAGE QUALIT Y MADE EASY FOR YOU

To plan and perform any procedure with confidence, the details are important. You need crystal clear images that display detailed root and canal morphology and enhance your diagnostic abilities. With Carestream Dental, high-quality images and customizable filters let you look deeper and see with more precision.

For more information, call 800.944.6365 or visit www.carestreamdental.com Watch videos here>> CS 8100 3D and RVG 6200

Š Carestream Health, Inc. 2016. RVG is a trademark of Carestream Health. 14471 EN IN AD 1016

Brian Wells, DMD

TABLE OF CONTENTS

Practice profile

2

Trending products Turn on the lights of endodontics!

Dr. John West illuminates endodontists on the latest technologies ....................................................... 10

Smiles and ice inspired to perfection

Technology Investing in a CBCT system — the must-haves, the nice-tohaves, and where to splurge

Case study CBCT provides clarity of prognosis Dr. Mark Anthony Limosani’s case study illustrates how CBCT provides insights into endodontic procedures

Volume 9 Supplement 1

8

Jordan Reiss poses key questions to choose technology that brings benefits to the endodontic practice ....................................................... 18

Endodontic practice 1

PRACTICE PROFILE

Brian Wells, DMD Smiles and ice inspired to perfection What can you tell us about your background?

I grew up in a large family — I am the third child of nine children. I have three brothers and five sisters. Since my father was in the army as a West Point graduate and member of the Army Corps of Engineers, I grew up in many different places. I was born in Fort Ord, California and as a child lived in Indiana, Maryland, Europe, and the Middle East.

However, I spent a large part of my childhood in Maryland, outside of Washington, DC. As a child, I learned to ice skate and developed an interest in figure skating, which became my first passion. I became a competitive pair’s skater, and my first partner was my sister, Ann-Marie. She and I competed at the Junior World Championships in 1988 in Australia and in the former Yugoslavia in 1989. When Ann-Marie retired, we were ranked third in the United States and sixth in the world at the junior level. I continued on with two more partners, Laura Murphy (who is now a dental hygienist in Delaware) and Shelby Lyons. My skating career took me to Delaware and then Colorado where I lived and trained at the Olympic Training Center in Colorado Springs. I competed at the national level for 13 years and had the most success in my skating career with Shelby. In 1998, we finished second at the U.S. Figure Skating Championship and qualified as members of the U.S. Olympic Team. That year we also competed at the World Figure Skating Championships and finished 10th. I was not able to compete at the Olympics because a team that was injured during the Nationals was “elected” to the Olympic team. This incident led to my retirement from figure skating in the Spring of 1998. This was a devastating experience that led me to rethink my direction and career. But skating taught me when you fall down, you get up and move on.

I was 27 years old and had to decide what I wanted to be when I grew up. I knew that I didn’t want to be in a rink. At this time, I decided I wanted to attend dental school and needed to finish my college degree. I moved to New York City and attended CUNY Baruch College. When I retired from figure skating, I was at the pinnacle of my career; 2 Endodontic practice

Dr. Wells at Wells Endodontics with the GentleWave® System

Brian Wells with Shelby Lyons

it was hard going back to school and just being another undergraduate at a large city college. I went from signing autographs to sharpening pencils. But on my first day of school, a beautiful woman, Maggie, sat down next to me; we married in 2002.

I graduated from Baruch in 2000 with a degree in biology and started dental school at Harvard University in 2001. While at Harvard, I was president of my class and began my passion for dentistry.

I graduated from Harvard in 2005, the year my first child, Olivia, was born. I attended Tufts University School of Dental Medicine for my endodontics residency from 2005-2007. Maggie, my wife, finished her internal medicine residency at Tufts while I was there. Maggie, Olivia, and I moved to

Florida in 2007 to be near family, and we were quite excited to not have to live through another cold, snowy winter.

I established my practice, Wells, Endodontics, in a standalone building in Wesley Chapel, north of Tampa. I work out of three operatories and have three assistants — Melissa Ng, Cindy Overstreet, and Cralonda Blyden. My front office is staffed by my office manager, Dawn Mastrino and my sister, MaryBeth Wells. Another sister, Ann-Marie Dorsey (my first pair’s partner) is my marketing manager. My wife is the brains of the operation and the person I have lunch with every day. My semi-retired, engineer father, Johnny Wells, also is here making sure everything is working well.

When did you become a specialist, and why?

My dental path started when I was very young. I was not a person who said, “I want to be a dentist when I grow up.” There were no dentists or physicians in my family. My mother had made me a Superman cape for Halloween. I knew, as many children do, that the secret of flight is a cape. I tried on my cape and decided to fly upstairs to impress my family with my flying skills. My first flight led to a face plant and impaction of my anterior teeth. This incident led to many Volume 9 Supplement 1

and saving their teeth. What more could you want?

Do your patients come through referrals?

Yes, the majority of my patients come through referrals from general dentists in my practice area. We do get many patients from word-of-mouth and from online reviews.

Is your practice limited solely to endodontics, or do you practice other types of dentistry?

How long have you been practicing endodontics, and what systems do you use?

I have been practicing endodontics since 2007. I use a hybrid system to reach the desired result. I love using TDO — The Digital Office software. My workhorse file is a ProTaper Next™. I use Zeiss OPMI® pico microscopes with xenon bulbs. I have ASI carts with NSK electric high/low speed, rotary, and ultrasonic. I use Sybron Elements™ unit for obturation, 3D imaging with Carestream CBCT, and digital sensors. My newest addition is the GentleWave® System by Sonendo®, which I feel is a groundbreaking technology that is serving my practice and my patients very well.

Who has inspired you?

My practice is limited solely to both surgical and nonsurgical endodontics.

Because the art of diagnosis can be challenging, I have also become the “tooth whisperer” with difficult facial pain situations. I can’t solve all pains, but can at least rule out ones related to root issues.

Why did you decide to focus on endodontics?

As a competitive figure skater, I learned that I was a perfectionist.

Endodontics is a specialty measured in millimeters. It allows me to focus on details, while getting people out of pain

Brian Wells with his sister, Ann-Marie Dorsey, from their 1989 U.S. Figure Skating Association Junior Championship. They were awarded a Bronze Medal

Fabulous assistants — Cralonda Blyden, Melissa Ng, Cindy Overstreet Volume 9 Supplement 1

My first and constant inspiration has been my parents, RoseAnn and Johnny Wells. How they managed to raise nine children, including one who was severely disabled, has always impressed me. My parents have always put our needs in front of their own and gave me confidence that I can always be better. No matter how well I was doing in my skating, I always knew the value of a good education. Every one of their children has a college degree with six master’s degrees (or higher) among them. One of the biggest compliments anyone can give me is that I remind them of my father.

SuperStar front office — Dawn Mastrino and MaryBeth Wells Endodontic practice 3

PRACTICE PROFILE

years in the dental chair. As a teenager, I had a number of tooth-related issues that required the expertise of an oral surgeon.

I was very fortunate to be in contact with Raymond Fonseca, DMD — the Dean at the University of Pennsylvania. I was so impressed with his extensive knowledge, skill, and respect in the community that it opened my eyes to a possible career in a dental specialty. This was reinforced the first time I stepped onto Harvard’s campus and met Jarshen Lin, DMD, the Director of Undergraduate Endodontics. After spending time with him, I realized that endodontics was a perfect fit for me and my personality.

PRACTICE PROFILE My younger sister, JeanMarie, has also been one of my life’s inspirations. She was born with a missing frontal lobe and debilitations so severe that she was given a 5- to-7 year life expectancy. Seeing her fight and survive until she was 28 years old is a testament to my family’s love and her will to fight.

Even after her passing, JeanMarie reminds me daily to appreciate the gifts I have and to make the most of them. Throughout my life, I have tried to help other disabled people and families. I have volunteered for Special Olympics ever since I was old enough. As a world-class athlete, I represented athletes on the U.S. Figure Skating Special Olympics Committee. While at Harvard, I established Smiles for Miles with the help of mentors from the pedodontic and endodontic departments. The goal of this organization was to help bring dental care to disabled children.

Currently, I throw an annual skating party to promote my office, and we raise money for cerebral palsy research in JeanMarie’s memory.

In dentistry, my inspiration started with Dr. Fonseca prior to school and Dr. Jarshen Lin at Harvard; Drs. Dan Green and Bob Amato at Tufts were my endodontic inspirations.

they need treatment. Root canals get a bad name in the world for a good reason — either someone has had a bad experience, or they have heard about someone’s bad experience.

I try to change this perception, one tooth at a time. It makes my day when someone leaves my office saying, “That’s the best experience I’ve ever had in a dentist’s office.”

call the next day. We have a conservation view from every operatory with bird feeders in every window. The feeders attract many bird species (cardinals, mourning doves, tufted tit mice, blue jays, finches, red-winged blackbirds), squirrels, and raccoons. Sometimes we have deer, wild turkey, and bobcats to entertain us.

What do you think is unique about your practice?

What has been your biggest challenge?

I make a point of spending time with all my patients. I know that this might be the only time I will meet them, and I want to make sure they have a positive experience. I think a well-informed patient is a good patient. I explain every step of the procedure — including drawing in TDO on the radiograph explaining what can be seen.

I take pride in making a good experience from the first phone call to a profoundly painless procedure and the personal courtesy

My biggest challenge has been time management. I see emergencies and children, which create a dynamic in the office that can become very interesting. Meeting these demands in my day sometimes makes it very challenging and fun.

Would you have been if you hadn’t become a dentist?

Having already been a world-class competitive skater, I had the opportunity

What is the most satisfying aspect of your practice?

Let’s face it; most people don’t want to have a root canal. They are in my office because they are in pain or have been told

JeanMarie, age 10 — JeanMarie has been one of my life’s inspirations. She was born with a missing frontal lobe and debilitations so severe that she was given a 5-7 year life expectancy. Seeing her fight and survive until she was 28 years old is a testament to my family’s love and her will to fight. Even after her passing, JeanMarie reminds me daily to appreciate the gifts I have and to make the most of them.

4 Endodontic practice

Dr. Wells at Wells Endodontics with the GentleWave® System Volume 9 Supplement 1

Improve the view in comfort.

ZEISS OPMI Microscopes

// VISUALIZATION MADE BY ZEISS

ZEISS OPMI® pico and OPMI PROergo® microscopes combine state-of-the-art optics and effortless maneuverability for maximum visualization and optimal comfort. Work ergonomically even at extreme treatment approach angles and view otherwise difficult-to-see regions in greater detail during delicate and complex procedures.

For more information, please contact us at 800-442-4020. http://www.zeiss.com/us/DentalMicroscopes

SUR.8040 ©2016 Carl Zeiss Meditec, Inc. All copyrights reserved.

PRACTICE PROFILE

Their children — Olivia (10), Ian (8), Eva (5), and Owen (3).

Maggie and Brian at the beach

Top 10 favorites Wells family

of doing shows. I spent much of my life coaching skating, which helped pay my way through dental school. Without dentistry, I probably would have stayed in the figure skating world.

What is the future of endodontics and dentistry?

I think previous breakthroughs in endodontics were in “vision” — the microscope and cone beam CT. These are now standard of care for a good root canal. The new frontier, I think, is revolutionizing the irrigation and instrumentation of root canal treatment. The GentleWave technology that I have adopted allows me to conservatively improve my handling of complex anatomy.

The results are beautiful.

What are your top tips for maintaining a successful specialty practice?

6 Endodontic practice

It is easy to get bogged down with the intricacies of referral patterns, crappy insurances, and difficult cases. It all boils down to good communication with your referrers, your patients, and your staff. I have great professional and some personal relationships with my referring dentists, but I always treat my staff like family. (Many of them are family.)

What advice would you give to a budding endodontist?

I have learned that there is more to quality care than just being able to do a good root canal. Don’t forget the “care” in caregiver — you can’t fake it. Always remember that there is a person underneath the tooth you are working on. I always diagnose before I treat. Buy the best technology — ZEISS scopes, The Digital Office (TDO), CBCT, and the GentleWave System.

We have chosen a great profession with a bright future.

1. Maggie and the kids 2. Singing (off-key) to patients while working 3. TDO — The Digital Office software 4. GentleWave® System by Sonendo® 5. ZEISS OPMI® pico microscopes 6. Carestream CBCT and sensors 7. Sybron Elements™ 8. ProTaper Next™ files 9. Tesla Models S and X 10. Indian Rocks Beach

What are your hobbies, and what do you do in your spare time?

I like spending as much time as possible with my wife, Maggie, and my four children — Olivia (10), Ian (8), Eva (5), and Owen (3). We love going to the beach and Disney — two huge benefits of living in Florida (both less than an hour away). We are an all-electric Tesla family. I really enjoy holding my wife’s hand skating around a rink. EP Volume 9 Supplement 1

®

The Only Thing We Meddled With Is the Metal.

Efficient. Flexible. Brilliant.

All the ProTaper® efficiency, now with advanced metallurgy for greater flexibility and resistance to cyclic fatigue.

ProTaper Gold® – because performance is golden.

Rx Only ©DENTSPLY International, Inc. ADPTG Rev. 4 2/16

CASE STUDY

CBCT provides clarity of prognosis This case study illustrates how CBCT provides insights into endodontic procedures

T

he American Association of Endodontists (AAE) and the American Academy of Oral and Maxillofacial Radiology (AAOMR) recently updated their joint position statement on the use of cone beam computed tomography (CBCT) in endodontics. At the heart of the statement is the need for endodontists to utilize limited field of view (FOV) CBCT when capturing a CBCT scan. Collimation to the area of interest reduces patients’ radiation exposure, allowing practitioners to adhere to the “as low as reasonably achievable” (ALARA) principle. Endodontists should strive to use the smallest possible field of view and voxel size, lowest mA setting, and shortest exposure time to further limit dose.

This patient is an excellent example of when limited FOV CBCT provided insight on a case when 2D radiographs and traditional testing proved inconclusive — Jordan Reiss, National Sales Director of 3D imaging for Carestream Dental

Mark Anthony Limosani received his DMD degree from the University of Montreal in 2007. He attended the specialty program in endodontics at Nova Southeastern University where he also received his master’s degree in dental science.

He is a Fellow of the Royal College of Dentists of Canada and a Diplomate of the American Board of Endodontics. He is currently on staff at Miami Children’s Hospital and teaches at the AEGD residency program at Community Smiles. Limosani has lectured locally and internationally on dental traumatology, restoration of endodontically treated teeth, restoratively minded endodontics, diagnosis and treatment planning, and cone beam computed tomography (CBCT) use in endodontics.

8 Endodontic practice

Case study by Mark Anthony Limosani, DMD, MS, FRCD Overview A 67-year-old female taking FORTEO® (teriparatide) for the treatment of osteoporosis was referred to my office by her general dentist because of her history of ongoing low-grade discomfort associated with the UR quadrant and, more specifically, with tooth No. 3. Her dental history revealed previous root canal therapy was completed

on tooth No. 3. She didn’t recall when, but was confident it was greater than 5 years prior to presenting to my office.

Clinical examination revealed a slight buccal swelling associated with the tissue buccal to tooth No. 3. No sinus tract was evident. The palpation of the temporalis and masseter muscles did reveal some triggerpoint sensitivity suggestive of myositis Volume 9 Supplement 1

CASE STUDY

possibly subsequent to parafunctional habits.

Tooth No. 3 demonstrated slight sensitivity to biting, palpation, and percussion. A 6 mm probing was noted on the mesiobuccal (MB) aspect of the palatal (P) root. This finding was concomitant with purulent discharge.

The PA radiograph (Figure 1) demonstrated that tooth No. 3 had previous root canal treatment. Probable radiolucent findings were associated with the apical portion of the MB and P roots. The root canal filling material associated with all three roots appeared underextended and underfilled. A decision was made to take a cone beam computed tomography (CBCT) scan (Carestream Dental, CS 8100 3D) in order to obtain more valuable diagnostic information.

Findings The sagittal slice demonstrated attenuation patterns suggestive of a narrow bony defect associated with the MB aspect of the P root of tooth No. 3. The axial slice demonstrated the high likelihood of an unaddressed second MB canal as well as a furcal defect involving the MB and palatal roots. No radiolucent findings were associated with the apical portion of the MB root.

Figure 1: 2D periapical radiograph of previous RCT on tooth No. 3

Treatment plan My endodontic diagnosis for tooth No. 3 was a previously endodontically treated tooth with an acute apical abscess. The differential diagnosis associated with the etiology of bone loss was assessed as follows: 1. A crack extending from the MB root to the P root 2. A second mesiobuccal (MB2) canal, unaddressed during the initial therapy, that was causing persistent periradicular periodontitis The patient was given the option to have the tooth extracted or to re-access the pulp chamber in order to investigate the presence of a crack or missed canal. She agreed to access the tooth, whereupon a crack was discovered (Figures 4 and 5), extending from the MB canal through the palatal root.

Figure 2: Oblique sagittal CBCT view of No. 3 with attenuation patterns suggestive of a narrow bony defect associated with the MB aspect of the P root of tooth No. 3 (red arrows)

Figure 3: Axial view with finding of an unaddressed MB2 canal (yellow arrow) and furcal defect (blue arrow) on No. 3

Thoughts on CBCT As clinicians, we can all recognize the importance of managing patient expectations prior to initiating treatment. When explaining all potential risks and benefits associated with our intervention, it becomes imperative for us to gather a significant amount of evidence in order to allow the patient to make an enlightened decision. CBCT helps uncover another layer of the dental diagnostic truth, while concomitantly enabling us to properly document our decision-making process.

Volume 9 Supplement 1

Figures 4 and 5: Operating microscope intraoral photographs of the partially debrided tooth No. 3 with the finding of a crack extending from the mesiobuccal canal through the palatal root

CBCT technology provides practitioners with another level of comprehension both from a diagnostic and a case management perspective. With 3D imaging, we are able to

evaluate cases more accurately, while at the same time providing the patient with more effective diagnostic tools that minimize additional costs, procedures, and discomfort. EP Endodontic practice 9

TRENDING PRODUCTS

Turn on the lights of endodontics!

Dr. John West illuminates endodontists on the latest technologies

I

n endodontics, we do it in the dark. Or at least this was the case until the lights were turned on by new and transformational endodontic technologies. When you think about it, endodontics is the only dental discipline where we cannot “see” and “do” simultaneously. Imagine spending your dental day making preparations with blindfolds on. You could not do it, and you would not do it. And yet that is what endodontics in the past has asked of us — to do it in the dark. At least this was the case until the lights were turned on by five critical technologies.

John West, DDS, MSD, is founder and director of the Center for Endodontics in Tacoma, Washington. He graduated from the University of Washington Dental School and received his MS degree and endodontic certificate at Boston University where he has been awarded the Alumni of the Year Award. He is an educator and clinician, and his focus is interdisciplinary endodontics. He has authored several textbook chapters and is an editorial board member for the Journal of Esthetic and Restorative Dentistry, Practical Procedures in Aesthetic Dentistry, and the Journal of Microscope Enhanced Dentistry. He can be reached at 800-900-7668, johnwest@centerforendodontics.com, or visit centerforendodontics.com

10 Endodontic practice

Volume 9 Supplement 1

The endodontic operating microscope was introduced into endodontics in the mid1990s. It was our first quantum step into the world of seeing and doing at the same time.

The microscope literally brings dentistry and, specifically, endodontics closer to reality. It allows the clinician to precisely make diagnoses and influences treatment plans and treatment itself. The microscope allows for illumination and magnification at the same time through co-axial light, which does not produce shadows, and it enables the clinician excellent posture by looking straight ahead without bending over to see. Even better, the clinician is not tethered to a headlamp, which allows him/her to freely move from operatory to operatory. The microscope is the first and most important step toward seeing in endodontics and improving outcome predictability.

Digital radiography Digital radiography has essentially replaced processed film in all areas of photography and photographic documentation. Digital is more detailed, instantaneous, and can be enlarged chairside for more accurate diagnosis, treatment planning, treatment, and doctor/patient education.

Digital radiography is the next step after the microscope to bring the clinician closer to reality. Dental caries can now be detected earlier by digital imagery than the traditional dental film bitewings, making the value of digital radiography not just better treatment but better early caries detection, minimally invasive dentistry, and improved prevention.

3D imaging CBCT 3D imaging allows the clinician to see an endodontic tooth in three dimensions by axial, sagittal, and frontal views. The tooth, like a CAT scan, can be twirled around and literally viewed in three dimensions. For the very first time, endodontic clinicians can trace and visually navigate the root canal system, and imaging technologies just keep getting better and better. CBCT and similar technologies can also help treatment planning by diagnosing what teeth not to treat and

Volume 9 Supplement 1

TRENDING PRODUCTS

Microscopes

prevent wasting time, energy, and money.

The 3D technology has been highly popular and positive not only for the dentist’s education, but also for the patient.

Sterilization The classic endodontic triad is cleaning (disinfection), shaping (preparation), and obturation. While shaping technologies have allowed all clinicians to create predictable shapes to pack vertical compaction warm gutta-percha portal of exit seals, sterilization has evaded the endodontic world until now. New technologies are claiming near complete sterilization and root canal systems cleaned of detached pulp, necrotic debris, and bacteria. While over 25 peer-reviewed articles suggest near sterility is not important, merely observing access cavities after their use proves the effectiveness and efficacy of these instruments. The accesses and isthmi are squeaky clean!

NiTi rotary and reciprocation files NiTi endodontic shaping files have enabled the endodontic clinician to not only see but “do.” The NiTi files allow the dentist to truly follow and navigate the natural root canal system and, by simply inspecting the flutes of the file, determine the shape of the preparation. NiTi files, along with the previous four technologies, have made endodontic shaping more predictable, easier, and safer, not to mention more profitable for the doctor and a longer-lasting investment value for the patient.

In summary, these five “lightbulbs” have not only made endodontics better, but also made the dentist better. The dentist experiences newfound competence and consistency. Treating in the dark is a scary thing.

Endodontics has moved from dark to dawn, freeing the dentist from the fear of not seeing and being out of control to the fun of seeing and becoming more confident. When we can see it, we can do it. And when the patients can see it, they are engaged and more easily enrolled. After all, your patient is the one person who is not reading this summary about what is now possible in predictable endodontics. But lucky for them, you are!

Endodontic practice 11

TRENDING PRODUCTS

3D imaging CS 8100 3D by Carestream The CS 8100 3D extraoral imaging system is based on the award-winning compact concept of the CS 8100 and offers the smallest footprint of any 3D imaging system on the market. With the power of 3D imaging, this system delivers the most accurate view of patients’ anatomy for improved diagnostic treatment and surgical planning. Doctors can view any anatomical situation from every angle, with 1:1 accuracy and without distortion or overlap of anatomy. Four selectable fields of view are ideal for task-specific diagnosis.

Additionally, the EndoHD mode offers a resolution of 75 μm for extremely detailed images with no additional dose to the patient above the standard 5 cm x 5 cm exam. The laser-free, patient-centric design promotes patient comfort and helps your staff speed through exams with almost no need for retakes. CS 3D Imaging software makes image review, measurements and image sharing more accessible. Plus, the system is easily compatible with major third-party imaging software.

For more information, visit http://www.carestreamdental.com.

GALILEOS ComfortPlus by Sirona GALILEOS ComfortPlus is an advanced CBCT unit with optional HD mode and offers clinicians and specialists numerous options for diagnosis, treatment, and patient consultation, and provides seamless workflow integration and superior image quality with the low dose. It includes Integrated Implantology; GALILEOS FaceScan, which helps patients better understand and accept treatment recommendations; and SICAT Function, which enables diagnosis and treatment of TMD and airway analysis. It is also compatible with Dolphin software.

i-CAT™ FLX V-Series Building on the success of its i-CAT FLX cone beam 3D imaging technology, i-CAT has released the i-CAT™ FLX V-Series, the industry’s first fully upgradable solution. This dynamic system offers three maximum fields of view, enhanced low-dose and ultra-low dose 3D imaging, and dedicated 2D traditional panoramic capabilities at a price point starting at under $90,000.

The i-CAT FLX V-Series enables clinicians to support current or incorporate new treatment offerings, with an imaging solution that can grow as their practice evolves. Of particular use for the endodontist is the i-CAT FLX V8, which supplies 8 cm x 5 cm and 8 cm x 8 cm scans in the high-resolution needed to lend more detail for the identification of lesions. Within Tx STUDIO software, scans can be explored axially and buccolingually for a complete survey of fractures, accessory canals, and endo-perio involvement. Later, should the practice need a larger scan size, the clinician can choose an in-office upgrade option.

For more information, visit info.i-cat.com/vseries-brochure.

12 Endodontic practice

Volume 9 Supplement 1

ORTHOPHOS SL is a proven and powerful performer with unparalleled image quality — from incredibly sharp 2D panoramic images, to full 3D volume flexibility due to its selectable field of view, and easier, more secure patient positioning for the perfect X-ray from endo to airway analysis. The revolutionary Direct Conversion Sensor (DCS) converts X-rays directly into electrical signals without the conventional intermediate step of conversion into light. Thus signal light is minimized, resulting in images with unparalleled definition. Its Sharp Layer (SL) technology allows you to generate several thousand images during a single rotation, giving you dynamic images you can adjust to any situation.

Planmeca ProMax® 3D all-in-one imaging systems Planmeca ProMax® 3D imaging systems feature an endodontic imaging mode that provides clear visualization of even the finest anatomical details. This advanced imaging mode is an ideal choice for endodontic and other cases with small details — extremely high resolution, 75 µm voxel size.

Endodontic imaging mode enables precise patient diagnostics and treatment planning.

For more information, visit http://www.planmeca.com.

X-Nav Technologies The X-Guide™ system is designed to elevate the surgeon’s control and precision over the entire implant process, including planning and placement. This results in the ability to deliver a more desirable functional and esthetic outcome in dental implant surgeries. The X-Guide system utilizes the surgeon’s plan to provide turn-by-turn guidance during live surgery, giving the ability to visualize precise movements of the handpiece during osteotomy and implant delivery for more exact placement — it’s like GPS for the handpiece.

The X-Guide system makes it easy to be exact by providing robust treatment software plus new, patent-pending X-Point navigation technology — the first, single-view guidance of implant position, angle and depth. Compatible with most cone beam 3D systems, surgeons do not have to stop at precise planning anymore — now they can place in remarkable detail as well. With the X-Guide system in the dental practice, same-day guided surgery can be a reality for more patients. This is a big advantage, as more patients want their implant results to be functional and esthetic while minimizing complications and optimizing their time.

For more information, visit www.X-NavTech.com.

Volume 9 Supplement 1

Endodontic practice 13

TRENDING PRODUCTS

ORTHOPHOS SL 3D by Sirona

TRENDING PRODUCTS

Digital radiography DEXIS™ digital X-ray system DEXIS offers the award-winning DEXIS™ Platinum sensor that incorporates PureImage™ technology — a group of highly sophisticated components, TrueComfort™ design with beveled corners and smooth edges, and highly portable direct USB connectivity. The sensor’s companion product, DEXshield™, yields a 30% reduction in radiation exposure. Combined with the feature-rich DEXIS™ imaging software, the Platinum sensor provides dentists with the most consistent and best image quality at lower doses, the most comfortable sensor, and the fastest workflow. Specific to endodontics, DEXIS offers integration with practice management programs, select 3D scanners and microscopic cameras, as well as a report-writing program for easy communication. For more information, visit www.dexis.com.

RVG 6200 by Carestream With exceptional true image resolution and pre-set endodontic filters, the RVG 6200 intraoral sensor lets endodontists view the finite detail of root morphology. In particular, the CS Adapt module, an intuitive user interface, allows doctors to select from pre-set image enhancement filters — 12 of which are specific to endodontics — to fine-tune their view according to clinical needs. An easy, three-step acquisition process — position, expose, view — makes capturing images easy. Plus, the sensor is always on, always ready. Referrals and patients alike will notice a difference with the RVG 6200. Customizable mount templates let endodontists showcase results quickly and clearly in referral reports, while a thinner rear-entry cable makes for easier positioning and contributes to greater patient comfort. Durable, shock-resistant sensors are designed to withstand bites, shocks, and drops. The sensor integrates easily with TDO and other endodontic practice management software and is available with three warranty options, including a lifetime warranty.

Lasers The Picasso Plus Dr. Ron Kaminer offers this information: The Picasso Plus is designed for both dentist and hygienist in mind; it’s simple to use, looks great, and is the No. 1 choice around the world. When offices purchase Picasso dental lasers, they purchase confidence. Picasso dental lasers provide the ultimate tool for treating soft tissue procedures. From laser gingevectomies, perfect impressions through laser gingival troughing, safe implant recovery, or laser periodontal treatment, Picasso soft tissue lasers provide the most effective and affordable solution for every dental office. Diode lasers have also been shown to be an outstanding adjunctive tool for the disinfection process during routine endodontics. As a final step prior to obturating the root canal system, diodes assist in cleaning bacteria in the canal and well into the dentinal walls.

For more information, visit www.amdlasers.com.

14 Endodontic practice

Volume 9 Supplement 1

Global Surgical A-Series™ Global Surgical is committed to delivering the best microscope experience available. The A-Series™ model is designed for intuitive control while significantly improving visualization, setting a new standard in dental microscopy. The high levels of magnification enhance visibility to do more precise work resulting in less invasive treatment and earlier diagnosis.

The capability to capture and share high-quality multimedia advances communication and collaboration between dental professionals, patients, and colleagues.

Patients are able to view live images while discussing treatment options. HD recording produces visuals with fine detail that can be utilized in presentations and teaching opportunities.

Meticulous ergonomic design is applied to every component of a Global microscope to prevent unnecessary back and neck pain or fatigue for a more relaxed work day. The A-Series™ promotes long-term health benefits by assisting the operator in maintaining optimum upright and balanced posture.

For more information, visit http://www.globalsurgical.com/.

LoupeCam® HD camera for loupes LoupeCam® pioneered the market for HD Camera for Loupes providing enhanced visualization for the dental professional and its patients. This new modern way of performing dentistry enables visualization, recording, documentation, taking still images, and streaming without interrupting your procedure. LoupeCam® offers the only cross platform product on the marketplace — direct compatibility with Windows, Mac, and Android. Additional accessories complete the experience with a Bluetooth pedal, hand control, and a tripod. Finally, a cloud-based server allows all the videos to be stored (HIPAA-compliant) and to be shared electronically without a hassle. For more information, visit www.loupecam.com

Orascoptic™ — EyeZoom™ loupe and Endeavour™ headlight With the EyeZoom™ loupe, endodontists are able to change their field of view based on the type of procedure they are performing. With a simple rotation of the telescope barrel, a doctor can transition from 3x to 4x to 5x without interrupting the flow of patient care. The 3x provides a generous field of view that can be utilized when making an initial diagnosis. The 4x offers a slight bump in magnification while still maintaining a sizable field width, lending to enhanced visibility for a tooth division or root repair. The 5x dials in on the smallest of details, making it ideal for an apicoectomy or an intentional replantation procedure.

The Endeavour™ headlight works in tandem with the EyeZoom loupe by providing a precise focused beam of light. Offering three light intensities that can be toggled between using capacitive touch, the doctor can align the light output with a specific procedure.

For more information, visit http://www.orascoptic.com/.

Volume 9 Supplement 1

Endodontic practice 15

TRENDING PRODUCTS

Magnification

TRENDING PRODUCTS

MoraVision™ Stereoscopic Operating Video Vision System This Stereoscopic Operating Video Vision System is the only one of its kind available on the market today. For the first time in history, a dentist could sit up straight with unprecedented comfort and postural freedom to work and perform dental procedures without looking down into the oral cavity. Instead, with MoraVision™ the dentist can view the operative field with clarity on a large flat panel HD monitor in real time and in 3D with accurate depth perception. At the heart of the MoraVision™ system is an integrated foot switch designed to maximize precision and efficiency by remotely controlling its 16x zoom and fine focusing functions. MoraVision™3D takes vision ergonomics in dentistry from a posture dependent fixed line of sight between the eyes and the operative field, either directly or through binocular eyepieces to a highly variable and posture-independent line of sight divorced from the operator’s face and the binocular eyepieces. With MoraVision™, the line of sight can be gained from any focal point located on a 180° hemisphere over the patient’s face. In addition, MoraVision™3D brings to everyone in the clinical dental educational process the conceptual clarity of seeing the exact operative field, as seen by the operator, either in real time or from recordings, with depth perception and in the natural state of the three dimensions. This conceptual clarity eliminates any gaps in conceptual understandings, speeds up the learning and teaching processes, and brings unprecedented efficiency and proficiency to clinical dental education.

For more information visit MoraVision.com.

Obturation elements™free obturation system by Kerr Designed for use with the warm vertical condensation technique, the elements™free obturation system offers both downpack and backfill capabilities in a cordless design — giving dentists and endodontic specialists the freedom of movement to perform endodontic procedures anywhere without restrictions. Perfect for Continuous Wave and single motion downpack obturation, the downpack heats to 200° C in less than 0.5 seconds and with an adjustable heating range of 100° C – 400° C. Other notable features include a 360° one-touch activation ring to instantly heat the plugger and quickly cool upon deactivation; digital temperature control for procedural accuracy; motorized extrusion for less hand fatigue; and aerogel insulation that surrounds the heating element for dentist comfort and patient safety.

Sterilization Sonendo® GentleWave® System The product of years of research and development, Sonendo’s GentleWave® System consists of a console and a pre-sterilized procedure instrument designed to deliver Sonendo’s Multisonic Ultracleaning™ Technology for exceptional cleaning of even the most complex root canal anatomies. The Multisonic Ultracleaning difference allows for the preservation of important tooth structure and delivers more thorough, more effective cleaning than can be achieved with a standard root canal treatment.

Case studies and publications documenting results with the GentleWave procedure can be viewed online at sonendo.com/technology. EP

16 Endodontic practice

Volume 9 Supplement 1

We will never be “good enough.”

Average. Adequate. Good enough. For too long, standard root canal treatment has left bacteria, biofilm and smear layer behind. And for too long, treatment failure has been considered unfortunate, but unavoidable. That’s why Sonendo has developed breakthrough technology, giving you the power to deliver a level of clean that’s anything but “good enough.”

The GentleWave® Procedure Instrument allows for unsurpassed cleaning and disinfection and supports fast healing.1

Talk to Sonendo® about the GentleWave® System today—and go beyond good enough.

Visit sonendo.com/better.

1 Sigurdsson A et al. J Endod. 2016; 42:1040-48 © 2016 Sonendo, Inc. All rights reserved. SONENDO, the SONENDO logo, GENTLEWAVE, the GENTLEWAVE logo, MULTISONIC ULTRACLEANING, and SOUND SCIENCE are trademarks of Sonendo, Inc. Patented: sonendo.com/intellectualproperty. MM-0167 Rev 01

TECHNOLOGY

Investing in a CBCT system — the must-haves, the nice-to-haves, and where to splurge Jordan Reiss poses key questions to choose technology that brings benefits to the endodontic practice

E

ndodontists have consistently embraced new technology faster than general practitioners. So fast, in fact, that the AAE/AAOMR had to update its joint position statement on the use of cone beam computed tomography (CBCT) for 2 years in a row in response to the spread of the new technology. CBCT systems give endodontists greater diagnostic capabilities and provide enhanced care to patients. There’s compelling evidence that you should be using this technology in your practice; however, “going 3D” is an even bigger paradigm shift than moving from film to digital.

A CBCT system is a worthy investment, but admittedly a big one. If you’re considering a CBCT system for your practice, there are some key questions to ask to ensure your new technology works to your advantage.

released a more comprehensive update to the original joint position statement released 5 years prior regarding CBCT. Of the 12 recommendations for when limited FOV CBCT “should be considered the imaging modality of

choice,” 10 recommend the use of CBCT over intraoral radiography. Therefore, it’s essential that any CBCT system you choose provide a focused FOV, such as 5 cm x 5 cm. Ideally, a system should include endodontic-specific

Must-haves 1. Does it feature a focused field of view (FOV)?

In 2015, the AAE and American Academy of Oral and Maxillofacial Radiology (AAOMR)

Jordan Reiss is the national sales director of 3D imaging for Carestream Dental and assists practitioners in the transition to various digital technologies. He has spoken at numerous events on different facets of 3D imaging, conducted hands-on events for more than 1,000 clinicians, and has extensive knowledge on the vast landscape of 3D systems available in the market. He holds an MBA from Vanderbilt University.

18 Endodontic practice

Carestream Dental CS 8100 3D 150-micron 5x5 cm mandibular posterior scan with finding of large apical lesion and fenestration of the buccal plate on patient with multiple crowns adjacent to region of interest Volume 9 Supplement 1

2. Can I view clinical images taken with this unit to determine image quality?

A patient’s own anatomy isn’t the only thing that can block your diagnostic efficacy when trying to treatment plan a region of interest. When looking at a CBCT system, be sure to request scans of complex cases involving metal, sliver points, gutta percha, or implants — cases where there’s a lot of reconstruction. Slick marketing for CBCT systems focus on catchy terms such as metal artifact reduction (MAR) or scatterreduction technology (SRT), but looking at real cases in the software that comes with the system will provide clarity.

3. How intuitive is it for the clinician and the staff to use?

Easy-to-use 3D imaging software makes using your system more intuitive,

while supportive educational resources and consistent, reliable updates ensure you’re using the software to your greatest advantage. Also, consider a system that makes it easy for your staff to acquire images — some examples of this include laser-free positioning and face-to-face positioning. Don’t forget about how the new system will integrate with your existing dental practice management software (DPMS).

4. Does the company you’re looking to purchase from offer ongoing training?

Every CBCT system on the market comes with an upfront training session, but I cannot overemphasize the value of good training, education, and support on an ongoing basis. You’re about to make a big investment, and you’ll want to ensure you’re getting the most out of your system.

Look to partner with a company that hosts live 3D hands-on courses, provides access

CBCT systems give endodontists greater diagnostic capabilities and provide enhanced care to patients.

to an online video library of tips and tricks and how-tos, or offers free webinars, both recorded and live.

Nice-to-haves 5. How easy is it to share files?

All systems are DICOM-compatible, but does the system you’re considering acquire images natively in DICOM, or do you need to convert the file? A DICOM-ready file eliminates extra steps, reduces overall storage, and easily imports into third-party systems that allow for surgical guides, implant planning, and many other procedures.

6. Will this system help or hinder my relationship with referrals?

The ease of sharing images brings me to the importance of referrals. It’s important that you can share the full version of your 3D software (including implant planning) with referrals, so they can better understand your diagnosis and eliminate the chance of miscommunication.

Splurges 7. Are there any add-ons or upgrades I could consider in the future?

Look for a system that can grow as your practice does. If you plan to collaborate with implantologists or are hoping to someday add another specialist to your practice, consider a CBCT system that allows you to add multiple FOVs to meet future needs. Other add-ons include extraoral imaging filters, object acquisition, and cephalometric arms.

8. Will this system help me with advanced treatments and techniques?

Having a system with a deeper gray scale (or bit depth) allows you to do more, such as create .STL files (digital models and impressions) that can be used for surgical guides and implant planning. The popularity of these features is likely to grow in endodontics in the next few years.

Carestream Dental CS 9000 3D, 200-micron scan of mandibular anterior region demonstrating ability to view behind metal plate Volume 9 Supplement 1

What you should take away from these questions is that, as a specialist, your technology must adapt to your unique needs — not the other way around. Asking the questions above can help you navigate the selection of CBCT systems on the market and ultimately help you find the one that will improve your diagnostic capabilities, treatment planning, patient care, and colleague collaboration. EP Endodontic practice 19

TECHNOLOGY

modes that combine a focused FOV with high resolution at a low dose.

844.880.ENDO (3636)