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Practice Profile

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Randy Garland, DDS

Randy Garland, DDS

Exceeding expectations What can you tell us about your background?
I grew up in southern Orange County and earned a bachelor’s degree in biology at San Diego State University in 1983. There I met my future wife, Kim, at the...

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Scott A. Norton, DMD, MSD

Scott A. Norton, DMD, MSD

Focus on family, patients, friends, growth, and community What can you tell us about your background? For as long as I can remember, I wanted to make people smile. I always loved getting the class laughing in grade school. Looking back, I am sure...

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Dr. Fleur A. Blethen

Dr. Fleur A. Blethen

Empathy, tenacity, and perseverance are keys to this clinician’s flourishing practice  What can you tell us about your background? I was born and raised in Seattle, Washington, and lived there until I was 13 years old. My family relocated...

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Clinical Articles

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Management of a tooth with a large internal resorption defect

Management of a tooth with a large internal resorption defect

Dr. Robert Slosberg facilitates accurate mapping and obturation of the resportive defect with CBCT imaging Abstract
A patient presented with advanced internal root resorption of tooth No. 9. The prominent location of this tooth...

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Pulpal diagnosis of teeth presenting with condensing osteitis prior to endodontic treatment — a retrospective study

Pulpal diagnosis of teeth presenting with condensing osteitis prior to endodontic treatment — a retrospective study

Drs. Brian Shaughnessy, Margaret Jones, Ricardo Caicedo, Joseph Morelli, Stephen Clark, and Ms. Jennifer Osborne review the occurrence of teeth presenting with condensing osteitis and their associated pulpal diagnosis over a 2-year period. Introduction Read More...

GuttaCore® system: a step forward in the evolution of endodontics

GuttaCore® system: a step forward in the evolution of endodontics

Dr. Andrei Zoryan dispels some of the common myths surrounding carrier-based obturation Carrier-based gutta percha Carrier-based obturation (such as Thermafil®, GT® obturator, ProTaper® obturator [Dentsply Tulsa Dental Specialties]) is one...

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Practice Management

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Life after root canal — it’s not just about having enough money

Life after root canal — it’s not just about having enough money

Dr. Robert Fleisher ruminates on how to prepare for retirement There are so many articles about everything that you become pretty much overwhelmed and can never expect to read them all. So you pick and choose. You like to learn about the latest and...

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Superior customer service

Superior customer service

Dr. Roger Levin presents the 10 top ways to help create a perfect dental team With the changes brought on by the economy, top companies are bringing in the best resources they can find to evaluate where their organizations stand. They want to know...

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Office Matters: Hard-piped filtered water system vs. self-contained bottled water system

John Bednar helps avert problems coming down the pipe If your office currently has a hard-piped filtered water system, now is a good time to consider if and when you should change to a self-contained bottled water system. A hard-piped filtered water...

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Dr. Julian Webber discusses his commitment to pain-free endodontics



It’s far easier now to do a root canal than it ever was before, thanks to all the fancy instruments, gizmos and gadgets that we have. However, the basic principles remain exactly the same.

One of the biggest advances is the advent of technology that has made it possible to anesthetize the patient so that there is no discomfort, whether from the anesthetic itself or the treatment.

I have used The Wand® (Milestone Scientific) for the last 13 years. What appealed to me originally was that it is very non-invasive. I feel I can give an injection absolutely painlessly without the need for a topical anesthetic. The different injection techniques available with The Wand, especially in and around the palatal area, are innovative and very well accepted by the patients—much more so than conventional syringe anesthetic delivery systems.

How it works, in essence, is that the anesthetic is delivered ahead of the needle. A technique is recommended of pushing on the tissue before you actually start the injection and starting to inject before you pierce the tissue so a topical anesthetic itself is delivered. I find that technique excellent for all Wand- recommended protocols—which are numerous. And, it is a big practice builder. The patients love it—they always comment positively on it.

There is always a learning curve with something new, but I would say it was minimal with regard to The Wand. I particularly like the new Wand, the Single Tooth Anesthesia (STA) System® (Milestone Scientific). The ease of giving intra-ligamental anesthesia, and the feedback it gives me so I know I am actually in the periodontal ligament is very worthwhile. Certainly at any stage of the endodontic procedure, the intra-ligamental technique with the Wand STA alone is more than adequate.

I always advocate this product. I talk about it in my lectures, I show images, and I always recommend the proper distributors. I suppose it is like anything; it is the initial cost that puts people off. And as there is a learning curve, if they don’t master it straight away, it goes in the drawer. I can only say that it is worth mastering straight away because you can reassure patients with complete confidence when you say there will be no discomfort.

Any anesthetic technique should be painless, however, with The Wand STA it always is. It is much easier to ensure that. It uses the same amount of anesthetic, and it takes the same amount of time as a conventional syringe, perhaps marginally less. The faster you are giving the local anesthetic, the much greater opportunity there is for discomfort during the delivery, which is a common complaint.

The Wand STA automatically reduces the speed at which I can administer the solution, and therefore, keeps the opportunity for pain at bay. So for me, speed is not the issue. It is the fact that with the technology as it is, I can give a truly painless injection, and that is all I am really interested in.

Professional tips for The Wand STA

  • Maximize the use of palatal and periodontal ligament injections as they numb the tooth and not the mouth.
  • When injecting into the palate, press a cotton bud (the Wand is supplied with tipped applicators) against the back of the bevel to create pressure anesthesia and to catch drops.
  • Another technique for preventing the anesthetic dripping into the patient’s mouth when injecting into tight tissue is to leave the aspirate button on at the end of the injection. This causes the anesthetic to be sucked inwards. Tap the foot pedal and withdraw the needle after three beeps, then lift the handpiece out of the mouth.
  • When carrying out a block, place the needle on the mucosa, then rotate the handpiece several times through an arc of 180 degrees. This equalizes the pressure on the needle bevel, allowing it to go straight in to the injection site.
  • It’s possible to conceal the Wand from phobics and nervous patients. This can be achieved by snapping off a section of the plastic handpiece so you can hide the rest of the handpiece and needle inside your hand.
  • It’s advisable to carry out this process for PDL and palatal injections as it enables even better control and improves access.
  • If you use 2.2 ml cartridges, always keep a spare adaptor so that you are not left with an unusable Wand if you lose the only one.
  • Avoid running out of handpieces by hiding a number–say 15–so that you have a buffer stock if you use all the others up. This will ensure you do not run out while waiting for the next delivery.

 

Bio

webberJulian Webber, BDS, MSc, DGDP, FICD, is a partner at the renowned Lister House Endodontic Practice in London. He is Editor-in-Chief of Endodontic Practice and an editorial adviser to Independent Dentistry. He has taught at Guy’s and the Eastman Dental Schools and has lectured widely in Europe and the United States. Dr. Webber is a faculty member of the Pacific Endodontic Research Foundation in San Diego, California, where he has perfected and taught techniques on microscopic endodontics. He has written numerous articles and contributed to textbooks in the field of endodontics.

 

 

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Research has shown that irrigants are more effective when they are electro-mechanically activated.

Acoustic streaming and cavitation have been proven to significantly enhance cleaning of difficult anatomy. Studies have shown that low frequency (Sonic) oscillation (160-190Hz) was not sufficient to create acoustic streaming or cavitation within the canal space.

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