What Tool to Use, Why, Where, and How? – Dr. John West

 

What Tool to Use, Why, Where, and How? – Dr. John West

The first step in successful clinical endodontics is to decide what tool to use why, where and how hello everyone? My name is John West and I’d like to welcome you to this presentation ProTaper next, you know as a clinician and an educator for the last 35 years. I’M always curious to know what the students main questions are, and it always comes down to one main question and how do you make those shapes? How do you make consistent shapes and how do you build a system that is transferable so that I can do it too? Well, most of you that know me know that I always like to start with the answer and in order to start with the answer, let’s look at today.

What are we doing now? What are we capable of doing so on Monday morning, you’re going to see this patient and they’re having a toothache, you examine the patient and in fact the maxillary left central incisor tests, non-vital it probes within normal limits, and therefore it’s a tooth that could be saved. Then we also examine a parry radicular radiolucency, that’s on the mesial wall as well as it is a peak Lee, and so we imagine what that shape would look like in order to successfully save this tooth. There is a sinus tract that we trace. That confirms, in fact this is the culprit and the tooth that needs to be treated and can be treated, and so what I like to do is sit with my assistant, see the shape.

That’S finished, hold that thought, feel it and say to myself. You got it, and so let’s do that, there’s the patient’s tooth. I want you now to imagine the right shape for this tooth, given that there’s resorption, given there’s a radiolucency and so the shape that we imagine is this continuously tapering funnel the walls are smooth allowing the opportunity for material to flow wherever significant or portals of exit And notice the access cavity – it’s appropriate, not too big, not too small. It has preserved the precious ferrule and yet has allowed us enough funnel form to create the hydraulics for a successful result, and we might even imagine further into the future and see it healed. So, first of all, we have to make the shape we make a cone fit.

We have a Down pack, we have a finish and there it is healed just the way we imagined it well. We also can do this with multiple route of teeth, a more complicated teeth and when we do this and add onyx is fun and then every once in a while something bad happens, one might call it a temporary setback. And then we try to fix that, and sometimes we go from bad to worse, and this is not good. You know this feeling it’s a feeling we want to avoid and it’s a feeling that we can avoid. This is what happens if you look at some SEMS.

They Bend they break, and this is what the goal one of the goals of improving antibiotic instrumentation, is all about. Well, what do you just imagine that you could see a patient who had, as you can imagine crooked root canal system, especially apical e? What, if you had the confidence to be able to make consistent shapes with relative ease, if you pay attention to the principles of endodontics and glidepath and making a shape appropriate for operation? What, if you could do this well what’s next and how you do this? Is this presentation?

What’S next? Is ProTaper next now I’d like to walk you through the rest of the agenda for the presentation having given the introduction, the second part of the agenda will be to discuss the context of this presentation, and one of the parts of the context is. I want you to know that I stand in your shoes at the heart of things, I’m a clinician, I’m not an ivory tower and Adonis, I’m not a researcher, I’m just like you. I got ta get the job done. The second part of the context.

I want you to think about is in your own technique, each step of the way to please ask yourself: the question is what I’m going to do next predictable and then the third part of the context is, I want you to challenge everything, I’m saying and equally Important, it’s important that you challenge everything you’re saying once we know where everybody stands, then we’ll discuss and teach the features and the benefits of ProTaper next. What is it that sets it apart? Why should I test it? How should I test it and what is it going to do for me and what is the technique and then I have a specific invitation for you to possibly test and integrate the ProTaper into your current system at the minimal amount of inconvenience and risk, and that Sort of thing – and then we’ll conclude – and so this all started a long time ago, and it started with the little guy to the right herb shoulder. Who was the first to identify specific principles that allowed us not only to do it once, but to do it twice and do it three times and do it four times in a row and do it next time?

Just because we say so because we know how to do it, the greatest variable, of course, is us. The clinician along these same thought processes were too compadres of mine to the right of herb, Childress, Cliff, Rawal myself and then Pierre much too from Paris. Seven, professor Pierre much too in Paris and the three of us had and children as well a few things in common, and that was we wanted to be able to consistently make shapes. That would allow us success in endodontics and not only that. We believed in the principle of less is more.

We believe that if we could have a lot of principles in just a few tools, that was a lot better than having a lot of instruments in just a few principles, and so out of that schilder wrote the books on endodontic clinical experience and how to make Shapes and fill these root canal systems three dimensions, and he did this in the 1970s 1974 to be exact, and what he showed in this illustration is from John Engels. First textbook, the Old Yeller, some of us call it and if you look at that shape, I think maybe in a way. This is why I became an endodontist. I fell in love with that look and some of you might say it’s under shape over shaped. I believe it’s just right, and this was in Engels, first textbook.

The second textbook had this image and nobody said it, but I figured it out in talking with dr Shoulder that these were the same patient and to me what he was teaching us is. Not only can you do this clinical endodontics once, but it can be done consistently over time, so here, in fact, in a way, it’s two in a row. Let’S illustrate the shoulder principles of cleaning and shaping so on. The left is a drawing of a root canal system that doesn’t have any shape and shoulder taught us to make a continuously tapering funnel shape objectives. One and two allowing restrictive flow of material moved epicly so that it would seal epically and laterally objectives.

Three four and five have to do with preserving the flow or the original contours of the root canal system, as well as preserving the position and the and the size of the four Aminah. Having done that, we tried to do this in clinical situations. We didn’t have night-tide. In those days all we had was files, reimers and gates, glidden drills. So in illustration, a you have a unshaped root canal system and a B you would take files and follow to the terminus and at some point you begins what was called serial, ribbing and shaping.

We didn’t have night, I again, so we would take pre-curved, Reimers and we’d slide them short of maximum resistance and carve on the out stroke on the out stroke when you think about it, it’s the only dentistry ever done, I’m not leaving the patient in a way, But we’d carve on the out stroke and then go to the next free and then we go to see we would recapitulate sequentially re-enter all those vials and as you did, that de and F finally, a reasonable shape existed, but we didn’t have a way to completely Smooth it out, and so what happens is when we had endodontic finishes, and these are from the 1970s, so I’m five or six year old and Adonis at that time.

On the left, you see, the mesial shapes are not perfect at the end, they’re just different bumpy thin and the patient on the right was kind of a favorite result of mine for quite a long time. But if you really look at the mesial’s, for example, they just what I guess you would have to say. Wimp out, they don’t are not robust and there may even be portals of exit apical e that the hydraulics were not able to seal. If we look at this retreatment patient the post is removed, the gutta-percha stre move.

We discover the missed, apical Anatomy, we shape it, we pack it, but if you look with the arrows pointing instead of having a nice smooth contour, it has a little bit of a bump again. It may not be clinically significant, but we never know when cases when results are going to be clinically significant in terms of the quality of the observation. All we ever really wanted was to be able to take a patient. Let’S say the premolar is the pate, the tooth that needs endodontic care and that will let me make a Down pack. We have appropriate shapes and hydraulics which, regardless of the horizontal view, the walls are smooth.

This is all we ever wanted, and so we know that these anatomies are complex in terms of the tooth adlets we’ve seen this before, and can we make technologies that allow us to duplicate nature’s Anatomy? And the answer is yes, so it was in 1995 that I’d like to begin the pro taper story, and this is a story maybe of three people, but it’s way beyond three people. This is a story about a company, a story about commitment. It’S a story about starting with the answer: it’s a story about a belief and end, it’s a story about dedication and we began to think of what we do in terms of the shoulder principles of progressive shaping. How could we put that in nickel titanium – and this is where a pro taper was born and now machines, like space-age machines, make these things?

But the thing I love about this picture is the person on the left is a person and there’s still quality control, one at a time, not one at a time but quality control, and this is constantly being checked, and this sets these instruments. In my opinion, apart still we in 1995, we were concerned that these things could break. You know and Adonis and others can remove these things many times, but it’s something we want to avoid and we can so. In 2001, we launched Pro Taper and basically, we have one shaper to remove the chronal on restrictive, dentin, shaper, two of the middle restrictive dentin and then connect the dots with the finishing files on the left is sx, which is a highly exaggerated, progressive instrument short for Short teeth or for up writing dental dental triangles on any tooth, and so we began to write articles and pro taper after three or four years began to be discovered. And what I always like to say is: there’s three truths and one is the moral truth and one is the scientific truth and the last one is the real truth and that’s the truth of the marketplace in the marketplace began to speak.

But at the same time I want to emphasize this image, which was taken in 2004 and a tribute to sure builder. He couldn’t be there, he was ill and what I want to make a stand here is throat tapers not really about Pro Taper. It’S not about those three people. What Pro Taper is really about. What really makes the difference is above our heads there in writing.

Virtuosity is in your hands. Make no mistake about it. I would say that we could take the finest per taper next next next and put it in the hands of the worst clinician who isn’t watching this program. By the way, we could put it in the hands of the worst clinician and they couldn’t do a good job, and we could take the worst tools that we have out there or just old tools. Maybe something the original night tie instruments and we could put it in the hands of many of you out there and you would create elegant, wonderful shapes.

The question is: how easy is it? How much confidence do you have so in 2006 we did expand ProTaper to ProTaper Universal, we made retreatment files and we made an entire system, but the thing we did notice is that, as we taught dentists and colleagues and other endodontists also what we do and how We do it and the fun. That’S involved it when you know what’s next and that’s no pun intended, but when you know the next skill that you have to do, you know that the outcome you want, you know where you are and if you’re not there, you know what to do different to Get there, the thing is, though, we would have doctors take courses and they did really terrific results, whether it was cliff model teaching pyramid to myself many others, many many others. Sometimes they would call and say, John. That was great, but I can’t do it in my town and what we began to learn is we were doing something different with the instruments than they were doing and that’s what I want to talk with you about now.

The first big thing that we’re doing different was what we’re calling brushing or painting, and this article behind me explains it, but let me Excel when suggest you in the audience, replicate what I’m doing so, let’s put your left hand up if you’re right-handed and your right Hand up if you’re left-handed and you have a rubber stop on your rotary instrument and you’re going to let it run and I’ll show you how to hold the how I hold the handpiece shortly, let it run and short of maximum resistance paint or brush the wall.

Let it run and paint and brush the wall away from the furka and let it run, and now I’m at the rubber stop or your apex locators, I’m there, and then you paint your way out: examine the flutes ah dentin in the last few millimeters. That means you, we just cut that exact shape. So now we flush it. We go through our irrigation protocol, we gauge it, we fit the cone and when are we done with the shaping when the cone fits and so off we go so that’s brushing as opposed to or painting as opposed to scratching.

I see some dentists just scratching the walls like this and you need to let it go and let it come back paint back. Let it go paint back, let it go. What we’re doing is making space for the bigger flutes and we’re removing restrictive dentin when present and we’re designing it just the way we want away from Furka Burkle danger, where there’s bulk of anatomy. So, let’s now move to the features and benefits of next, and I think this is really the heart of what we want to talk about, because, if you’re like me, I want to know how to what are they, how to use them, and when do I use Them so what’s next about ProTaper next! Well, what actually happen next was the third person from the right that would be Mike Shanin blow and Mike has been a friend of cliff in mine for well cliff for a really long time and me maybe 25 years and Mike’s been thinking about.

What’S next for a long time, he will admit to me – and you that has been a dozen years has been on his mind and what his focus was was: how can we make files that could maximize safety, and so this was one of the original work that Mike showed, and if you look at that circle in the top right, which is a cross section of the file on the left, you can see that this is a rectangle. Not a convex triangle, like Pro tapers I’ll, show you in a bit but a rectangle, but how the heck did it get over to the side well by changing the central offsetting the core and then now.

Let me explain if you could. This is a SEM and it’s colored, so you can see it you’re, looking down the pro taper taper next file and you’re looking at the rectangle as it would exist in that cross-section and when you look at the instrument from the side it looks different. It looks wavy, it looks serpentine and when you look at the cross-section compared to pro taper, that’s the original pro taper cross-section.

You can see clearly that this is a rectangle. Even the walls themselves are not perfectly straight. There’S lots of progressive movement. The key here is, it’s highly flexible and only two points at any horizontal section preparation, while we’re preparing while we’re following while we’re brushing our cutting, and that may explain when we talk about that part of the instrumentation or the shaping. So here is the family of ProTaper next X, 1 through X, 5, and there are the sizes on the right and then you might ask well gee.

I want a little bit more taper with the X 3, for example, but with the brushing and with the envelope of motion developed by this serpentine. If you will, it actually begins to create a shape bigger than the file itself, so you’re not just going to stick them in and pull them out. That isn’t the technique, you let it run brush, let it run and brush. We decide you and I decide the shape. So, let’s look at these instruments.

Closer X, 1 is really the X. 1. 2 & 3 are the bulk of the shapers and X 1. You can see the geometries X, 2 and then X, 3, recently we’re in Switzerland and we’re teaching endodontists there how to use ProTaper next and the response by one of the participants was the word enchanting. I’Ve never heard the word enchanting in endodontics or an instrumentation, but i thought that was interesting.

This was not one of the features we built into ProTaper next, but the feeling of enchanting is enchanting to me, because it is the kind of feeling that, when we’re doing endodontics and it’s easy and we’re confident – that’s the word that comes up Jeff Coyle, who runs The university British Columbia endodontic Department, it was once a student of mine, he’s a DDS MSD PhD he’s one of the smart people in the world. He described this system as slick, so that’s also a word.

I hadn’t heard before. Let’S look at how these guys work so on the left is a central core instrumentation and on the right is the ProTaper next and you will show this in many different forms, so you can truly get it, but you can see there’s less spots touching on the Right in this diagram, and also there’s bigger spaces for dentin, shaping and shavings and debris removal, if you look at a horizontal cross-section on the top, is the ProTaper Universal and below is ProTaper next again, demonstrating that there are bigger spaces in the lower one in between The waves of material because this offset then above so there’s less spots touching and there’s more space. If we look at a artist, rendering or computer rendering, I thought this was kind of fun, because I was recently in Winnipeg and teaching a group of endodontists the ProTaper.

Next thinking, technique and so forth and as I walked into the hotel there was this beautifully placed tree, which almost said the same thing: kind of that serpentine look. So I thought that was fun so when we originally made ProTaper. Quite honestly, if you ever remember some of those early animations, it showed one curve and now we’ve got multiple curves because they are slinky. They are able to follow because of a couple reasons I’m going to talk about next. So, let’s review, then the principles of canal shaping – and they simply were on – are developing a continuously tapering cone.

We talked about that earlier flow across multiple planes, maintain the location of the frame and and keep it as small, as is practical. So how? If we tried to solve this over the years with nickel titanium briefly, if you look at the history of Nick titanium 1991, you can see there’s four characteristics. The one that stands out and should stand out is the radial lands. This was a safe way of making shapes, but it wasn’t efficient in 2001.

You can see that there are three editions with a pro taper actually and the big distinction here was active cutting edges. We wanted more flexibility, more capacity to cut 2007 huge transformation change. This. The status and culture of endodontics with the science of metallurgy and each file system, of which I thought there were 30, but someone recently said they’re 80, so maybe there’s 80, maybe there’s 30 as a heck of a lot of them. Each each technology, each design has a sweet spot for the kind of metal that they use and not everyone has discovered that for that metal for their file, but that’s an ongoing research and now in 2013, really is something that I think will make a big difference.

It’S not it’s not the answer to everything on earth and all of us can break all files, but these are huge pluses one is the offset cross section. Two is a progressive, changing tapers, as we have seen in the wonderful, not wonderful, but the the acceptance of a progressive taper instrument and then finally, the unique asymmetric rotary movement.

These three really have set next apart. Let’S talk about those three, so this is a cross-section horizontal, SEM of course of profile. This was what we started with, and it was a very wonderful instrument way better than trying to connect the dots with hand, instruments we could blend out the shapes and, in some cases, start early and do all the work for us, but sometimes the work wasn’t as Efficient as we wanted it to and then with the ProTaper Universal, we began to see a cutting instrument.

That truly was a fish efficient, and I think, if you just talk to most endodontists, it’s would be unanimous that they, what they loved, was that they cut and then now with the ProTaper. Next, you can see again, as we showed before, that horizontal cross section, which is actually a rectangle in cross-section ProTaper. Universal, is convex triangle and notice. There’S three points of contact. The centre of the file is in the centre and stays in the center.

Once there’s a revolution with one of these instruments that shape exists as opposed to ProTaper next, where the centre of the file, as you can see with the X, stays there. And yet there are only two points of contact and if you imagine looking up the shaft of the ProTaper next, it does appear to be a serpentine coming at us. It’S taking that horizontal cross-section and cutting in two points. If we look at simply a static image on the left, you can see that and – and this would be true of any cross-section in these files on the top is next on the bottom is universal. So let’s look at the bottom left.

You can see three red arrows and that’s the three points of contact, whereas on the top on next there’s two in the middle three points on the lower two points on the next step, above and so on on the apical area, but regardless of the horizontal section, This is going to be the difference that makes the difference. I’M going to show this to you in animation in a second, but I want to show you what to focus on at the end on the left is ProTaper. Next, the horizontal cross-section and again, you can see with the arrows the small red arrows.

The two points of contact: if you go two circles down, you can see a red arrow about in the middle, so you can see one point of contact and if you follow that down further, you see where it’s contacting and further, and this will rotate as we See it in animation you’ll be able to begin to sense where the two points are cutting and there’s only two and as the instrument rotates. Of course, those two points of contact continue to cut along the blade where the red arrows are, but where there are no red arrows, there’s no contact.

If we slow this down, you might be able to see it easier. It’S just the points of the red arrow. This is the big difference and if you look at where the red note red triangle, in other words, solid blue, that is not touching the side of the shaping shaped canal or canal you’re shaping whatsoever, and so we are very specific in where it’s cutting and there Are large spaces for removing dent and debris? Okay, let’s leave the animation now and go to some SEMS of the instrument itself and it looks different.

Doesn’T it you know that it’s different and you know what it is different if we now look at this one more animation of the effect of the asymmetric core, you can see that only two points are contacting at any given time compared to a fixed taper, so That would be a very specific progressive, shaping, like shielder taught us many years ago, we’re choosing to shape the canal where we want, as opposed to the instrument, telling us and also again we’re making bigger spaces for removal of dentin, which we need to remove to allow Us to fit the cone.

The big thing on the my er, of course, is the greater resistance to cyclic fatigue, and this is throughout the literature, and it’s been proven time and time again. This really, of course, changed. The experience of rotary instrumentation made it safer and, as you can see there as well increase flexibility, and so this is another feature ProTaper next. That was an absolute must to create the performance that we needed an enhanced performance. Simply a image of a package of sterile x1, 2 and 3’s, and that’s where I would start with x12 and 3s and I’ll tell you how maybe you can integrate this into your practice and test it out motors are dedicated to the ProTaper next.

These are wonderful instruments. The e3 on the left and the pro mark on the right Pro mark has a little bit more range in torque to fit the file so they’re very effective. That way. What I want to say, though, is how you hold the handpiece, and what I would encourage you to do is hold the handpiece between the end of the handpiece and the cord as if you were holding perhaps a cigar, or maybe you were just pausing to hold Your hands like this and literally you’re, going to cradle the handpiece, because if you have or we have a glide path, no rotary, no glide path there at no glide path, no rotary, no glide path, no rotary, no glide path, no rotary! If we have a glide path, then the work or our skill is done, because the the design of the metals have allowed us to follow and shape.

So really our job is done. We can almost go along for the ride and I would encourage you to say these words of just let it run and paint and let it run and paint if you want to say brush, that’s fine, let it run and brush or paint, but that way you’re Not trying to get to a rubber stop you’re, not trying to achieve anything, because when we try to do something down a path with rotary, then it can be dangerous. But if you just sit back and hold the handpiece, let it cradle. In your hand, that could make a big difference for you. It has for me.

The motor settings also are important. This is the the directions for use our 300 rpm torque, setting between 200 grams centimeters and 520 grams centimeters, and there’s a range there and everybody’s going to find their spot. Personally, I would use the higher range because I don’t want that instrument talking to me, I’m willing to talk to it, but I don’t want it to talk to me, but Mike should an Blow. Who really was the thought process between the offset? He would go with the 200 gram centimeters, and that is for you to determine yourself.

There is some creativity here, but not too much and then one setting for all files that we don’t change it in between files. Ilio broody has proven. This is safer. You can read this in the Journal of endodontics and then again brushing and with the higher torque we believe is ideal. Another feature of the ProTaper next that has been a positive is the handle is 11 millimeters versus 13 of the ProTaper Universal.

This allows us to get a little closer to our dentistry and also you don’t have to have the patient open quite as wide, so this has been a plus. So here’s the family x, 1, 2, 3, 4 & 5, and you can see what the arrows on X 1 is suggesting that there’s an increased percentage taper as you move up the shaft, as is true also with X 2 starting with X 3. However, there’s a progressive, decreasing taper, this allows you to still brush make shapes and still have enormous crme flexibility.

So that’s what they look like and what I would focus in would be on now the sequential procedural path which in review, of course, is accessed glidepath got to have it take your time in all these shaping cleaning, of course, and then finishing so, let’s take each Of these, showing you the technique for the ProTaper next, first of all, Universal, of course nothing to do with next is a access that you basically check off. Okay, I’m done if you’re, finding you having to change the access halfway through the shaping you need to do that sooner and cliff trottle taught me how to finish and nope not go to that next step John.

Until you have absolutely perfect, then you’re going to follow that entrance down and begin the glide path and there should be no restrictive Det for a small file. The big issue, both in anterior teeth and posterior teeth, are triangles of dentin, which are beautifully illustrated here. These triangles have to be removed in order to have straight line access and yet still preserving plenty of ferrule and by the way the ferrule is most critical, we’re on a posterior teeth, the buccal lingual, the buccal angles, where the ferrule is essential and the triangles. Of course, are mesial distal essentially and by you can remove these triangles with rotary instrumentation. An excellent instrument would be, for example, sx.

You could use also x1, but the big thing is the concept of removing these triangles before you say: okay, it’s time to follow to the end zone and in this video is excellent illustration of the value of brushing and allowing the bigger geometries to move easily apical E that funnel at the top on the one on the right – and you can see it on the left as well, that would be our access cavity and you can see that first, three or four millimeters as the canal simply is brushed north, south, east and west. But especially away from the Furka Furcal, dangerous cliff throttle would call it and then just follow and notice that the instrument through brushing allows the space for the instrument to follow easily deeper. And that is. I want you to remember that, because that is huge and a wonderful procedural technique that will make a big difference. Then, of course brushing.

If you look at the arrows, you can clearly see with x-1 paint, let it run and Pete let it run a lot of us trying to get to that rubber stop as fast as we can and enjoy it take your time. This is where you make the difference and notice here from a side view also the brushing you can see the shaft of the instrument is bent as if you are truly painting the wall in your home and notice. Again, it’s freeing the instrument to easily fall deeper, validate and verify the glidepath you each should be able to make vertical strokes. First, small amplitudes out the portal of exit out the constriction and increase the amplitude. Until finally, we know we own the glide path.

We can make a larger glide path using path files in this case one and two were used. There is a path by all three as well or you can move to a bigger hand file. So this is a choice point, and maybe you need to make a bigger space, and maybe you don’t when are we done? When is the shape finished? Well, we have to gauge that, for example, x2 drop to the end zone, and now we flush it and see with a pre-curved 25 file if it falls and snug that shape is finished on the distal.

However, we notice that a 25 is loose, and so therefore, we would proceed with the x3 and make our shape flushing and you come out. The dental assistant is trained to flush the chamber every single time, whether it’s a hand, file or rotary. Now we’re confirming patency making sure that it’s clear, although it almost always, is clear after correct use of rotary, but still we want to be absolutely certain as far as knowing if the shape is finished again. When is finished when the verifier fits or when the cone fits and in this instance were demonstrating, the use of a carrier base guttacore to be specific and honestly, when you make great shapes, almost all techniques of operation are going to be facilitated. Some are better than others.

Some are more technique, sensitive than others. That’S another subject: it’s not today’s subject, if you are not using verifiers and you’re making Cohn fits. This, of course, is an extracted tooth from a workshop. That’S what it would look like, and so when we look at this novel, unique asymmetric instrument, maybe this animation shows it best. Please note the tip is staying exactly where it is: there’s no movement there, and yet you see these waves really.

What this is is Shielders envelope of motion and nickel titanium and, to me, that’s the big distinction of ProTaper next, once again, you’ve seen this before should be hitting home. Now is you’re cutting the same efficiency, perhaps more, but you’re cutting with fewer blades touching, which in my hands means I have more space to be safe and also have more space to collect dentin that I want to shape and, of course, you’re going to remove these Instruments are not going to let it sit there. This is animation you’re, going to remove them clean off the flutes irrigate and proceed again now, let’s put the features and the benefits of ProTaper next to the test. Let’S see how it performs. First, we do the same thought process.

We imagine the result in our minds eye and if we’re really smart, we might even take a cone beam, discover there’s a second mesial-buccal we’re going to review the tooth out of which there might be, I think, 30-some maxillary molars. You spin them around really get to know those musial buckles, for example, and imagine the result that wonderful palatal shape the distal-buccal usually terminates. How makes a little hook at the end and the mesial-buccal. How many have four canals well about 50 %? Oh no!

It’S more than that, it’s 90 yeah, 90 % or more according to Straub, co and others. Of course, there’s 90 % Plus horrify, but about 50 % are separate, but Nature doesn’t care about canals she makes labyrinths. So we imagine this labyrinth. We imagine the shape of the palatal. The DB goes a little bit to the turn, how many mesial buckles, let’s just say there were two so imagine this.

This is all in our imagination the cone fit. When am I done with the shape when the cone fits and let’s make two mesial buckles, and so there’s our image of the cone fits? What’S next would be the pack down imagining that and then the finish, but we haven’t done it yet isn’t that the fun part is now we see in our minds. I start with the answer. We have the right tools at the right time and we have the confidence that we’re going to be predictable, and so, let’s take 70 quick examples.

Two simple examples of seven in a row, kind of thing: nothing exotic and you can see. There’S a mandibular premolar lesion of endodontic origin tests, non-vital sinus tract traces to the exit, no doubt and here’s the cone fit, and the next picture course is going to be the finish slender shape for slender roots, not too big, not too small, smooth walls enabling Anatomy To be filled along the way, the treatment tooth is right in front of the implant and when we see, of course, a canal that disappears up high there, we know it’s going to branch as it did in this instance, and this happened to be finished with X. 2 and X 3 more in the body, but you can see the canals are beautifully followed and the results, probably two dimensionally, exactly what we want this central incisor. You can imagine that it was a non vital pulp. The end of the canal is bigger than the incisal part, pulps die and calcify crown down, and so what we want to do is principle.

Last principle of shoulder is to leave the raiment as small, as is practical. We can’t make it smaller. We discover like in the tooth Atlas that it maybe it’s a 30 or 40 apical e. Yet in the top part, it’s restricted debt and hence the following and the brushing in the let it run and paint and let it run in paint – and here is the finish two different views you can see. This is a very appropriate shape, and yet there was enough shaping for hydraulics and we have protected the ferrule and there’s no mistake about that.

This is a beautiful, beautiful shape. If I were to do this one over and as I usually look at patients and say if I were to do it differently without beating myself up what would I do next time and this one, I wouldn’t change much. Here’S a pretreatment there. Sorry, a treatment of a premolar and you can see the anatomy, gets canals on different canals, there’s lateral, canals off lateral, canals notice. The flow is preserved, just as we wanted in mechanical objective flow.

This patient. You can see now the first instrument to the radiographic terminus. This would be the length that we do our reproducible path, glide path. We want to be past the constriction and making that, as we showed in the animation earlier, here’s the cone fits the down pack and notice. These are simple shapes and yet they appear elegant, appropriate.

Not too big, not too small, just right. I’Ve said that a few times because the next files allow us to often do it just right. If we follow the directions and then this patient there was a sinus tract race to the firki on the right is the down pack. I want you to focus on the shapes, there’s an oblique view of the finish and here’s the patient a few months later healing in the firki and the sinus tract has closed as it predictably would last patient. I want to show you is not the one: that’s there that is the so-called coke-bottle gates, glidden look from the past and you can see the difference by using the right rotary shaping.

You can have elegant shapes that allow us a good operation. So all of these in images really have been a convergence of this ProTaper next technology, examples of them of that technology and remember what the convergence really is. Is it’s the progressive taper geometries from the original ProTaper concept? It’S the offset core and then finally, the addition of the my er and if you want to read more in the April 2013 edition of endodontics in dentistry today, the shaping movement, the fifth generation technology, led by cliff rattle and then joined by Pierre much to myself. In writing this article.

It talks about the generations of technology, an excellent review, and we’ve talked about a lot of stuff in a short period of time here, and this make an excellent review. So the question is John: is this for me? Have you given me enough to move me to do something different, and so what I want to talk about now is an invitation and there’s three ways you can experience ProTaper next, one is to buy one package X, one two, three put it on the Shelf, where You can remember where it is the next time you are uncomfortable in making u-shape, regardless of the rotary instrument system, you have, and they all have value to some degree, some more than others. When you feel uncomfortable uneasy, I’m I don’t feel right, then stop go to find the Shelf the X one two and three: let it run and paint and notice what you notice. Okay, so that’s one way one set of instruments, the second one, a little more valid.

Would be to tape, mandibular molars, five manipular molars mesial canals shape one after the glide path, with your current system shape one with next and do five of them and what was good and what wasn’t good the most valid way, and I wouldn’t suggest you not do Any of these, sometimes it’s hard to get the extracted teeth, but a valid way to do this, and I’ve done this all my career doing little mini studies, because the best education in the world is our own. I mean I can talk to you till the cows.

Come home and you can read articles and listen to the science, but doesn’t mean a darn thing if it doesn’t work in our hands, does it so? What I would suggest to you is document this start with patient number one on Monday or whatever day you choose month from now and treat ten patients in a row using new rotary instruments of whatever is your preferred instrument system, whether it’s hybrid or a singular system, And then just write down your experiences, what worked, what didn’t work and then do ten in a row with ProTaper next write down your experiences, what worked and what didn’t work? You know what you will discover the answer for you and I think that’s a valid honest way of doing it and we remember in the beginning I talked about you want to challenge, not just what I’m saying but what’s going on in our own heads, and this Is a very valid way to test it, and it’s been very useful for me because I’ve been able to say sometimes I agree, and sometimes I don’t let’s review now, our time together, we’ve covered a lot of material and I’d like to give you some take-home messages.

So we began in the introduction that the great endodontic clinician, the masterful endodontic clinician, knows how and when to use what tools and why and I think, we’ve made some good educational progress there together in context. What I want us to remember is that we all want the same thing. We want to know that what we’re doing is predictable and we want to know that we can have a result. That’S going to be positive and the biggest challenge, remember, I said, is the challenge, not just what John or others are saying, but what you’re saying, because that is sometimes the biggest barrier to learning. We specifically talked and demonstrated the features and the benefits of ProTaper next, and you remember the big three.

The convergence one is, of course, the continuation of progressive geometries. Two is a change in metal. The sweet spot for this instrument, which is a DM wire and then the third novel and unique asymmetric central core offset, enables us to two spots at a time in any horizontal section and leaving bigger spaces for removing shavings and carvings and debris of dentin. Having spoken the features and benefits, I made a personal invitation for you to test these guys out, give it the acid test. We owe it to ourselves to test new techniques and technologies.

The simplest way is just put it on the Shelf, use it when you’re uncomfortable. The second way is extracted teeth, mandibular, molars, mesial-buccal, mesial-lingual, pretty similar good comparison and then, of course, 10 in a row could make it five in a row of current technique and ProTaper. Next you’ll decide: you’ll discover you’ll, come in fact to your own conclusion, and it is with that that I love this quote from Einstein, because it’s totally appropriate right here and the only source of knowledge is experience. So I’ve, given you some knowledge today, but doesn’t mean a darn thing until you experience it yourself and what I want to say, as I close, is it really isn’t the end? It’S really a beginning.

It’S an opening and I look forward to meeting you all on the journey because for many of us what’s next is ProTaper next and I invite you to test drive. Thank you very much.

 

Read More: Differential diagnsosis of persistant pain after root canal therapy: Dr. Donald Nixdorf Interview

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