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Endo tips    Better Endo    Endo abstracts    Endo discussions

 Cone fitting is gold standard
The opinions within this web page are not ours. Authors have been credited
for the individual posts and images where they are. - www.rxroots.com

From: Terry Pannkuk
To: ROOTS
Sent: Friday, September 08, 2006 2:30 AM
Subject: [roots] Cone Fitting is the Gold Standard

You know me; I love adding a little gas to the fire. JJJ  We need to 
fight about something different than grafting for a while.

Here'ís today'ís middle mesial case (5 canal molar).  Of course itís just 
my lower-level-of-evidence opinion,  but thereí is no way
I can imagine a squirt being controlled into this anatomy.  
You would be guessing which is resorbable cement, and which is
overheated amorphous phase gp, but whatever it would be it wouldn'ít 
be dimensionally controlled Cone fitting is the ticket to control 
- Terry

Acutally...Squiring is perfect for this anatomy. When I squirted this type of tooth...You do the outer canals 1st... and often the Middle will have material come up during the squirt process... Alternating compression during the inital down pack and alternating wadding would be perfect. Joey D, "I don't want control...I want to obturate the entire canal system in 3 dimensions to the terminous... anything beyond is just excess" Many questions though: Is there a microfilm of sealer and core of gp apically? Is it resorbable sealer only apically? Is it naked gp with no sealer apically? Is it folded with voids apically? I remember this sectioned case that was a squirt: C to D looks good but A to B looks very ďspottyĒ. It seems to me that the apical third and complex anatomical regions are the areas of questionable obturation. At least when you place a gp cone to the apex, you know you have gp to the apex. The only question then becomes deformation and we have the science to know that 4-6 mm away at 330-340 C for 3 seconds compacted in 5 sequential waves deforms but doesnít melt it into amorphous. Iím still waiting for someone to add to this science or dispute this science, otherwise itís all opinion and glances at fortuitous individual sections or guessing about what a radiopaque material is on a radiograph. In other words there is no science and everyone is speculating that their technique is best. Again, the Classic Schilder technique only has the 5 part series of Goodman stuff, but itís better than anything else out there which is nothing. I can only conclude that having a little over nothing is therefore the Gold Standard - Terry The Sky is Falling. I agree with Terry as a GP. If we are going to get decent endo from GP's the easiest way it teach them to fit a master cone with a good sealer. That is integral to me feeling like I've filled the canal. A puff may tell me that I've gotten the POE filled but I want gutta percha or Resilon to plug as much of the apical area as possible and as close to the patency without blowing out the apex as possible. All of this is assuming that we have also properly disinfected a well cleaned and shaped canal. In the hands of a Joey D or Mark Dryer, I'm sure squirting is going to be as effective as a master cone but very few people in the bulk of the profession doing endo are a Joey D or a Mark Dryer. Fred and Bill Watson would do the entire thing with hand files, a Bic lighter, and plugger with good results but Terry and these guys fall into a different category than the vast majority of those doing endo. I want the apex plugged with as much gutta percha or Resilon because I'm not a Terry or Fred or Bill. Musikant advocates using the same cone on every single case. He's stopping that cone 2-3 mms short of the apex and simply using hydraulics to fill the apex with sealer. Realizing that sealer is the actual sealer of the apex, I do not feel that ALL sealer is right. Musikant does and I think he is wrong but I've found Musikant to be more bullheaded about being right than anyone I've ever met. Personally, I think that lost him a major outlet for his technique. My feeling on this has delivered me to Jerry Avillion's System A. I can have my fitted master cone at the apex and plasticized gutta percha or Resilon with sealer for the canal in the pulpal 2/3. I think System A is a good technique for those who lack the skills of your guys if they are going to do good endo. I have no doubt that I could learn to "squirt" but, like Terry, I simply am much more comfortable having a well fitted master cone at the apex with a decent stop to prevent loss of apical control. Bill Watson described that blow out I had with EndoRez in few words..."poor apical control". He was right.
I'm sorry for agreeing with your Terry. ;-) Guy The obturation looks thin and thready in this specimen because the canals were not adequately cleaned to allow for proper obturation. Notice the yellow necrotic debris outlining the obturation material between points A & C. Inadequate preparation diameter would cause this case to fail no matter what the obturation technique or material is. It's the debridement that allow a case to heal, not the obturation. The obturation functions to maintain healing by preventing microleakage and recontamination of the canal and periapical region. I waited for someone to comment on this observation before posting but all of the banter was about the obturation and overlooked the central responsibility of the endodontic procedure, proper debridement. Nobody's obturation technique or material is better than anothers if they are both obturating inadequately prepared canals filled with muck!!!!! - Randy Hedrick Randy, Very reasonable point, but Iím not sure the resolution allows us to read quite that much about he cleaning and shaping in that case. Squirts seem to fold , pop, and push voids as the Obtura or similar device expresses gp. I get the same problem when I try to push too much composite into a prep through a Centrix syringe. At what point do you think youíve squirted enough so that you have gp to the apex instead of a radiopaque stream of resorbable sealer? Maybe just making sure youíve deposited a blimp sized gp puff into the tissues means you'íve flown a stream to the apex. It sure doesnít seem very elegant or controlled. Thereís some success with nearly every obturation technique including the hated Sargentii technique. It seems we should all desire maximum control when obturating a case. We should also be expected to understand the dimensional stability of the material weíre using; i.e. what happens when we are heating it, as well as all the controllable aspects of that handling like temp, application of pressure, depth compaction, time of compaction, and geometry effects. This is largely ignored and unappreciated in the literature, except Goodmanís treatise. It bothers me just as much as anyone else that we have one guyís study responsible for everything we know about warming and compacting gp. What really bothers me is why this study isnít being followed-up. Goodmanís work sheds a negative light on the product industries failure to acknowledge and respect the only research ever performed relating to the validity of their products. My negative opinion of Thermafil is largely related to this lack of evidence support and the unscientific way that it is promoted. Iíd be happy to abandon the Classic Schilder technique for something better, but not without some appealing rationale - Terry Randy...you miss the more important item here. Pannkuk believes that the Schielder method is THE best due to the rheologoly.. Unquestionably, all methods of obturation have their problems.....no single mechanism has all the ideal characteristics. Terry has made up his mind that Squirting sucks... but I can show many cases inwhich a cone was used that sucked...using a system B technique or even Classic Shielder - Joey D Joey, I maintain that I have good reasons to believe squirting sucks, as thermomechanical compaction sucks, and as carrier-filled obturation sucks. People can call me mean, sarcastic, arrogant, or a know-it-all, BUT Iím not eating any crow until someone provides me with some reasonable rationale for what they do as opposed to what I do. Youíre right, in that I adhere to strict Schilder principles because of the polymer chemistry, rheology studies done at BU. The entire product industry has ignored this research; the vast dental community has ignored this research; no one has tried to reproduce or update this research; so I conclude that there is rampant ignorance regarding rheology. No one addresses the molecular phase changes of gutta percha, no one wants to talk about overheating gp to the amorphous state; everyone assumes it doesn'ít matter without carefully studying it like Goodman did. Would you really rather accept a simple falsehood than study a complicated truth? Iíll be first to admit, Iím not an expert polymer chemist, but until someone with some intellectual honesty and integrity rips Goodmanís research apart and convinces me Iíve been worrying about the wrong thing, I wonít consider changing, especially when some guy like Cady says Iím hurting his feelings by accusing him of not wanting to think. This is all product driven. Iíll bet you that if Tulsa Dental could profitably sell an obturation system that adhered to the Goodman research and could patent it; all of the sudden theyíd be singing a new tune sending out opinion leaders to lecture on the crap I lecture about; i.e. alpha, beta, amorphous phase molecular transformation and the different volumetric considerations of each phase. Instead these companies sell Simplifilth, Thermafilth, Fiberfilth, GT obturators, and every other cockamamie line of crap that perpetuates their successful business plan. Believe me, thereís no way theyíll tolerate an opinion leader talking about Alvin Goodmanís work. A real clinical scientist would be interested in reproducing the Goodmanís studies, or updating the results to make sure the polymer chemistry is valid. Instead we have pretend scientists sticking to the cherry picked data acceptable to the commercial interests. I find this disgusting and real sad that our profession has succumbed to the level of prostitution - Terry Come on Terry, give Alan a break. He's old like me and trying to do damn good endo. He's actually doing some very good stuff. Sadly, I agree with you. I don't think all them obturator systems are merchandized for most endodontists. John K uses Thermafil and I'm sure does it fantastically but I think with GP's they are looking to produce that nice white line and there obturator systems provide and easy way to do it. We've lost the fact that good endo requires good mechanical, biological, chemical disinfection and a formed shape that allows for a total obturation of the canal. Most of these obturator systems assure a nice white line. I've got to write a article for our district magazine on GP's and endo and this is going to be the point. Getting a nice white line means nothing. Every thing you do getting there is the answer to good endo. It will be basic but most of us GP's require basics to reach any level of competence. Too many "gurus" out there are teaching the "quick and easy" and not necessarily quality. The obturators can equal "quick and easy" for many many GP's. I think a properly sized Simplifill can place a fitted cone in the apex but the others leave a huge void in whether we've actually fitted a cold cone to the apex. I'm sure what I say will not be popular. Crap from GP's and a few bad endodontists is a boom for OMFS's and implants. Again, I agree with you but only for GP's...and maybe some endodontists. Most of these systems are absolutely directed at GP's because we are taught that the "thin white line" is the goal and nothing else. Sort of like Sargenti. Just poke it in there and the paste will do the work. I see many GP's just poking these obturators in there and saying, "that looks great" when they've stripped off all the gutta percha from the obturator and it's balled up at the top. I saw one of those last week on a retreat and should have posted it but I'm getting a bit gun-shy of posting cases on Roots. Over on DT an endodontist stated he had an OMFS friend who had no confidence in endo, especially retreats. Well hell, he sees nothing but failures. He has no science to back up this view. My surgeon sees implants as a last resort and pushes endo where ever possible. Also, this OMFS was selling implants. Dollar signs can often pollute even good people. I fear that dollar signs promised by the "gurus" teaching quick and easy endo putting money in your wallet also pollute the mentality of too many GP's. Endo is fun but it damn sure isn't easy and it damn sure is not quick if done properly. - Guy I don'ít expect to get a break, and no one else gets a break. No soft treatment of weak ideas and philosophy. Rip or be ripped - Terry Nobody has answered my question on simplifil - Dr Huq Ok, I was a little hesitant to offer another opinion thatís going to piss off people but since you asked twice, itís terrible crap - Terry no problem. oh yeah i did see ur simplifilth comment. care to offer a reason why its "terrible crap" ? - Dr Huq Violates the rheology/overheated, and a lousy shape - Terry Correct me If i'm wrong, but I do not believe there is any heating done during the simplifill obturation. Could you expand on your answer - Dr Huq You have to backfill with something Mohammed and that is usually hot gutta percha or Resilon. Guy That'ís the problem, too cold. The Lightspeed shaping doesnít appeal to me.. I used Lightspeeds to gauge the apex for about a year then quit realizing it was a useless exercise that didnít add anything to the treatment. Frankly, I know just enough about the the Simplifil technique to know it doesnít fulfill any of the objectives Iíve learned are important for obturation, like hydraulics, molding without subsequent shrinking, and flow. I believe gutta percha has to be heated sequentially and the flow developed through sequential compaction cycles with precisely applied constant pressure applications. The temperature at the level of the portal of exit should exceed 45 degrees to minimize shrinkage. If an obturation technique doesnít exhibit the necessary control and parameters known to maximize the sealing potential of the material being used (in this case gutta percha) I have no desire to learn it and certainly not use it to replace a much better technique that does satisfy the objectives. - Terry What's your opinion of System A. A very good endodontist is using it with great success. Guy Do you really have to ask him...I mean you know that answer right? :-)) - Mark Yea, but I have to ask him. Plasticized gutta percha is plasticized gutta percha. There is no absolute way to control heat of the obturating material so what's the difference. Incremental packing of gutta percha is certainly done with plasticized material. Again, there is no way to absolutely guarantee the temp of the obturating material. Obviously the less heat required then the less the shrinkage. Guy Ask Ben Schein where A very good endodontist using it with great success falls on the quality of evidence scale. Jeezuz!!!!!!!!!!!!- Terry Do you still gauge? If so, with what? If not, how do you know etc etc etc? - Simon No, itís pointless. I donít have apical tug back and the apex is blown out, like it is on many retreatment cases or cases with inflammatory root resorption, I usually fill with MTA and blob it out the irregular end. There may be some very rare cases where I might consider picking up a Lightspeed and seeing where it constricts but I havenít in about 6 months now. Itís basically a pointless exercise (pun intended) - Terry Dr. Huq, On 9/10/06, Dr. Huq wrote: Correct me If i'm wrong, but I do not believe there is any heating done during the simplifill obturation. Could you expand on your answer. I was mistaken about the heating. I reviewed the online videos. I thought that at least it was a heated, condensed technique. It is astonishing that an endodontist would use a cold, uncondensed technique. Failing to condense your obturant leaves your preparation technique suspect. I know this. I usta be there. I did not trust my length determination, apical management, shaping, cone-fitting etc...and various "crutches" were developed in obturation protocols to avoid sailing a cone out the end. Crutches like single cone techniques, lateral condensation, SimpliFil and a host of others to avoid compacting or "pushing" on the obturant. Let alone heating and pushing on it. This is at the core of many peoples contention with these techniques, like Thermafil, as they can yeild a good, or even a great radiographic result with a terrible preparation. As you hear clinicians speak, their methods of obturation speak miles about their preparation. If they don't know where there are or what they have, they will have tenative, cold, uncondensed obturation methods. If they have confidence in where they are, and what they have, they will use a warm, condensed technique. Here is a link to a DT thread where this is discussed with cases. I am rdaneskejold. You can form your own opinion. - John A Khademy This technique was designed specifically for lightspeed. Due to the fact that lightspeed uses end cutting burs and shapes the apical area first.I suppose you are not a fan of lightspeed? - Dr Huq I posted this response last Friday before I left the office: I've been using LightSpeed for 13 years, Simplifil for about half that long, and Resilon/Simplifil for 2 years. It is most important to use Simpifil in a LightSpeed preparation to get the best results. I find that Resilon is a softer material than GP and it is necessary to choose one size larger Simplifil than the final size of the preparation if the canal doesn't have an apical stop. It works like a cork in a bottle in that you are placing a tapered apical plug into a larger, parallel walled apical preparation. Hmmm they don't use sealer on wine corks yet how often do we get wine failures??? There are a lot of people who use other techniques and speak with such conviction that they think their technique is the only one that is worthwhile. None can prove their technique has the highest success rate that would validate their claims. All of the discussion about which obturation technique is the best is moot because the debridement is way more important than the obturation when it comes to healing. There is a raft of current independent studies from so many domestic and international sources that confirm that LightSpeed cleans the apical canal the best. I can't even keep track of them all anymore. It doesn't matter what obturation technique or material you use, it is not going to be successful if it is placed in a sea of necrotic muck. The larger apical preparation of LightSpeed not only removes more debris mechanically, it allows better exchange of irrigants to disinfect the minimal amount of debris that remain after a proper LightSpeed preparation. In my opinion, the larger preparation also gives the smaller hand instruments more freedom to clean isthmuses when files are curved properly. Simplifil was born out of the recognition that a completed LightSpeed preparation is perfectly round and could be obturated the best with an obturation material that has a round cross section. The final ideal LightSpeed preparation is a round parallel sided preparation in the apical 3-5mm. The Simplifil plug is an 02 TAPERED plug. When it is seated in the preparation it exerts both lateral and vertical condensation forces in the apex. Sealer fills the accessory canal and isthmuses. If you feel you must attempt to fill these areas with the core obturation material then you will need to use some heat but remember you do not automatically get GP or Resilon into these areas just because you used heat. A lot of those areas are filled with sealer and anyone who claims that they always fill all those areas with core material and not sealer is not being ethical with other people or themselves. A lot of people like the look of a continuously tapering preparation. What does the look have to do with healing and success? It's the debridement and disinfection that allow the case to heal, not the "look" of the obturation. Some highly skilled clinicians can accomplish effective debridement with hand instruments. It takes a lot of time as does the classic Schilder obturation technique. I've been on ROOTS for a little over a year and I can tell you that not everyone has the technical abilities of Terry Pannkuk, Marga Ree, or John Khademi. Not everyone can a star in Major League Baseball either. Why spend all the extra time doing it with tedious hand instruments when anatomic, SEM and microbiologic studies from around the world indicate that you can do a better job with less stress and strain on the clinician and patient with LightSpeed instruments. There is huge amount of current research to support it. Much more research than a 5 part study from the 70's on polymer chemistry on a dental material. There are many thousands of dentists who could substantially improve their endodontic technique by switching to LightSpeed/Simpifil. Millions of patients would benefit significantly as a consequence of the improvement of their dentists endodontic technique by using LightSpeed/Simpifil. To dismiss this safe, effective, scientifically validated technique in my opinion is a huge error in clinical judgment and an ethical failing of the highest order. That doesn't mean you have to use it or that your personal technique is not worthy, but don't try to discourage dentists who need it. That would perpetuate the low level of endodontic care that so many of you are upset over - Randy Hedrick Extraordinarily well stated, Randy. Coming from you it has more umph than most of us. I was just telling Kendel on another forum that since I've started doing all my own endo, I've noticed one thing about failures. The vast majority are due to loss of coronal seal which is essentially the same failure as failing to properly debride and disinfect canals. I know most of those from other offices and some from my early days were done without isolation. Many of the old Sargentis that were done in two offices lasted for years until we lost coronal seal. A infected canal whether from initial poor technique or a later failure of sealing will get them every time. Again, thanks for a nice reply. Guy Thanks Guy. As Martin Trope has said before, "It's the debridement that allows a case to heal and it's the obturation that helps keep the case healed." And a little coronal microleakage to the apex will certainly cause the case to fail - Randy Not that I know of. Our post office is like getting something to Siberia. Who makes Light Speed? - Guy Randy wrote: What does"the look" have to do with healing and success? It's the debridement and disinfection that allow the case to heal, not the "look" of the obturation. Randy, you're missing the point of "the look" entirely. And you're not alone. Many BU critics and proponents of obturation techniques that don't require "shapes" use this as a club to beat Schilder advocates over the head. It shows their complete lack of understanding of his main philosophy which said that: "the cleaninig facilitates the shaping and the shaping facilitates the cleaning." This is the BU mantra. Better shaped canals are easier to clean. You have better access, visibility, tissue solvents work better, fins and accessory anatomy are more accessible. And cleaner canals are easier to shape. Cleaner canals catch files less in the apical section junk, deflect instruments less, allows for better penetration of irrigants to allow you to shape. I urge you to go through Machtou's Summit VI lecture again on .pdf. I have it in other media - E mail me privately re this if you like). It clearly shows how Pierre does a fabulous job irrigating and canals mainly through active irrigation that is ONLY possible when you have properly tapered preps.Unfortunately, short of extraction and sectioning of the tooth, radiography ( as lousy as it may be) remains the only tool with which we can judge the adequacy of our treatment results. Herb may have gained a reputation as the guy who popularized the "vertical compaction of warm GP" idea. But as someone who studied under him I can tell you, that was the easiest part of treatment and he routinely said so. Those who understand his teaching know that for many years ( and while people like Ingle were doing "the Washington Monument thing") his was the lone voice that demanded cleaned and shaped canals with a particular shape and look. His 5 principles for canal design) But that was hard work, and it required multiple recapitulations and : 1. an appreciation of anatomy and 2. the admission that cold "anything" ( pushed down sideways or whatever) just could not "micro-replicate" anything. ( To use Kendo's term.) In know one thing- a better shaped canal ( performed in my hands) is much more likely to be better cleaned and have a better chance for success. When I see lousy shapes, ( in my cases) I am more concerned and have more problems with those ( especially non-vital) cases. I rarely need to retreat a well shaped case unless the canal is a "clean miss" - (totally undiscovered) What irks me most is the CaOH advocates who work short, parallel the case and then expect that a 2 step CaOH will make up for lack of good shapes. I think that is just lazy and bad tecnique. Fred and I have been fighting about that for years. But you know what...? I don't worry about Fred's cases because they DO have nice shapes and even HE has gone to warm GP. So although he may say ( as you do) that shapes are not agood indicator of quality of cleanliness, I'd bet he gets a lot more worried when the shapes are lousy. ( Such as in the many retreats of other people's work that we all need to do on a regular basis .) So are shapes important and does the "shape" of the obturation (the look) have some relationship to success?? Yes, I think so. And if you honestly examine the cases you need to retreat on a routine basis, you'll come to the same conclusion - Rob K Exactly.......Terry Rob, great post. For a BU grad, you speak so that lesser mortals can understand.:-) Although you and Randy may be contra here, both have made great points. The issue is debridement and disinfection. That is something that many still don't get. The good guy that I used to have do my endo still uses old anesthesia for his sole irrigant and the guy who did the crap case on me (which will be an implant Friday) used only 0.04 tapered ProFiles to a 35 tip with CHX as his only irrigant... no bleach. Still both of you make excellent points and make them so we can understand them. Guy Rob, Terry, Randy doesn't get it. I mean, he just got a 'scope. I will take 5-10 years of dedicated effort. Hell, even the Pygmy has had a scope for that long. :-)) It is comical he continues to use the word Paradigm. He is trapped in the paradigm of the 1960's where a round prep was created with a round file and filled with round material in a round canal. Canals are round ...Right? :-)))) Might as well use a silver cone as a SimpliFil carrier. Really, what is the difference? I mean, at last a silver cone does not have polymerization shrinkage..... :-)))) - John A Khademy I did a bunch of these the first six months of my practice back in 1971 and I still see them working well. Heck, John, I'm old enough to remember when upper first molars only had three canals...not six or seven. :-) Randy made some good points and I'm betting he can use a scope with the best of them. I'm still struggling but I'm old and don't do the number of endos you guys do. Hell, I remember when we didn't even have loupes and a lot of good endo was done. Guy Randy, I've been following lightspeed for about a year now, and have been pondering switching over for some time. Mainly due to the apical debridement issue. I have seen many of the studies you are talking about. The main reason I have not switched over is that I have seen that a lot of endodontists do NOT use it. I wanted to know why, as the science behind it always made sense to me. Hey, but what do I know, i'm just a dumb GP trying to do the best possible care for my patients. Thats why I come on here, to find out what the specialists think is best - Dr Huq I think a lot of endodontists and GPs use them in a hybrid setting. Guy Mohammed, LightSpeed is such a different instrument it's in a class by itself in terms of design, operation and effectiveness. Many will look at it's small thin shaft and immediately think the instrument will be very fragile and it scares them off, it's not. Smaller diameter shafts have a higher number of cycles to failure than large diameter instruments meaning they are more durable(Pruett JP, Clement DJ, Carnes DL. Cyclic fatigue testing of nickel-titanium endodontic instruments. JOE 1997;23:77-85.) That's also why LSX is used at 2500rpm and tapered instruments are used at 150-600rpm, tapered instruments don't have as many cycles to failure. In the last year I have only 1 retained LSX instrument fragment in a tooth. Other dentists are so set and comfortable in their tapered instrument paradigm that they can't escape. There are some cases where the LSX instrument won't work like sharp acute curves and like any other instrument system those canals must be done by hand. You can reach Charles Harris at LightSpeed if you want more information 800-817-3636 x-207. You should know that I do about 2 hands on seminars for LightSpeed a year but I don't get a commission on sales and the reimbursement barely covers my overhead costs while I'm out of the office. Why do I do it? Because it's the right thing to do and I'm on solid scientific bedrock. The last 2 seminars I did was for the Univ of Fla endo program and the UF AEGD program in my home town. More and more endodontic programs are recognizing the importance of larger apical preparations made possible by LightSpeed and are requesting the hands on course - Randy Dr. Huq, Why....The instruments themselves are not a big deal, and are a useful adjunct, and obviously can be used in many cases as the primary instruments. The problem is shape that is created using the technique as it is taught. It is essentially unfillable with any condensed technique. As you examine specialty practices, you will find bread and butter type practices with cariously exposed teeth, all the way to someone like Gary Carr, who has around half his cases be retreatments from endodontists. As you climb up the difficulty level, from vital teeth to retreatment cases, you will find more and more similarities in mindset and technique. It does not take much to get a 3 year result on a carious exposure. It is a completely different story to take a case that has been infected for 3 years, and turn it around. On TDO many of us have retreatment practices. We all use microscopes. It is a given. We all cut tapered shapes. Another given. We all use a warm, condensed technique. We all use a combination of hand and rotary instruments, usuallly several different kinds as the case permits or demands. The idea of "switching" implies that it is an either/or situation, which it is not. There is some merit to these instruments, and some fine clinicians use them, usually in combination with other instruments. The reason you don't see a lot of serious endodontists using these instruments and techniques as they are described, is they result in the same short, untapered shape and essentially cold, uncondensed single cone that we are constantly retreating. When you realize that it is not about the file, and that a file system, or switching systems is not going to magically improve your endo, or make your endo easier, or make your endo faster, that NONE of these things have anything to do with it, THEN we will be ready to talk about the instrument systems. Until then, think about how Lightspeed, GT's K3's, SafeSiders, or whatever would have helped you with this case from this AM. "Routine" upper second molar on one of my top 5's hygeinist. Quicly located four canal orfices. Gates't out the MB/DB/P. MB2 is the dot near the palatal. Chased it and it trifurcated. Great. Went back and spent the remaining hour getting to length on the MB/DB/P. Just getting to length with a #20 hand file. Get it? :-))) - John A Khademy They would not have helped me. That's why I refer cases like this out to you guys. My thinking is that you using lightspeed on the apical portion, and regular tapered rotary files on the rest in a hybrid technique might do a good job. I'm a guy trying to figure out the best way to do the ones I feel are simpler cases. I don't tackle tough cases, b/c I know an endodontist can do it better, and I would not be serving my patient by tackling them. If I see somethng suspicious on x-ray, I don't do it. The more cases I see on here, the more I realize what I can't do. I actually refer more now than I did before I joined - Dr Huq What do you class as a " tough case"? Do you have any criteria you use to assess this? I'm asking as I am drawing these up for referring docs. - Bill Theyíre not really end-cutting Ö. And you donít have to shape the apical first - Simon Dr. Huq, I should point out that some people who don't appreciate the science and research behind LSX only offer belligerent personal opinion, not science, in their effort to discredit the LightSpeed technique. Terry in particular loses control, resorts to swearing, bathroom humor and flips people the bird. It is unnecessary, unprofessional and counterproductive. He's been told to tone things down before by endodontists that he respects and admires yet he continues to sully his reputation with his own words. What's even more ironic is that someone who uses these schoolyard bullying tactics claims to be a proponent of ethics. How ethical is it to try to deny the very instrument system that many dentists need to improve the standard of their endodontic care. Those tactics don't help the dentist and they harm their patients by discouraging dentists from upgrading their technique. His tactics and behavior are more suited to Dental Towne and Jerry Springer than the professional level of discourse that has been the recent standard here on ROOTS. ROOTS should not be dominated by a single technique promoted by a trash mouthed bully as it has been lately. I believe the intent of ROOTS is the free exchange of ideas not intimidation into a single lockstep technique. Dr. Huq, I'm sorry that your simple question and my reasoned substantiated, non agressive response has caused such as ridiculous and unprofessional reaction - Randy Randy, I'm going to try LXS ASAP if I can find out where to order them. I know a lot of great endodontists who are using them to finish apexes and that includes Jerry Avillion. Jerry takes them out the apex. As soon as I get the order directions and protocol, which I can get from Jerry I'm on them. I figure that I'm going to be ten years ahead of Terry if I live that long. Right Terry? :-) Guy Guy, I'm not sure you're correct about Jerry's technique. I know he takes a 20/.08 a mm past the apex, but wasn't aware he even used Lightspeed files, let alone takes them past the apex. BTW, can you imagine how Terry's posts will read when he gets as old and cranky as you? :-))) - Mark John, now you know this is not totally true. Certain files can make endo easier and better in the hands of someone like you. I know that ProTapers changed the quality of my endo tremendously. Of course the more I learn on here, the longer a molar takes. Now you show me a damn MB2 in the palatal canal...damn! I think that there are certain files we should learn with before moving on to more aggressive files. I wish I'd had Fred's VTVT and K3s when I started. I use them now to finish apexes and on cases I worry about separating a file. Still I find the ProTaper extremely hard to separate. That being said, I'll probably separate one today. The moon has been full down here for a month. Mohammad is young and I'd recommend that you advise him on a file and technique that is going to help prevent separation.. not SafeSiders please. I'm catching hell now about giving Musikant a hard time on DT. K3s and Fred's technique is going to prevent a lot of separation and that is important for someone just getting into endo. Constantly breaking files can be depressing. Some guy on DT said he'd separated 8-9 in a few weeks. He shouldn't be doing endo. He didn't like that answer either because Barry had rescued him also. I wonder how that first Peeso perf is going to feel. If you've separated 8 or 9 files in a few weeks you have not business with a Peeso in your hands. I think Mohammad should start with K3s and then more to whatever feels good. Guy I think if you donít understand the fundamental concepts of endo and common sense that correlates geometric shape to debridement, getting some new piece of crap file isnít going to do anything but give you a false sense of security that will make you a danger to your patients. Some people never get it. While a few strive to be the best they can be, many insist on being the worst they can be refusing to heed prudence - Terry Guy and others involved in this thread, Very relevant and well said. There are a few extremely good endodontic technicians, there are a few extremely good endodontic educators, there are extremely few good endodontic technicians who are extremely good educators. It is my observation that many talented individuals blessed with technical skill or teaching ability are missing the most important determinant in the trinity of characteristics necessary for true greatness. That determinant being humility. Without humility that encourages approachability, technicians and educators are doomed to mediocrity as men. They become irrelevant in time, because there is no cosmetic that will cover arrogance. Men are not inspired to morality and service by hateful name-calling and disrespectfulness. We as endodontists, who have had the great good sense or good fortune to gain the mentorship in a specialty program, very often forget that it is to our benefit, with kindness and understanding, to share what we know with our colleagues. One might go so far as to say that if Endodontics goes out of favor as a treatment modality, it will be as much of a problem of the greed of endodontists as that of the so called "snake oil salesmen". We are all in it together whether we like it or not. One day a month of donating time to help teach dental students would be a good start. One evening a month dedicated to sharing knowledge to upgrade the skills of our non-specialist fellows on subjects such as diagnosis or case selection would be another. Surely we can think of many more examples. Greed is not only associated with money and possessions. More often it is associated with lack of caring and stinginess with good will. It's not a good thing when the only way you can find to touch another's life is with a lighting rod. But, it's never too late to think about a change in tactics. Who knows, we might all be better people for the effort. TAIK Grant - Randy Dear Randy, Thereís a nauseating ďfeel-goodĒ ambiance equated to the acceptance of mediocrity. It is usually promoted with etiquette, distaste for disruption, and the shunning of agitators questioning validity - Terry Terry, The problem is you will not provide anything other than anecdotal accounts that you are doing the right thing in your technique. At the same time you dismiss other valid researched techniques with a higher level of evidence than you can provide. Opinion does not carry the same weight as a multitude of research from around the country and around the world that confirm the validity and efficacy of Lightspeed/Simplifil from a multitude of perspectives. BU has graduated 10-12 endo residents a year for 20-30 years. Do you mean to tell me that there wasn't anyone in that group that could prove your technique is so superior that all else is unworthy? You don't even have anything to prove your hand instrumentation technique is as good at debridement as LightSpeed. Until you give me some evidence you're just blowing smoke - Randy Randy, One who understands science would realize there is no such thing as proof in the natural world; only a preponderance of evidence provided by mounds of anecdotes implies and approaches proof. YES, I AM TELLING YOU THERE IS NO ONE IN THE BU GROUP THAT CAN PROVE MY TECHNIQUE, YOUR TECHNIQUE, OR ANYONE ELSE'S TECHNIQUE IS SUPERIOR - Terry Terry, one thing Randy could do is start posting some difficult cases, like your surgery, and mine. Not stuff from the archives, but day-to-day cases, like we do on TDO. It is pretty easy to do cariously exposed cases with no microscope, which certainly colors your view of what works and how it works. You actually begin to believe that it does work. A bunch of "clinicians" in some lab working on extracted teeth with no microscope and with 1/10 of our experience talking about apical debridment carries little weight with me when they can't even find the canals. There is nothing in the literature to help either one of us with those surgeries, or this recall case from today. Show me a paper that says how to find these canals, and how to get down them. When you get the screwed up, and complicated stuff we seem to see on a daily basis, look at how it is done and then hafta fix it, and have been doing so under the microscope for years, you can only conclude that the lit is shit, and at best, is of little use to the serious clinician. Often it is dead wrong. - John What you are asking to evaluate here is the technical ability of the operator not the cleaning efficacy of the instrument. Research has clearly established fact that LightSpeed cleans the apex better than tapered instruments and does so safely without transporting the canal as much as tapered instruments. That research has been done on extracted teeth in the laboratory and with microbiological culturing studies in humans (Trope et al) - Randy Randy, I just make decisions right or wrong based on my best effort at critical thinking. Why suffer fools who ignore science for personal convenience. Whoís trying to impress anyone? Isnít personal education about testing ideas and validating a philosophy? If this is a scientific forum ideas should be ripped apart if they are based on feeling. Why should you care about how I feel about my technique? Why should I care about how you feel about your technique? The only thing I feel is disgust for those who insist on using a crap idea because itís their friendís or mentorís idea. Alvin Goodman is a friend but it sure would be great to have someone critically evaluate his work; instead of saying they don'ít feel that itís any good. Goodmanís work seems valid to me because gutta percha seems to flow the way his study suggests. You are free to rip his work apart and it wonít make me feel bad. Goodmanís research flaws are of great interest to me. Where are they? This has nothing to do with my crap personality and has everything to do with bias and idiotic thinking based on ďfeeling goodĒ because the person with their head up their ass doesnít want to offend a buddy who sells a product or hurt the feelings of someone who spent years researching a bad idea. Simplifil seems incredibly outdated; Lightspeeds are a terrible way to shape a canal with a smooth taper. I experimented with them for gauging. If someone knows something the rest of us donít know about this please draw diagrams, post supportive cases, and present evidence that will lead us to believe otherwise - Terry Terry, one thing Randy could do is start posting some difficult cases, like your surgery, and mine. Not stuff from the archives, but day-to-day cases, like we do on TDO. It is pretty easy to do cariously exposed cases with no microscope, which certainly colors your view of what works and how it works. You actually begin to believe that it does work. A bunch of "clinicians" in some lab working on extracted teeth with no microscope and with 1/10 of our experience talking about apical debridment carries little weight with me when they can't even find the canals. There is nothing in the literature to help either one of us with those surgeries, or this recall case from today. Show me a paper that says how to find these canals, and how to get down them. When you get the screwed up, and complicated stuff we seem to see on a daily basis, look at how it is done and then hafta fix it, and have been doing so under the microscope for years, you can only conclude that the lit is shit, and at best, is of little use to the serious clinician. Often it is dead wrong - John Frankly, I havenít because Iíve never heard of anyone using the technique except on ROOTs. Iím just expressing an opinion that it seems like a bad idea conceptually. Iím anxiously awaiting someone to rip me apart and provide evidence that it isnít. You have to kick and scream around here to get some decent evidence - Terry Randy, The only evidence I'm interested in is healing/success. The only study I'm aware of that looked at that was done in Toronto and showed the Shilder technique to be the best - Mark I thought it was the ones with separated instruments / silver points :-) - Bill Well and there you have it. You can draw just about any conclusion from the lit. So pick the lit you like and in the meantime keep doing what seems to work in your hands. :-)) - Mark Iíd sure like Randy to show some 10 year recalls of his cases. How many cases do you want me to present of a short, threadyĒ failure retreated and healed after retreatment with the classic Schilder technique? Letís see all of Randyís retreatís of Classic Schilder failures with his thready, short Lightspeed technique - Terry Basically whoever has the biggest Pile of Evidence (POE), not be confused with a POS, is the one who should be believed. Right? - Terry OK, realizing that these are not up to the caliber that most of you would do, I have a question. I use ProTapers and 0.04 or 0.02 tapered ProFiles and K3's to finish the apexes. Using System A to finish... with a fitted master cone and cold lateral accessories. Are these tapers achieved from ProTapers close to a Schilder taper or much smaller? I see so few of Terry's stuff that I don't know what is classic. I see John's but I'm drawing a blank on that one right now. I've got Mark's in my head but he uses a Peeso. I don't have the guts for that. I stick with the SX which I feel safer with. I realize that the distal of the 31...yesterday afternoon...is short but that IAN canal scared the hell out of me. I've been in one of those before with a bucket of EndoRez. I don't know if Epiphany would be as kind. There is also a lesion on the mesial root of #18 of the #19 case I did this morning. Those apexes are finished to a 40 0.04 ProFile. 18 was done right after I came back from a course at UF and got sold on Sealapex. I've had to retreat several of these and I'm beginning to believe that Sealapex just might not be the best sealer floating around out there because I was using ZOE on my uppers and have not had to retreat any of those. Sealapex was supposed to create less post op pain and I don't think that was true either. This was probably 12 or 13 years ago because 18 was done 12 years ago. I'm leaving it alone until it is a problem. This is an absolutely serious question. Do I need to start finishing my apexes with another method? I intentionally stopped short on the distal root of 31 and thought I was short on the mesial roots but wasn't. I cleaned the last mm with handfiles up to a 30 and made sure I got it disinfected with CHX. I use it as my wetting agent for the bonding agent for Epiphany. All had a master cone, cold lateral with accessories and a 25 Pac Mac with condensers. This discussion has raised questions in my mind as to whether I could be better shaping these canals with something else and finishing the apexes better with something else. I've now found that Jerry Avillion is using GT's and not Light Speed but have heard a lot of people say LXS, LSX, LSX when discussing finishing apexes. All responses would be greatly appreciated. We can't learn without criticism. Thanks in advance, Guy Follow Avillion's approach to the "T", and it will resolve many if not most of your questions. I'd recommend that you sign up for the course at Flucke's office. Jerry will be there and I'm positive you'll get a lot out of it - Mark Guy, The cases look good apical diameters look like about a #50 which should be adequate. The question is are the obturations in the original path of the canal. If the canal has been transported there will be residual debris in the canal along the inside of the curve of the root. LightSpeed follows the original path of the canal the best and transports the least of all the instruments, another advantage that gets lost in the banter about apical preparation sizes. The distal on Rowland, #30, looks short, was it blocked? Williams - Hand instrumentation of the distal apex would help, I don't think any rotary instrument can reliably get around those sharp, tight radius curves. You know what to do about the voids over the mesial canals. I admire your drive to continually improve and be open to suggestions - Randy 30 was Williams and it is short. I was trying to stay away from the IAN canal. You can see cement in my patency - Guy Dr. Huq On 9/12/06, Dr. Huq wrote: Do you guys re-treat a lot of lightspeed/simpliful cases? Unknown. I certainly retreat a lot of parallel prepped, short single cone cases that could easily be LightSpeed/SimpliFil cases. They could also be hand file cases. They could also be metal Thermafil carrier cases. But again, the focus is wrong. Like an amateur golfer looking for that magic club, across the board I see GP's and similarily minded endodontists looking for the magic file, or the magic filling technique. This discussion pervades every endo forum I have seen...except...TDO. No one there argues about stupid files, because it is about the results. What Terry, RobK, me and countless other retreatodontists have found is that parallel sided, short, uncondensed single cone style of treatment constitute the bulk of our failures. These lazy, sloppy techniques have a broad appeal because they are easy to do, get the white stripe down the root, and kid yourself that you did a root canal. Often, they work for a few years until the patient switched dentists or moves on. They we get them. Most endodontists, and no serious endodontist uses this treatment style because it is what he sees failing every day. More importantly, and all the BS lit aside, these cases are very often successfully retreated by the techniques and principles most clearly and loudly espoused by RobK and Terry. Treating cariously exposed vital cases is no real trick, and a single club with an average golfer will meet with a pretty good degree of success. This is nothing to write home about, although some people seem to think so. Treating the screwups that have been infected for years and mangled by the previous treatment requires a much bigger bag of clubs, the knowlegde of which club to get out of the bag, how to use it, and years of practice at high magnification to make it all happen. Ask Randy how often he bends his files under the scope he just got. Then ask Carlos Murgel. This is where the razors edge is - John A Khademy Great answer. Thanks. My issue is not with having a taper. Tapers are great, I'm all for that. My issue is debridement at the apical portion of the canals. How do you know you are adequately instrumenting this portion. There was a study done in which they cut the apices off a gazillion teeth and measured the width of the canal near the apex. The average diameter of these teeth were higher than 25-35 on most teeth. Do we not need to completely debride this area? Keep in mind that I'm not trying to retreat anything. I'm just trying to get it right the first time - Dr Huq That's where the meticulous use of pre-curved hand instruments comes into play if you don't want to create large apical prep sizes - Mark John, As you say, most of the cases that present to me for retreatment are certainly parallel shaped. However, my concept of the Lightspeed prep as taught by the gurus of that technique, is not anything like the typical case that presents to my office failing. In my mind I see a Lightspeed prep done the way Senia promots as being much more opened up than what the typical wimpy looking prep that presents for re-tx. Yes, the parrallelism is common between the Lightspeed prep and the typical failing case we see, as you mention, but the prep size differs. Maybe this is the critical difference? I'm not disagreeing with you or Terry as per the value of the tapered prep, and I doubt I'll ever change from doing it that way myself, but I also think there must be docs like Senia, or Randy, that use an alternative technique and see good results, otherwise how could they survive in a business sense? I suppose the key question to ask is how much surgery do these docs do, especially on their necrotic and re-tx cases? If they are surgerizing a lot of their cases, then I suppose you're right. I don't see a lot of my re-tx and necrotic cases coming back for surgery, and I credit that to meticulous disinfection I try to do in addition to the merits of the tapered prep that Terry explained....but it could just as well be geographic success, or maybe some of my teeth are being extracted without my knowledge - Mark Mark, I don't understand why John and Terry feel so threatened by LightSpeed they don't have to use it if they don't want to. However there is a myriad of dentists out there that can improve their endodontic procedure substantially and safely by switching to LightSpeed. It doesn't transport the canal like tapered instruments, it allows preparation to larger apical sizes (dictated by the canal anatomy) that make the irrigants more effective. There is no way they are going to convince everyone to do it their way. It's too tedious and few people have their technical abilities. If the classic Schilder technique were as simple and successful as Terry would like us to believe everybody would be doing it. It's not. It never will be. The classic Schilder technique will fade away over time and patients will benefit because there will be fewer strip perfs, apical zips, and split roots from forcing large stiff condensers into gutted, overprepared roots. The Schilder technique is not the end of evolution in endodontics although some dogmatists think it is - Randy Randy, Do you do a lot of re-treatment? If so, do you retreat a lot of cases that look like the classical Schilder tx? I do a lot of re-tx, and almost never retreat a nicely tapered case tx'd to length. Most of these failing cases feature short filled parallel preps, the exception being thermafills, but those are always undershaped, not properly shaped. I think that's what John and Terry are alluding to. That doesn't mean a short filled parallel prep can't work in the hands of someone like Gilberto Debelian, but I like my chances much better doing a Schilder style approach. Also, not sure what you are getting at with your comment about strip perf. I don't see that much at all, and can count on the fingers of one hand the strip perfs I've caused using a variant of the Schilder technique over the 5000 or so root canals. Anyhow, I agree with you that fine tx can be delivered by various approaches including yours. I still like mine better though. :-)) - Mark Mark, About 25% of my practice are retreatments. In our area(Florida) there are few clinicians using the Schilder technique because it wasn't taught in the dental school in the SE USA. Perhaps that is why you are not seeing the failures since you are in central Florida too. Often when a Schilder prep tooth fails it is split and is extracted due to overpreparation if it was the classic Schilder method. Newer tapered instrumentation techniques have attempted to correct Schider's original preparation errors. If they are extracted you won't see many in your practice. I especially like your last statement: I've seen your work, it's very nice and if it works in your hands keep it up. There's nothing wrong with that but some people like to start fights. I'm not going to back down when science is on supports my technique. It would be another thing if Terry could post some research that invalidated my technique but it isn't there. I like my technique, I'm not going back to the old Schilder technique, endodontics is moving on - Randy Randy, I think you are one of the best additions to Roots in a long time. I've learned a lot from your postings, and please don't take my recent tough questions aimed in your direction as any lack of respect. While I find myself aligned in a different camp from you from a philosophical/mechanical treatment aspect, your postings have always given me things to think about, and I always enjoy reading them. I for one enjoy reading different perspectives from my own - Mark Terry, I'm not calling you mean...I just think yiou have made up your decision about certain things....IE SQuirting... and I think it's inaccurate. Now you can call me mean for saying that...but it's just what I think...and I have NO way of proving you or me right without some big huge study costing millions of bucks and time. I personallly think the Goodman studies don't really show what you think they show ...and to me...the Goodman studies are there but aren't significant... You on the other hand consider them the GP Bible and swear by them. Unquestionably...we agree there needs to be some definiative research... I would love to be a real scientist...most everyone who has known me through the ages always thought I'd be a research lab rat working in a little room without windows... but I don't have the contacts, the money, or the equipment to this right. I suppose I should spend some time and look at GP a little...and see if I can develop the contacts...but alas... my overhead is so high I"ve got to do real work for a living....I'm gonna go stuff some Overheated GP now as a matter of fact. Joey D, "Is it Tomato or Tamatoe" LOL, Iím still donít hear any specifics about what is not important about Goodmanís studies. If you heat gutta percha, it seems very significant! Saying you donít think itís important is way to general and not specific enough. The OOO saw fit to print it in a five part series. The burden of proof is on all the people that donít have science to back up their obturation technique - Terry The OOO saw fit to print it in a five part series Yep...in the 70's - Joey D Just to throw a little wood into the fire ;-) I used squirting in 2002 and 2003, 24% of the time a la Dovgan/Stropko. The rest using Terryís Rheology I only wish I had Terryís meticulousness - I underlined those four letters as comic relief for spanish speaking dudes ;-) At least in-vitro optically..Squirting with Obtura works well ;-) See attached paper by Weller et al - Benjamin Schien Ben, there are only 200 problems with this study.... First, you can't equate better adaptation to better sealing Second, and this is a biggy...they didn't use sealer. I twould substaintly change the outcome I think. - Joey D Joey, what technique doesn't use sealer. How do you seal a canal without sealer?????? Guy Guy, The problem with the study Ben quoted didn't use sealer...so Thermafil didn't do so well....Joey D I freaking out on this forum...............do the words volumetric and gravitometric mean nothing to anyone.......... does anyone dispute that leakage studies of any kind particularly these sealer based one are total and complete crap (sorry GUY). SHOW ME ONE FREAKING LEAKAGE STUDY that did more than thermocycle, show me one that used a cyclic masticatory force for any period of time. RESILON/Epiphany has to work better than Gutta Percha and AH-26 cuz it bonds GUMBY DAMN it, but the C factor is so low that under function or parafunction that bond strength may mean JACK S--T....... Can you more densely compact Resilon than Gutta Percha, I don't think so, does it make a difference...............I'd bet the farm........... How come now is talking about the biochemistry of the Gutta Percha used, the amount of filler, opaciers, colour agents, et al based on brands........... .S/O is playing with forumulation finally. Do a molecular analysis of the reasons for the failure not these bogus leakage tests and frankly as to ethics et al...... go spend some time on Dental Town and listen to advocacy of grey market implants - Kendo HmmmmÖ.thatís a nice apical seal with that Thermafil plastic obturator (if you trust plastic) - Terry P.S. The way they scored adaptation was way too subjective. Not acceptable, and they didnít look at real typical clinical anatomy which would have been much more complex. Riddled with bias. Terry, I'm the published expert around here on Thermafil.... Even though I'm thrid author...I'm the one who came up with the original idea and model....the first author ended up taking over the project because I graduated and didn't have time to write it up and do it write...blah, blah, blah Here's what I've got to say about this briefly. 1. Thermafil and Squirting are similar in some items. Both require riding on properly placed sealer....No sealer... Not so good. 2. Thermafil and Squirting are highly dependant on the prepartion. Coke bottle preps will kill a thermafil obturation because the carrier strips off which can be overcome with squirting...A nice tapered prep without canal abnormalites works best for both. something like15% of the carriers we looked at stripped off the end.. .it took years for me to figuare out...it was the preps fault. We used step back without patency. Squirting is highly dependant on the clinicians ability - Joey D =================================================================================== 1: J Endod. 1993 Mar;19(3):130-5. Links Comment in: J Endod. 1993 Jun;19(6):266. Adaptation of thermafil components to canal walls. Juhlin JJ, Walton RE, Dovgan JS. Department of Endodontics, College of Dentistry, University of Iowa. The desired result of the Thermafil system is described as a centered carrier encased by gutta-percha in apposition to the canal walls. This study examined, in curved canals, the intracanal relationships of: (a) the metal carrier; (b) the surrounding gutta-percha; and (c) the sealer. Following the manufacturer's recommended techniques, 20 resin blocks that had canals prepared with conservative flaring were obturated. Cross-sections were made in the cervical, middle, and apical thirds and were evaluated with a stereomicroscope and scanning electron microscope to determine the location of the Thermafil components. In an additional 20 resin canal preparations obturated with the Thermafil system, the sealer was stained with dye to evaluate coating patterns. Then, these blocks were sectioned at the apex and examined under the stereomicroscope for adaptation at the apical extent of the preparation. In most preparations, the carrier abutted the canal wall in the cervical and middle sections but was usually surrounded by gutta-percha in the apical one third. The adaptation of components showed the most variability at the most apical extent of the preparation; complete encasement of the carrier did not occur in any specimen. Sealer distribution was variable throughout, usually being absent in the apical canal. =============================================================================== Joey D, Generally agreed. And the coronal opening is important for Carrier Based obturants as well, No? - John A Khademy ANY OBTURATION TECHNIQUE IS HIGHLY DEPENDENT (sp) ON THE CLINICIAN'S ABILITY .........that's not rocket science....... Rosenberg, Carr (when he was on ROOTS)........apical control zone............ It was even the essence of Schilder's concepts albeit, he was full of it by keeping the apical size to a predetermined number cuz that flies not only in the face of physiologic reality but was laughable the first time anyone actually measured an apex altered by any pathology........... it worked because keeping the apex that small made warm vertical condensation in an era o heat carriers and little bitty pieces of gutta percha for backfil viable. Look at John Khademi's work. now there is technical brilliance, and I'll eat Dovgan's three day old underwear if the majority of his apical preparations are to a 20 or 25 file............. DAMN IT - SOMEONE GET BRISENO ON THIS FORUM AND NOW AND DEAL WITH REALITY NOT BIAS AND PAP............. Where is Rick Schwartz - now there is an endude who is loved and respected and bridges the gap between the Lightspeed crowd and BU moonies...............have him join this debate. Dovgan, dude, you're disappointing me, you're sounding defensive............ injection molding, GOOGLE NEXUS and microstructural replication, read what they refer to and rethink your commentary. You're being bullied......... kendo .and 80ís, over a decade of interest. I got the beef; whereís your beef to support squirting? - Terry I don't think the Goodman studies support Schielders technique...You ain't got the beef. You got a beef like substitute called soy - Joey D Ok then whereís your soy? Prove to me that gp doesnít expand when heated to Beta and dropped back down to Alpha. Ok then whereís your soy? - Terry Terry, Here's the logistcal problem with the Schielder technique.... it used to be they flamed an instrument ...but how much control of temperature do you have with that? Then the System B came out...and while it feels good to dial in a temp, each and every tip and handpience is different...and sometimes quite a bit off because the feed back loop looks at current... and if there is any other resistance in the system ...it doesn't match. The Touch and heat can't even give you a temp. Now finally, you can take a temperature probe and calibrate it with a thermocouple...but reading heat is a huge problem.. it takes 5X the T1/2 of th probe to have > 95% confidence in the temp... Now understanding alll this...can you assure me the Schielder technique doesn't violate some of the Goodman rheology? Joey D, "That's my case in a nutshell" For some reason I'ím constantly accused of not providing education for the masses. I think itís probably justified due to lack of interest and lack of commercial sponsorship. Actually thereís much more control than you think. The cherry red temp of the tempered steel Schilder heat carrier when plunged into the cushion of gp at the 4-6mm level created a pretty consistent temp of the gp pad after 5 cycled introductions. The insulating nature of the gp passes the heat as a very consistent gradient ranging from an average of 330-340 C when plunged, then dissipating to a 43.5 plateau that can'ít be exceeded apically. I keep posting this chart over and over again but no one pays attention to it or understands it. It doesnít seem like rocket science to me. Am I missing something? Let me point out how the cherry red heat carrier technique peaks out at the second application. It isnít amorphous and itís deformed here! Iím pretty certain that there must be pretty large temperature range above 330-340 C that still gives the proper wave and doesnít cause excessive apical temp unfavorable changing the phase of gp; we just donít know what it exactly is. I stay close to the 330C because thatís what we have as evidence. If youíre below 330C it doesnít deform. Clearly no one has paid attention to this because I routinely hear recommended temps for the System B technique well below the 330C range. Maybe you can accuse me of having secret access to the BU Library and Jim Stephenís thesis who correlated this 330C temp to the flamed carrier tip, but I still think itís a amusing that you have gurus coming up with these imaginary temps theyíve developed with crap evidence instead of scientifically figuring out the rheology for their own technique. It seems like they all prefer to discount rheology and bash Goodmanís work rather than perform the science to disprove or prove itís validity - Terry JoeyD, Terry has some Beef. He also has some Pork. :-))) The Beef is in the form of the Rheology that he quotes. The Pork is in our inability to determine the exact rheological properties of todays GP, and we are talking matters of a few degrees. Futhermore, the heat delivery methods are different today i.e. touch 'n heat and SystemB. How much does this matter? I dunno. I have been steadily cranking up the heat on my systemB and I have sailed one cone (just yesterday as a matter of fact). I think the 200C temp is too cold to get the apical segment warmed up to the right amount. I am at 290C now. As I recall the heat carriers were 330C...Terry? Lastly, We all see the same screwed up stuff, and we seem to get most of it managed. As a personal preference, I don't like to junk hanging out the end, no matter what you call it - John A Khademy John, The Rheology he states is just a smoke and mirrors for justifying the classic Schilder method....Joey D Itís not acceptable to just say you donít like Rheology. The burden is on you to show why! - Terry Plasticized material by heat shrink? - Guy If thatís the case I fully expect you to show me how the smoke and mirrors magic trick was performed. Itís not acceptable to just say you donít like Rheology. The burden is on you to show why! - Terry On 9/8/06, Randy Hedrick wrote: The obturation looks thin and thready in this specimen because the canals were not adequately cleaned to allow for proper obturation. .... I have seen this sample before. I think the top one was a Lightspeed prep. Even if it is not, it certainly looks like one with the classic "bud" shape of the lightspeed instruments terminating about 1mm short of the end of the canal system. While these instruments certainly have some merit, and can work well in a variety of cases, I am at a loss how a size 60 bud is going to go around these corners. While the initial shape can be cut with a variety of instruments and systems, no automated system can replace what Pannkuk has been saying: Recapitulation with hand files. From last week: - John A Khademy Most brands of gutta percha softened above 80 C. And since Gutta Percha is poor thermal conductor, it will stay soft for at least 30 seconds. (it's easy to test out: throw one GP into boiling water for 5 mins, then play with it). >3. Is it naked gp with no sealer apically? >4. Is it folded with voids apically? Depends upon which sealers. For sealers flows poorly (too thick) like AH-26 or EZ-Fill, voids are easily formed. For flowable sealers, like AH-Plus, endorez, etc.; less chance to form voids. How fast and whether sealer sets and dessolves also matter. AH-26 set very slowly, and before set it's miscible in water. So more chance for it to form voids than faster set sealers like AH-plus. So how about reokoseal? it never set, but since it's not soluble in water; so its clinical performance is not that terrible. Additional points for AH-26: after it set, the silver inside the sealer will dissolve slowly (to leave voids), and oxidizing (stain tooth and irritate tissue). - A Joel Gutta percha is overheated and dimensionally unstable above 50 C - Terry Terry, I can tell you...if you look at the top obturation (I don't think the bottom is that bad) , you can see areas A&B look like crud. The reality is, they probably did NOT get enough hydrolics to extrude material...its one of the reasons. ..if I don't have a big puff, I reobturate... The key to this is like alot of things in life...know what to look for... and if in question, redo - Joey D The guys at ft. gordon (if I'm not mistaken) actually wrote that gutta percha will only thermoplasticize if within 3 millimeters of the apical extent. this is off the top of my head. I'll research it to make sure that statement is accurate - Dr Barden Wrong. :):):) - Terry

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