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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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30 year posters

Ultradent was established in 1979 as a family business in the truest sense. Dr. Dan Fischer, President/CEO of Ultradent, rallied family members to support manufacturing operations in the kitchen of their family home. Focusing on technologies that revolutionized delivery systems, innovation, and patient care, Ultradent grew at a rapid pace. Today, Ultradent manufactures and packages over 700 materials, devices, and instruments and employs more than 1,000 people worldwide. Despite its continued growth and rapid expansion over the past 31 years, however, Ultradent has never lost sight of its mission: to enrich quality of life and improve human oral care globally. To this end, Ultradent has dedicated the resources of its Research & Development (R&D), Operations, Administrative, Sales, and Marketing teams to deliver technology to reach the masses

The mission for quality of life and oral health
Ultradent’s mission is to enrich quality of life and improve human oral care. To meet this goal, Ultradent has developed as a global company with distribution in more than 100 countries and subsidiaries in Germany, Italy, Brazil, and Japan. With such an extensive outreach, Ultradent has had an opportunity to implement initiatives that have revolutionized how affordable, effective oral health care is provided to the masses. Ultradent’s mission is reinforced through educational programs for dental students, practicing dentists, prominent dentists, and lecturers around the world.

 

Ultradent also works to improve the quality of life and health of individuals through donations to financial and charitable programs such as the National Children’s Oral Health Foundation, Sealants for Smiles, and support of individual service missions, to name just a few. Ultradent also established The Diversity Foundation, a progressive outreach program committed to promoting and fostering multi-cultural awareness.

endo showcase groupEndodontic solutions through “Endo-Eze Showcase Events”
One of Ultradent’s most recent educational initiatives calls for a paradigm shift in the practice of endodontics. Offered as “Endo-Eze Showcase Events,” Ultradent delivers its program to the local dental office where smaller, more focused groups benefit from grassroots training on endodontic technology. The courses call attention to the practical application of minimally-invasive, affordable solutions for the everyday dentist.

 

How has Ultradent impacted the dental industry?
Ultradent has made the concept of minimally invasive dentistry central to addressing changes in the oral healthcare marketplace. Ultradent supports a “minimally invasive, patient-centered” paradigm, which requires the use of new materials and technologies to reach more humans, providing affordable dentistry with long-term results in mind.

One could easily find evidence of this paradigm in Ultradent’s range of products, from the flagship material, Astringedent, to its newest addition to the Endo-Eze Anatomic Endodontic Technology (AET), Endo-Eze TiLOS™ (TiLOS). An evolution of Ultradent’s AET system, TiLOS is a safe and simple hybrid solution using stainless steel and nickel titanium hand files, engine-driven stainless steel shaping files, and nickel titanium apical files. TiLOS files are optimized for Ultradent’s 30° reciprocating handpiece, offering safe, effective, and predictable results.

TiLOS was developed to provide the right metal for each location of the root canal, using the safest and most effective mechanical movement. The system utilizes a cleaning and shaping hybridization technique using the technology and speed of the biomechanical systems while maximizing the intuitive, traditional nature of hand instrumentation. It reduces the influence of anatomical variations, pathological conditions, and other typical complications. The system reflects Ultradent’s approach to the practice of endodontics, which considers the practitioner and patient in a simple and quality technique that ultimately saves supporting alveolar bone.

tilos groupThe TiLOS system consists of three stainless-steel shaping files─purple, white, and yellow (similar to Ultradent’s AET system), with the respective tip diameters of the active portion (.10, .13, .13 mm) and respective tapers (0.02, 0.03, and 0.04 mm/mm); two hand K-type stainless steel files, #15 and #20; and three NiTi transitional files with an active portion initial diameter of 0.25 mm and tapers of 0.08, 0.04, and 0.02. TiLOS’ hybridization also includes a change from rotational motion to reciprocating (oscillating) motion of the NiTi Transitional Files. The AET handpiece reciprocates (oscillates) the files 30 degrees in each direction, allowing preparation with the same effectiveness as when rotated but with a less aggressive movement, meaning more control and less file separation in the fragile apical area.

 

The technique begins with the enlargement and preparation of the coronal and middle third (using the TiLOS system) to eliminate interferences and straighten the line of access. These reciprocating stainless steel shaping files replace the familiar Peeso or Gates Glidden reamers that cause indiscriminate cutting and loss of tooth structure. This step is followed by highly flexible reciprocating NiTi Transitional Files and hand files in the apical portion of the canal. By following this sequence, the coronal and middle third allow a straight glide path access to the apical third without interferences, stress, fracture, and deformations, making instrumentation safer and more effective. This also facilitates irrigation, subsequent cleaning, and the placement of gutta-percha with larger diameters.

tilos kit and handpieceUltradent’s unique approach ─“Minimally invasive instrumentation of root canals”
TiLOS was preceded by the Endo-Eze AET (AET) system, which is an anatomically sensitive, minimally invasive technique that reduces the potential for damage to dentin or root fracture and preserves the root structure. The AET system consists of unique tools to solve everyday endodontic problems with practicality. The instruments and methodology of AET adapts to the natural anatomy of the canal. Rather than forcing the tooth to adapt to the instruments used, AET lets the anatomy of the tooth be its guide, resulting in more conservative preparations without compromising the ability to cleanse and obturate the canal.

Canal instrumentation using AET
One of the goals of root canal instrumentation is to prepare a progressively tapering conical shape that is uniform and continuous from the coronal orifice to the apex. This can be a challenge, however, in canals that are not circular in nature. AET is based on a progressive approach to endodontics first championed by Francisco Riitano. AET begins with a basic understanding of canal morphology. The AET preparation technique as outlined by Riitano involves the division of the root canal into “operative” thirds: coronal third, which measures from the occlusal surface of the tooth to the coronal orifice of the root canal; middle third, which measures from the coronal orifice to 3-4 mm from the apex; apical third, which corresponds to the final 3-4 mm of the canal, ending at the apical foramen.

The AET preparation technique addresses each “third” in one of three phases:
  1. Coronal access (using access burs)
  2. Coronal/middle preparation (using engine-driven, counter-rotating Shaping files)
  3. Apical preparation (using apical hand files, or alternate engine-driven rotary NiTi files).

 

The AET preparation technique in the middle third of the canal involves the circumferential preparation of all walls of the canal. This is accomplished using counter-rotating contra-angle, uniquely designed stainless steel instruments known as Shaping files, and Apical hand files. The Shaping instruments used with the AET preparation technique have a square cross-section like a K-File. The tip of the Shaping instrument is a non-cutting safe tip, and is flexible and rounded. It is intended only to guide the file in the canal. The cutting surfaces of the file extend throughout the length of the instrument, with the bulk of the sharper and stronger cutting blades in the upper two-thirds of the instrument. This allows a Shaping instrument to simultaneously negotiate the canal, enlarge the canal circumferentially, and eliminate interferences as the instrument is used.

Although the AET preparation technique uses stainless steel apical hand files, engine-driven rotary NiTi files may be preferred by some clinicians, especially in canals that are very curved. This “blending” of the AET preparation technique in the middle third with existing rotary technology at the apex allows for an approach to root canal therapy that may more adequately address the unique clinical needs in all areas of the canal. The technique is a logical, straightforward sequence of engine-driven reciprocating files, followed by a short sequence of hand filing in the apex to affect a canal shape that is minimally invasive and listens to the needs of the tooth.

Delivering innovation that is functional and convenient
Endo-Eze AET files are packaged in sturdy, autoclavable, plastic containers, eliminating the need for an “endo tub.” These semi-disposable kits can even be autoclaved prior to use if “sterile” files are desired even when new. The economical patient kits contain the instruments needed to perform 90% of all endodontic procedures. The kits contain seven files that are color-coded according to length for easy identification. The sponge insert can be soaked with disinfectant to reduce microbes during the procedure.

tilos front kit4

TiLOS shares AET’s unique functionality with regard to the packaging system. Esthetic and functional, the autoclavable TiLOS Procedure Packs feature an integrated easel stand, making it a stable workstation. A built-in measuring device provides length determination, and an Endo Stop dispenser in the lid offers on-hand replacements for used or damaged stops.

The AET system can be used in conjunction with EndoREZ, a resin sealer that is the first self-priming, hydrophilic, dual-cure resin sealer for endodontic obturation applications. The hydrophilic properties of EndoREZ ensure deep penetration into dentinal tubules and delicate anatomy in the canal. EndoREZ is available with an accelerant, EndoREZ Accelerator, which reduces the set time of the sealer by approximately 75%, from 25-45 minutes to an average of 4-5 minutes. This time reduction allows the clinician, assistant, and patient to complete a comprehensive root canal/restorative procedure in the same appointment (preparing the post channel and cementing and bonding the post), saving chair time.
accelerator

Seizing the opportunity in fiber post technology
Ultradent’s UniCore Post and Drill system combines superior post strength and bondability with a unique drill designed to enhance self-centering in the canal, which prevents perforations. The versatility and design of the UniCore Posts provide an efficient and practical alternative to metal post and drill systems, enabling future removal of the post, if required, for retreatment. The system features translucent, radiopaque fiber posts with life-like dentin properties and a patented, multifunctional drill. The drill can be used up to 15 times to remove Thermafil or gutta-percha; or up to five times to remove pre-existing fiber posts for retreatment.Fiber posts have been the popular choice for restoring endodontically treated teeth because they are safer, more easily removed, esthetic, and they conserve tooth structure and provide improved fracture resistance to these compromised teeth. The Unciore Post and Drill system was designed to embrace the benefits of a traditional file system and provide for a safe preparation and a highly retentive, minimally invasive post-and-core rehabilitation when used with a strong adhesive system.

unicore starter_endodontics_08
The patented 3-in-1 Unicore Drills afford unsurpassed safety in post canal preparation. The non-cutting, heat generating tiny point on the end of the drill keeps the drill centered in the root as it melts the gutta-percha ahead of it. A novel high-RPM, low-torque (for slow speed) setting can be used. This same design and high RPM facilitates fiber post removal for retreatment should it ever be required. The heat-generating drill tip softens post matrix for penetration and removal. A “Lazy Flute” design scrapes the sides without engaging too aggressively. The third capability of this novel drill is for removing Thermafil. For any clinician who has tackled these before, they can appreciate the very meaningful benefit of this drill for this purpose. The color-coded packaging has been optimized in a “kit within a kit” system to make for easy identification, saving time, and preventing mistakes. The entire module (box, posts, and drills) are autoclavable to prevent cross contamination. And, the drill and posts are secured in foam, preventing mishaps or confusion if dropped or spilled.

The systematic respect for healthy, natural tissue is at the heart of Ultradent’s family of endodontic products. Ultradent will continue to work by the clinician’s side to deliver the materials and technologies for the best patient care.

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Latest News

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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