Dentistry Today — April 2023

Inside this issue

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   DENTISTRY TODAY CONTENTS APRIL 2023 • VOLUME 42 • NO. 3 ENDODONTICS 52 The Technology of Belief: You Are Capable of Saving "Unsavable" Teeth Dr. Sonia Chopra encourages all of us to open ourselves up to new beliefs about which teeth can be saved. Using real stories from her own practice, she explores some of the biggest and most common dental beliefs about "unsavable" teeth. 59 Common Sense Insights Into Present-Day Endodontic Instrumentation Techniques Dr. Barry L. Musikant discusses the impact of the precautions necessary to maintain the integrity of rotary NiTi instruments and offers alternative methods of instrumentation. These…

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   Save Me Many of you know of Dr. Sonia Chopra, a wonderful endodontist, especially if you are one of her 13,000 Instagram followers (@soniachopradds). She makes you think twice before condemning a tooth and explains her passion in this issue's cover article. Also in this endodontic themed issue, Dr. Barry Musikant discusses the use of both NTI files and stainless steel relieved, twisted reamers in treating many canals. He goes back to some old tried-and-true precepts that many of us are ignoring due to the new files' wide acceptance. One of cosmetic dentistry's icons, Dr. Joyce Bassett, pushes the limits…

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   How to Sell or Partner With Private Equity Valuation We live in a time of great change with respect to valuations of healthcare provider transactions. There is a growing gulf between buyer and seller expectations of overall valuation and purchase price. Capital has gotten more and more expensive very quickly over the last year. This has pinched margins and returns for the usual consolidators and builders of these platforms. The traditional private equity model relies on a buy and build model predicated upon dollar cost averaging of acquisitions. The original platform typically receives the highest valuation. You will see valuations…

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   VIEWPOINT continued from page 8 Structure There are a few financial components in the overall transaction to consider: • Cash at closing. This is the amount of equity you retain or receive in the go forward company. • Earnouts and note deferreds. These can be exceptionally tricky (or even impermissible) depending on how they are crafted. Approach with care. • Going forward compensation. Do not lose sight of the provider compensation going forward. This is usually materially changed from the historical practice. It is critically important to understand whether the buyer intends to use a productivity-based model or a compensation…

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   Material Protects Pulp Howard S. Glazer, DDS Doca Dental's Ceramir Brand, now acquired by Directa AB, is well-known for its Bioceramic Ceramir Cement. It seems only natural, then, that the company would develop a good resin-modified pulpal protection material, aptly named Ceramir Protect LC, in an easy-to-use syringe format. This valuable, moisture tolerant, insoluable, insulating, and protective material has a high pH value that provides hydroxyapatite formation and stimulation of tertiary dentin. Ceramir Protect LC provides more calcium release than several competitor materials and, due to the high pH, creates a hostile environment for bacteria. Consequently, there are many indications…

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   Revolutionizing Dentistry: How 3D Facial Scanning is Changing the Game Nazariy Mykhaylyuk, DMD Dr. Nazariy Mykhaylyuk is a highly experienced prosthodontist from Ukraine. He has fully transitioned to a digital workflow since 2016. With more than 100 full-mouth reconstructions completed in the last 6 years, Dr. Mykhaylyuk is an internationally renowned speaker, having given more than 450 lectures and courses across 70 countries. He primarily focuses on full-mouth reconstructions (80%) and smile makeovers (20%) in his 2 dental offices and laboratory in Kyiv. In this 2-part article continuing in the May issue, Dr. Mykhaylyuk shares his expertise on the importance…

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   Where is Technology Headed in 2023? Our editor-in-chief, Paul Feuerstein, DMD, discusses a few of the new technologies capturing our attention this year. Q. Why is this year different from all other years? A. In the first quarter of the year, we saw many new technology innovations. New products and processes are appearing for the first time, and they are game changers. Let's look at the categories: intraoral scanning; 3D printers; new printed materials; new orthodontic workflows; and, probably the biggest, artificial intelligence (AI). Q. What is new in scanning? A. There are new models from old and new companies.…

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   Improve Profitability and Achieve Predictable Results in a Shorter Amount of Time With SureSmile Clear Aligners Dr. Trent Smallwood discusses the benefits of clear aligner therapy and why SureSmile from Dentsply Sirona provides a better treatment experience. Trent Smallwood, DDS Q: Why did you switch to SureSmile? A: I've been offering clear aligners for 15 years, using one of the leading brands for most of that time. About 2 years ago, I started looking at SureSmile (Dentsply Sirona) and the obvious is it was having, I realized it was an opportunity to provide a better treatment experience, so I switched.…

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   DentiMax Sensor Demonstrates Excellent Ability to Visualize Issues With Teeth and Bone MESA, Ariz.–DentiMax's Open Sensor provides exceptional image quality that rivals more expensive sensors. It demonstrates an excellent ability to visualize enamel, dentin, caries, cracks, and associated structures of the teeth and bone. It is one of the thinnest sensors on the market and features a direct USB connection for fast and easy setup. Its open technology allows clinicians to use the sensor with their current software. For more information, call (800) 733-6820 or visit the website located at dentimax.com/open-sensor. USE FREE info card, exocad Software Helps Patients Better…

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    Owandy Radiology Orthodontic Software Offers Fully Automatic Cephalometric Tracing ROSLYN, NY-The AI powered Ceph Analysis Orthodontic Software is available as an optional module to the I-Max Ceph panoramic digital radiography unit. The orthodontic software is available in a standard or an advanced feature package. Both packages include an industry-proven artificial intelligence engine to automate orthodontic diagnosis and treatment planning for predictable results. The Ceph Analysis Orthodontic Software includes several features and benefits. It offers fully automatic cephalometric tracing. The AI-powered tracing feature automatically finds softand hard-tissue landmarks, planes, and silhouettes on lateral or PA radiographs within seconds. There is radiograph…

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    TECHNOLOGY SPOTLIGHT IMPLADENT LTD Bone Grafting Plug Offers One-Step Socket Preservation NEW YORK–The OsteoGen Bone Grafting Plug combines OsteoGen Bioactive Resorbable Calcium Apatite crystals with bovine Achilles tendon collagen for one-step socket preservation without the need of a membrane. The bioactive calcium phosphate crystals and clusters combine with the collagen to create a biomorphic structure that mimics physiologic bone. To prepare the socket, entirely remove infected periodontal ligament, flush out, and repeat. Make holes or partially remove lamina dura in the alveolar process, where available. Taper plug apically, deliver dry into socket, and let it soak up blood. Condense the…

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    PRODUCT FOCUS 3D Imaging/CBCT Systems Owandy Radiology When it comes to owning a 3D panoramic unit, cost and physical space are the most common obstacles. The I-Max 3D effectively addresses both issues because it (1) is sleek and lightweight (145 lbs); (2) offers multiple fields of vision, including 12 x 10.9 x 9.5 x 5, and 5 x 5 cm; (3) includes an intuitive, user-friendly human-machine interface; (4) is CAD/CAM ready since it is equipped with QuickVision software; (5) can share .STL files from a dental lab or a digital scanner; and (6) offers implant surgical guides. For more information,…

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    26 3D IMAGING/CBCT SYSTEMS PreXion Explorer PRO is the world's first 3D imaging scanner that features an integrated cephalometric xray as well as CT and dedicated panoramic modes. The model offers 4 fields of view, including 5 x 5 cm, 10 x 10 cm, 15 x 10 cm with a single pass, and 15 x 16 cm with no stitching. It provides high-quality image capture for orthodontia case planning as well as a true 2D cephalometric xray with a footprint that takes up to 3 ft less space than a conventional cephalometric arm. Explorer EX, a version of this model…

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    Self-Curing Composite Offers Failure-Free Placement THE VILLAGES, Fla–Bright Temporary C&B is a self curing composite for temporary crowns, bridges, inlays, and onlays. It is a unique combination of nanosized particles and ideally sized glass filler that provides enhanced composite strength. Its elastic properties provide easy, failure-free placement with the added advantage of the company's Chameleon Effect that matches shade, opacity, and fluorescence for a natural look. It offers 2 significant benefits, including (1) a short trim and finish time of 3 minutes, which eliminates the need for glazing and polishing, and (2) its convenience, which provides a tri-axis compatible with…

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    Ultradent Products Topical Anesthetic Gel Produces Increased Patient Comfort SOUTH JORDAN, Utah–Ultracare topical anesthetic gel, one of Ultradent Products' most sought-after products, is a delightfully flavored 20% benzocaine oral gel formulated for rapid, profound topical anesthesia. Dental professionals can administer Ultracare gel directly on a cotton swab for increased patient comfort. The gel's trio of benefits include 20% benzocaine for effective numbing; rapid onset (numbing of tissues that lasts 15 to 20 seconds); and its delicious, dye-free Walterberry flavor with no bitter aftertaste. For more information, call (800) 552-5512 or visit ultradent.com. e/Liner Offers Effective Identification on Radiographs SCHAUMBURG, Ill.–TheraBase…

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    INNOVATIONS 31 Pulpdent Composite Facilitates Remarkable Remineralization of Damaged Tooth Structure WATERTOWN, Mass.—Introduced in 2020, ACTIVA Presto is a versatile, highly aesthetic, bioactive composite indicated for all classes of cavities and load-bearing applications. Its stackable, low-flow viscosity ensures superior handling and accurate placement, even in difficult to reach areas. It bioactively seals margins and promotes apatite formation to help defend against secondary caries. Crysta MCF Technology sets ACTIVA Presto apart. Crysta is a newly patented methacrylate functionalized calcium phosphate molecule that is stabilized in a highly transitional state. When incorporated into composite resins, Crysta facilitates remarkable remineralization of damaged tooth…

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    Elevate Oral Care Gel Relieves Dry Mouth, Provides Continuous Buffering and Protection WEST PALM BEACH, Fla—Allday Dry Mouth Gel combats dry mouth differently than any other moisturizing mouth product. Its patented innovation uses a special muco adhesive hydrogel that works in concert with its maximum xylitol concentration to relieve dry mouth and help improve oral health. Since dry mouth patients are at extremely high risk of developing sick, achieving a non-acidic oral environment is crucial for disease prevention. Allday Gels is manufactured to a neutral pH of approximately 7.0, providing continuous buffering and protection with use throughout the day and…

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    Air2Zed Device Eliminates Need for Cumbersome Wires and Cables SCHAUMBURG, Ill—Air2Zed is a groundbreaking new technology that is poised to revolutionize one's imaging workflow. This patent pending innovation is designed to streamline operations by converting USB intraoral x-ray sensors to wireless. The Air2Zed technology eliminates the need for cumber some wires and cables, streamlining the x-ray process and freeing up valuable space in the treatment room. also means that practices can save money in the long term on repair and replacement costs for their sensors, which become damaged or worn out over time. One of the most significant benefits of…

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    Tokuyama Dental America Flowable Composite Provides Flexural and Compressive Strength ENCINITAS, Calif.–OMNICHROMA FLOW, a one-shade flowable composite, follows in the footsteps of OMNICHROMA. OMNICHROMA FLOW is capable of matching any of the 16 VITA Classical tooth shades with a single shade of composite. By eliminating the need to shade match or stock multiple shades of composites, OMNICHROMA FLOW simplifies restorative procedures and allows dentists to reduce their inventory, saving time and cost. OMNICHROMA FLOW is indicated for Class I through V restorations in anterior and posterior teeth. The following qualities make OMNICHROMA FLOW an excellent choice for dentists looking for…

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    Industry News H3D Enters the Dental Industry to Address the Shortage of CAD Technicians Copenhagen-based H3D has announced it is developing dental AI CAD in partnership with Modern Dental Pacific, Andent, and Orthodontics Esthete. H3D's entry into dental follows its strong success in the audio industry where it has become the AI CAD market leader. Labs see H3D's AI CAD as a solution to the labor shortage of CAD technicians, which will ultimately help them scale their businesses. Currently, CAD takes one CAD technician 10 to 20 minutes per order. However, there is an industry-wide shortage of CAD technicians, so…

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    Industry News Maxilla Marketing Builds Personalized Campaigns Many dental practices start campaigns in hopes that the phone will ring but fall short in a few key areas that fail to be different between just an average strategy and one that is truly successful. Maxilla Marketing dives deep into the details of not only your campaigns but also your office itself to pinpoint inefficiencies and missed opportunities. The devil is in the details, and dissecting the story of every potential implant patient is crucial—from lead generation all the way to completed treatment. If there is a breaking point anywhere along this…

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    NEWS & TRENDS gum inflammation... continued from page 36 contributes to these conditions through both indirect pathways (cytokines boosting systemic inflammation) and direct pathways (cytokines traveling to a specific organ, like the heart or brain). Studying this is difficult due to the challenge of measuring cytokines in the fluid found deep in the pockets in the gums. Fortunately, cytokines are also found in the saliva, which is easier to collect. The researchers wanted to know if clinically elevated gum inflammation could predict the level of cytokines found in saliva. The researchers evaluated the gums and saliva of 67 adults, aged…

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    Head to Chicago Next Month for AAE23 AAE23, the American Association of Endodontists flagship meeting, will take place from May 3 through May 6 in Chicago at the McCormick Place Lakeside Center, East Building. This packed, 4-day meeting includes a full schedule of educational opportunities, with courses specializing in a variety of subjects. This includes surgical and non-surgical root canal therapy, practice management, and taking a closer look at the future of the endodontic practice in an ever evolving world. Attendees can earn a total of 28.5 CE hours when all is said and done. For more information and to…

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    QUICK TECHNIQUE iVac Apical Negative Pressure Irrigation and Ultrasonic Activation System: Mastering the All-in-One, State-of-the-Art Irrigation Device Carlos Spironelli Ramos, DDS, MS, PhD The recent evolution of NiTi engine-driven files resulted in an outstanding file development in endodontic technique, especially regarding instrumentation efficiency compared to traditional stainless steel hand files. However, although it is a significant accomplishment with undeniable benefits, the permanence time and volume of the irrigation suffered an extreme diminution in the same proportion that the instrumentation became exponentially faster. The iVac system (Pac-Dent) promotes an irrigation/disinfection procedure aiming to compensate for the reduced irrigant time during instrumentation,…

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    DENTISTRY TODAY TOP 25 ENDODONTIC PRODUCTS READERS' CHOICE AWARD 2023 13TH ANNUAL READERS' CHOICE Top 25 Endodontic Products Dentistry Today's Readers' Choice Top 25 Endodontic Products, selected on the basis of lead generation, represent some of the profession's most innovative endodontic products. The products appear in no particular order. Ultradent Products UniCore posts are composed of glass fibers. The translucent and radiopaque posts respond to compressive forces, are dentin weld, without compromising the durability of the restoration. Each post's gentle taper corresponds to the natural anatomy of the tooth and perfectly matches the post space created by the UniCore drill.…

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    Readers' Choice Top 25 Endodontic Products Essential Dental Systems SafeSiders HF helical flat rotary endodontic instruments are designed with a relieved helical flat that rotates in the opposite direction of the cutting flutes. This relieved helical flat, along with a proprietary NiTi treatment process, provides the dentist with unparalleled root canal treatment. Advanced features include: (1) high resistance to breakage; (2) increased flexibility; (3) self-advancing design for fast instrumentation to the apex without being drawn in; and (4) less resistance and easier negotiation of canals. For more information, call (800) 22-FLEXI (223-5394) or visit essdental.com/safesidersbf. s a transparent, glass-fiber-reinforced composite…

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    Readers' Choice Top 25 Endodontic Products Sonendo The GentleWave G4 System takes you beyond canal complexity that can hinder thorough disinfection and debridement. Inside the console, the irrigant is thoroughly degassed, precisely diluted, and continuously refreshed. Next, it enters the sealed, closed loop delivery system, where the system's physics-accelerated chemistry becomes truly remarkable. The GentleWave procedure is a more effective way of cleaning teeth, including hard-to-reach areas such as the apical thirds and complex anatomies of the root canal system. Its predictability removes up to 99.9% of biofilm (data on file). It effectively disinfects and debriles undetected and intricate anatomies…

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    Readers' Choice Top 25 Endodontic Products Clinician's Choice MACROLOCK ILLUSION X-RO posts assure restorative longevity and unsurpassed strength while also providing excellent aesthetics and outstanding radiopacity. With a flexural strength of 1,800 MPa and an elastic modulus close to dentin, the MACROLOCK ILLUSION X-RO absorbs stress and prevents post fracture and stress on the root, especially in lower incisors. Further, several design enhancements ensure unmatched macro and macroretention to the cement and core material. Composed of extra radiopaque fibers, MACROLOCK ILLUSION X-RO features color-on-command illusion technology, which turns the post's color transparent upon seating. For more information, visit clinicianschoice.com. Cordless…

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    Readers' Choice Top 25 Endodontic Products Aseptico A product with 30 years of motor manufacturing experience, the 7000 Series Motor is one the most powerful and comprehensive dental motors on the market today. It features adjustable torque and can be used for implant, surgical, and endodontic applications. Aseptico's worldwide reputation for building strong, dependable dental equipment guarantees reliability and performance for years. Many other features set the 7000 Series Motor apart from the rest, including a dynamometer calibration system that ensures that the motor's torque output is always accurate. Six programmable preset buttons allow for complete personalization. The motor's upgradeable…

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    Readers' Choice Top 25 Endodontic Products COLTENE Since the introduction of the ParaPost system in 1962, COLTENE has continued to improve its design. The system offers a versatile range of fiber posts, metal posts, and prefabricated casting post components for any clinical situation. ParaPost fiber posts are available in 3 designs, including (1) Taper Lux, with 4% tapered design and 3 heads; (2) Fiber Lux, a universal, translucent post; and (3) Fiber White, a cylindrical, opaque post for masking discolored roots. ParaPost X-System Metal posts are manufactured with a patented, x-shape retention pattern that provides resistance to rotation, superior tensile…

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    Readers' Choice Top 25 Endodontic Products Venta Endo The most difficult and time-consuming part of the endodontic procedure is starting the root canal preparation but Venta Endo, has a simple and effective solution for this tedious task. By rethinking the way one holds and manipulates the initial file, a difficult task becomes an easy one, thanks to the Endohandle. This new pen grasp grip on the file keeps fingers out of the way. It provides more control and offers a clear, microscopic view of the orifice to easily find the canal. For more information, visit ventaendo.com. Glass Fiber Posts comprise…

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    The Technology of Belief: You Are Capable of Saving "Unsavable" Teeth INTRODUCTION Do you ever stop to reflect that, as dentists, we are living in a truly amazing time? We have incredible technology at our fingertips, and patients are fortunate to have unprecedented access to dental care. But no matter how much shiny, state-of-the-art technology is available, if dentists believe that a tooth can't be saved, it automatically becomes impossible to save it. We are all taught to cultivate certain beliefs in dental school. However, have you ever thought, "I wonder if that tooth would respond to treatment?" Remembering your…

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    Figure 1a. Preoperative periapical radiograph of tooth No. 31. Figure 1b. Pre-op bite wing radiograph of tooth No. 31. Figure 1c. Immediate final postoperative obturation radiograph of tooth No. 31. Figure 1d. One-year recall radiograph of tooth No. 31. Figure 1e. Two-year recall radiograph of tooth No. 31. The Technology of Belief... continued from page 52 our superhero roles as dentists to save teeth. A Tooth Story About a Giant Periapical Radiolucency Take, for example, a 49-year-old woman who presented to my office after her dentist found a periapical radiolucency around tooth No. 31. She was asymptomatic, and there was…

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    The Technology of Belief... continued from page 54 us to understand and trust our diagnosis to save teeth. When we understand the etiology of the disease process, we can make a more effective and meaningful treatment plan that we can be confident will serve our patients. But if we were taught that big lesions don't heal, and we impose that belief on our patients, it may lead them in the wrong direction. So many other dentists would have extracted this tooth. I believe that when we, the providers, can refrain our dental beliefs to trust that lesions can heal with…

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    ENDODONTICS COMMON BELIEF NO. 3: WHEN A CANAL CAN'T BE SEEN ON A CBCT, IT MEANS IT'S NOT THERE It is generally accepted that the MB2 canal of a maxillary first molar is one of the hardest canals to find and treat in the world of endodontics. Cone-beam technology has no doubt been a game-changer for me with respect to this canal. But it can also be a trap if we are not prepared to read the scans correctly. Finding the proper support in reading these scans can also be a challenge after we have invested in CBCT technology, so…

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    Figure 4a. Post-op radiograph of tooth No. 21 (the smaller canal was not instrumented with a rotary file, only activated irrigation via the GentleWave System [Sonendo]). Figure 4b. Immediate post-op radiograph of tooth No. 15 (the smaller MBZ canal was not instrumented with a rotary file, only activated irrigation via the GentleWave System). Figure 4c. Immediate post-op radiograph of tooth No. 19 (the smaller middle mesial canal was not instrumented with a rotary file, only activated irrigation via the GentleWave System). needs to be extracted" becomes "the I-shaped radiolucency is not synonymous with a root fracture." • "A probing equates…

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    Common Sense Insights Into Present-Day Endodontic Instrumentation Techniques INTRODUCTION Generally, an endodontic article with the above title would be one about making rotary endodontics safer, reducing the possibility of instrument separation with, perhaps, a secondary effort to discuss ways to improve the 3D cleaning and debriding of canal systems. What would not be addressed is rotary's potential to induce microcracks in canal walls.1-4 It would be a given that the overriding advantage of rotary NiTi is the increased ability to shape curved canals with far less distortion than the use of stainless steel K-files.5,6 It would also be a given…

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    ENDODONTICS canalways rationalize that the canals are probably not uniform in cross section along their entire length. There is no evidence present to contradict this conclusion when all information is confined to the mesiodistal plane. Other precautions include routine inspection of the instruments, noting any detectable defects of unwinding or overwinding of the flutes that demand immediate discarding of the instruments. The instruments should be used with a light pecking motion to minimize torsional stresses. Single usage is highly recommended, and the motors driving the instruments should be set to a low torque setting so the engine can kick into…

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    ENDODONTICS 61 cerned with exceeding the torsional limits of the metal. The 30° arc of motion is so small that it reduces the torsional stresses to which the instruments are subjected to the level of insignificance, eliminating any chance of instrument separation under these conditions. The same can be said for flexural stresses when negotiating around a curve. The repetitive, high amounts of tension and compression that a rotary instrument undergoes when negotiating significantly curved canals are reduced to insignificant amounts when the arc of motion is limited to 30°, despite the high frequency. The most significant difference between rotary…

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    The marketing of rotary NiTi instrumentation has been so ubiquitous that it has been accepted.... our main goal: the improved ability to thoroughly cleanse the canals in 3 dimensions without distortion. Practical Application This alternative method of instrumenting canals sounds good, but how does it work in practice? Let's take a typical mandibular molar to see how we apply the mechanics from start to finish. After giving the appropriate anesthesia—in my case, 2 mandibular blocks, the first with carbocaine, followed by xylocaine 1/100m, and then augmented with intralligamentary injections using articaine—I apply the rubber dam over a #4 clamp. I…

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