Much has changed in global endodontics over the past 40 years and a great deal of this change has been driven by the relentless introduction of new technology...
AAE Annual Meeting and Q&A Who is Presenting & Glide Path/Working Length, Part 2
This show opens with Ruddle sharing one of his hidden talents and giving us special insight into some untapped potential. Next, Ruddle identifies some great speakers who will be presenting this year at the AAE Meeting in April and what they will be talking about. Then, Ruddle finishes what he began, namely wrapping up the Q&A on glide path management and working length. The season closes out with another dose of What Phyllis Thinks, this time on the topic of books, movies, and music.
Show Content & Timecodes00:09 - INTRO: Hidden Talents 05:21 - SEGMENT 1: Annual AAE Meeting 30:21 - SEGMENT 2: Q&A – Glide Path/Working Length, Part 2 40:40 - CLOSE: What Does Phyllis Think?
Extra content referenced within show:
Downloadable PDFs & Related Materials
Clifford J. Ruddle, DDS, examines why glide path management is the key to successfull endodontics...
For more than 50 years there has been universal agreement that the triad for endodontic success is shaping canals, cleaning in 3 dimensions, and filling root canal systems. Further, it is globally accepted that 3D disinfection is central to success and has traditionally required a well-shaped canal...
There has been massive growth in endodontic treatment in recent years. This upward surge of clinical activity can be attributable to better trained dentists and specialists alike. Necessary for this unfolding story is the general public’s growing selection for root canal treatment as an alternative to the extraction...
This transcript is made available by The Ruddle Show in an effort to share opinions and information, and as an added service. Since all show text has been transcribed by a third party, grammatical errors and/or misspellings may occur. As such, we encourage you to listen/watch the show whenever possible and use the transcript for your own general, personal information. Any reproduction of show content (visual, audio or written) is strictly forbidden.
INTRO: Hidden Talents
Welcome to The Ruddle Show. I’m Lisette and this is my dad, Cliff Ruddle. Today we are showing the last show of our fourth season. So, are you excited about that?
I am. I’m really excited about this show for several reasons, and then you and I need to look ahead because Season 5 starts shortly.
Yes, well today we actually have a special segment on the upcoming AAE meeting, so we’ll get to that soon. But first, we each wanted to reveal something about ourselves that maybe you didn’t already know. Now, I had chosen to call this segment Hidden Talents, but I got a little pushback from my dad because he doesn’t want to really consider himself talented because he’s so modest. So, we can think of it as maybe untapped potential or side hobbies, whatever works for you. So, we’ve mentioned on previous shows that my dad used to work on construction, and he actually has a woodworking talent. And you brought a sword to show us that he carved out of a single piece of wood. Why don’t you show it?
Well, I didn’t realize that when I carved this about 40-45 years ago that it was going to make the show today, but you can see I made kind of a crude sword. Lisette is being pretty kind. But the reason I carved this – this is the story, not the hidden talent. But Lisa, when she was maybe in the fourth or fifth grade, little kid, you know, she was getting ready for Halloween, and of course, there was the costume. And remember, this was before Pirates of the Caribbean, the five movies, this was before Captain Jack Sparrow became legendary, and it’s before there was a rage for Halloween costumes.
So, she was short a sword the way I recall, and probably because I was practicing twelve hours a day and I never saw her hardly, I probably was guilt-ridden. So, I grabbed a piece of wood, and I had, you know, some tools, and I started carving this in my bean bag. And so, after 40-some years, I’d like to hand the sword back to you for your proverbial future piracy.
Well thanks, Dad. Actually, when I was so impressed by this sword when he made it, that I actually said, “Is this for me?” And he said, “Well you can use it for Halloween.”
Well now it is for you and you can use it judiciously.
I was blown away when I saw this, because I had no idea what he was doing, and he was keeping it a secret and he was just over carving something, so I was very surprised. Thanks, Dad. I really love this.
Great. Well okay, so I carved some crude wood in this qualifying for hidden talents. What are your talents? I mean you have many talents, so I’m curious which one you’re going to focus on.
Well, a lot of people don’t know this about me, but I do have a bit of a green thumb, and I actually got it from both my parents. But I do remember as a kid, my mom had like over one hundred plants in the house when I was growing up.
So, I actually have a lot of orchids in my house, and this one I plants for you. I’m going to give it to you today.
And I like to plant them in colorful pots and they always rebloom, which is like super exciting for me. I’m always going around like counting how many I have reblooming, and I probably have about 150 in my house, but yeah, I do really enjoy the orchids. They make me happy. I like working with them.
Orchids are phenomenal and if you look at them across time and across cultures, they’ve always represented love, fertility, elegance, all kinds of things, and so, thanks for the – well we have quite a few at our house, too, but thanks for this one on the set. It’s quite nice.
I actually try to plant like an orchid a month for them, so I’ve gone a little bit – it’s been a little bit irregular during the last year because of COVID and just trying to get my hands on some orchids. But yeah, it’s fun and I just really enjoy it. And you know, the flowers last so long, too. I actually have one that I got around Thanksgiving last year that still has some flowers on it. So, I’m not ready –
Some of our biggest joy was, you know, I always thought they were three, four months, and then we got some reblooming, and around the house things that we thought were kind of finished – you get those little bulbs going again, and all of a sudden, it’s another cycle.
Yeah, there is also a whole other thing with like trying to get these little like worms that get on them, but every now and then – this one doesn’t have any, don’t worry, so that is a challenge. Anyway, we have a very fun-filled show for you today. And let’s get going with it.
SEGMENT 1: Annual AAE Meeting
Today we wanted to do a special segment on the upcoming AAE meeting, which runs April 21 to 24 and is virtual this year because of COVID. So, there will be both live speakers where attendees can ask questions in real time and also on demand presentations where speakers have pre-recorded their lectures. So, our goal today is to highlight some of the presentations that we find intriguing. And we also have five video clips from presenters, talking about what they’re going to be presenting. So, we’ll get to that momentarily. But first, can you break down for us the main educational track that the presentations fall under?
And I think we actually have a slide.
Ah yes, thank you. I would have forgotten. Okay. Yeah, really, we have some really good tracks, and they put together some nice ones, and I think there were a couple I thought were missing, but you’ll maybe identify that. But the first one was the diagnosis and management of pain, and we can see some really good speakers in that track, and of course, pain a lot of times brings people in to us, but then, of course, how we manage it is important.
We have another track on surgery, and I notice that they’re going to be talking about piezoelectric and taking the cortical plate intact and putting it in some water and doing their procedure putting the plate back, so it sounds interesting. This has been all talked about for years, maybe decades, but it’s still fun. The non-surgical track fools me always a little bit, because in my world non-surgery means it’s already had endodontics and now we’re disassembling and retreating, but I notice in this track, it’s access, it’s irrigation, it’s glide path, it’s shaping, it’s filling root canal systems, and there’s some retreatment in there as well.
Another track would be professional development, you know, how to be a better professional about systems and structures, about professional growth, that kind of thing, that’s cool. And then there’s a track on biology and regenerating. And that’s a pretty important topic with where we are today in the science of regeneration, so it kind of gets us down to packing the root canal system, filling the root canal system, or regenerating materials, so what do we do, that will be interesting.
And then, of course, there’s cognitive dissonance. Maybe for our general dentist friends, cause this has been a really big deal since ’65 when Seltzer and Bender, two icons in our field, first described it in Triple O. Maybe you can give our general dentist friends, though, a definition or some comment on cognitive dissonance.
Yes. So, Seltzer and Bender defined it as “The existence of views, attitudes or beliefs which are inconsistent or incompatible with one another but, nonetheless, are held simultaneously by the same person.”
Yeah, I think that’s – you know, we’ll get into that more. That’s fabulous and it’s good to revisit it, because it’s just as relevant today as it was then. Then there’s the tech track, and I guess that doesn’t surprise anybody cause there’s a lot of stuff happening in technology and there’s going to be a few people speaking about their stuff and how it – I thought a couple people should have been crossed off. I thought it was like 20 years ago, but anyway, that track. And then we have finally, what – submitted presentations. And I think the submitted presentations was a grab bag to put everybody that didn’t fit precisely into a track, because even in the program it says, “It’s everything from access cavities to microsurgery.”
So, that’s a little bit about the tracks.
Yeah, I was kind of intrigued by the cognitive dissonance section, and it was funny, because every time I was looking through the presentations, when I came to a title that seemed sort of like a riddle or a paradox, then I realized it was under the cognitive dissonance section. So, just for fun I’ll read a couple of those titles. “Vital Pulp Therapy Versus Non-surgical Root Canal Treatment: Where are the Choices?” “Fallacy or Fact – The Necessity of Patency,” “To Treat or Not to Treat: Challenging Current Concepts”, Resisting Obturation: When to Consider Regeneration,” “Is Retreatment Always Necessary Before Surgery?” and then this one, “It Shouldn’t Work.” So, they’re kind of interesting titles.
[Crosstalk] Well, can I play off that it shouldn’t work? I mean in the 1990’s MTA arrived, and when MTA arrived, Mineral Trioxide Aggregate, out of Loma Linda, Mahmoud Torabinejad, Professor Torabinejad, he sent us these little canisters, film canisters, of MTA. And if we, you know, made a donation to the AAE Foundation we could get a little canister. And so, the cognitive dissonance was, you know, where do you use it? Well, we first started using it on hopeless cases. I mean cases that were clearly not going to work.
Like and as an example, a small child comes in and they’ve had a blowout perforation mechanically from an operator and there’s a combined endoparial lesion and I mean there’s a hole as big as a road grader in the pulpal floor. We dump buckets, proverbial buckets, into these defects and told parents, you know, it’s not going to work but we have a new material, we’ll try it and see, and they’d sign off on it. And a lot of those worked. So, that’s what I thought of when you said it’s not supposed to work, is it?
Yeah, it would be interesting to see what that lecture is about. Okay, so the first two endodontists we’re going to hear from happen to be female and are part of the educator forum, which focuses on global endodontic education, particularly in the time of COVID. Now starting back in April of last year, the AAE began a virtual monthly lecture series. It was by international educators for residents, and this was designed to help endo programs meet the challenges of COVID-19.
So, the speakers from this educator forum participated in the virtual monthly lecture series last year. So, first we’re going to hear from Dr. Isabel Mello, who is one of the moderators, and she’s talking about this educational session, so let’s look at that.
Good morning. My name is Isabel Mello. I’m Division Head here at Dalhousie University in Halifax, Canada. I’m also the current Chair of the Educational Affairs Committee with the AAE. I was invited by Cliff to tell you about this educational session that we are going to host at the annual AAE meeting. So, what we’re going to plan, or we have planned, for the educators is to bring different educators from different parts of the world to talk about challenges that they face during COVID era.
So, things that will be incorporated in the program, which challenges they had, and what things they are going to plan to keep even after COVID when COVID is gone. So, I hope you all enjoy this presentation and I hope to see everybody there. Thank you.
Isabel is really a unique human being and not only is she a great person, but she’s very, very smart. I had the opportunity to train with her in Santa Barbara in 2011 and that’s where I got to know her during a two-day program. But she’s gone on to become head and Chair, as she said, but what I wanted to point out, the reason you might want to catch her lecture out there is because she’s done a lot of work in irrigation, 3D cleaning, disinfection, rotary instrumentation, published articles. So, I’d like to hear what she has to say, and as her career has grown, I’m sure she has a lot to offer.
Okay, one of the speakers from the educator forum is Dr. Bettina Basrani, and she’s from the University of Toronto. So, now let’s hear from her.
Hello, everybody. I am Bettina Basrani from Toronto, Canada. And I want to invite all of you to the AAE 21. I am going to be part of a forum of educators, and we’re going to be discussing important points about education in endodontics during the time of COVID-19. In the panel I’m going to be discussing these points with endodontic educators from all around the world, from Asia, Europe, and America, and I hope that you can join us as well. Thank you very much.
Well, I first met Basrani, Bettina, many, many years ago, and actually who I met was her dad, Enrique Basrani. He was very famous in Argentina, and he drove South American endodontics for many years, and he wrote a textbook called Radiology Endodontics, and she made another edition. So, she went beyond that. And like her other sidekick out there in the Maritime Provinces, she’s done work on a lot of work, that Toronto group, on irrigation, cleaning root canal systems, technology, all that, so she’s a prolific publisher and she’s done a lot to our field, and she’s a really good educator, and I know you’re going to want to see what she has to say.
I think it’s great that the AAE has this educator forum because, you know, residents are the future of endodontics, so I would think that endodontic education, particularly in the time of COVID and the challenges we’re facing are very relevant right now. So, that’s great that they have this educator forum at their annual meeting. Okay, it also appears your partner in crime, Dr. John West, is going to be giving a submitted presentation. So, why don’t we hear from him now?
Okay, here’s Johnny.
Hello, everyone. My name is John West. I’m a practicing endodontist and Affiliate Professor at the University of Washington School of Endodontics in Seattle, Washington, USA. I really appreciate The Ruddle Show opportunity to invite you to my presentation at this year’s AAE entitled, “The Endodontic Triad, Dead or Alive?” The reason this question is important to us as endodontists I think is because here in 2021, are we good enough in terms of our predictability or do we want to begin to learn what’s possible in closing that gap of what’s possible and where we are through new technologies in cleaning and shaping and packing or obturation, or whatever you want to call the triad. I’ll be examining the triad from the perspective of the past and the present and the future.
And I will close my presentation with an introduction of a technology that will probably change endodontics really for many, many years to come. If it seems like it’s the future, it is. I think you’ll find my presentation intriguing, educational and challenging. I look forward to teaming up with you in yet one more virtual episode before we see each other again in person. Bye-bye for now.
Thanks, Johnny. It’s great to hear from you, and I know the world is going to want to hear from you so be sure to tune in and catch him on his day. You know, this topic he’s going to speak about, the triad, the trifecta, all that stuff, it was interesting when we were reviewing our show that we were looking at that paper, that 1965 paper, from Seltzer and Bender on cognitive dissonance, and guess what, they spoke about the triad. And they had a reference at the end of their sentence, and Ingle spoke about the triad about a decade earlier.
So, the triad has been around for many, many decades and John’s going to put some perspective on it. But it all goes together, it’s like a symphony, a little cleaning and preparation, a little bit of, you know, filling root canal systems, let’s cast Johnny.
So, just to let you know, John West’s presentation is on demand, but attendees can still ask questions. They just need to do it by email. I think I said previously that for the live presentations, attendees can ask questions in real time. Now we have two videos to show you from live presenters, and the first is Dr. Shimon Friedman from the University of Toronto, and so let’s hear what he’s going to be presenting.
Ah Shimon, let’s play it for you, baby.
Hello, there. I’m Dr. Shimon Friedman from Toronto, Canada, and I invite you to attend my lecture at AAE 21 in a short session with my friend, Dr. Carlos Boveda from Caracas, Venezuela. The session is titled, “Contracted Endodontic Cavities for Extended Tooth Survival. Is Less More?” It is scheduled for Thursday, April 22nd at 2:00 p.m. In the session, Dr. Boveda will describe the clinical context and application of contracted endodontic cavities, while I shall review the current research into the different impacts. I’ll then debate the research findings in the context of minimally invasive endodontics.
After attending the session, I believe you’ll be well informed on contracted endodontic cavity designs and should be able to describe how they differ from traditional designs, outline the principle steps in techniques of the clinical application and discuss the current research on the different impacts. I look forward to your attendance.
And Shimon, we look forward to attending. Just for the audience, Shimon’s been a friend of mine for decades and he’s a fascinating guy, completely learned, and I’ve learned a lot from Shimon. I want to acknowledge that publicly. He’s done a lot of research on outcome studies with retreatment, nonsurgical retreatment, and that’s been a field I’ve been heavily involved in, so I’ve learned a lot and I want to acknowledge. Just do I have time for a short story?
I mean he was a paratrooper. This guy is unbelievable. He was at the Hebrew University in Jerusalem for 17 years or something. But here’s a story nobody will know. So, I was at the AAE meeting, I gave a lecture in Dallas decades ago, and now Phyllis and I are flying up to Toronto because I’m going to do another big meeting up there, and we’re on the plane and we’re in business class, and we’re sitting there, and all these kids start going by. And I start going, “I think I saw them in my lecture. I think that’s a resident.”
So, at the very end of that line, Shimon comes along, and he says, “What are you doing?” And I said, “What do you mean? We’re on the same plane you are. What are you doing?” He said, “Where are you going?” I said, “Where you’re going.” He said, he was like thrown, I guess. But he’s never thrown. And then he said, “Well when’s your lecture?” And I said, “Not tomorrow, the next day.” He said, “What are you doing tomorrow?” I said, “We’re going to Niagara Falls. Phyllis is going to take me for my first time.” He goes, “No, you’re not going to Niagara Falls. You’re coming into the school tomorrow. You’ll be with the residents.”
So, anyway, I was with the residents. And thank you, Shimon, because you gave me a bowl of soup that night. Remember, we had soup and we had a wonderful evening with Thuan, his wife. She’s a very smart woman, done a lot of work on implants.
Yeah, it will be interesting to see what he has to say, because it looks like he’s going to be talking about things we kind of talked about on our show before, the contracted access cavities related to MIE and so that was –
Well yeah, whether it’s ninja or if it’s directed, you know, traditional access cavities, he’s going to emphasize the important of tooth structure, but he’s also going to emphasize the compromises we sometimes make with small, contracted access cavities with our shaping, our cleaning, and our filling the root canal systems. There is the ying and the yang, so we’re going to have Shimon give us some clarity.
Okay, the last speaker that we have a video from is Dr. Kenneth Hargreaves from the University of Texas at San Antonio, and he also happens to be the editor of the JOE, so let’s hear from him.
Hi, this is Ken Hargreaves from the University of Texas Health Science Center in San Antonio, and I bring you greetings. AAE 21 this year unfortunately will be a virtual meeting, but we have several exciting presentations. We hope that you’ll enjoy ours, so together with Dr. Niki Ruparel we’re providing a presentation called, “Potpourri of Pain.” Many CE courses will tell you what to do. Do step one, then step two, then step three. We’ve taken a different approach.
We’ve assembled together some very vexing and challenging endodontic pain situations, and we’re not only going to give you the best evidence in terms of what to do, we’re going to explain why because it’s our view that a well informed biologically principled endodontist is really required to be able to have that skillset to be the ultimate in terms of clinical endodontics. So, we hope that you’ll enjoy this presentation which will be virtual at our AAE 21 meeting, and I certainly look forward to seeing you at AAE 2022 in Phoenix. Take care now.
Thank you, Ken. Listen, we’ve had some good times together over the years. We’ve gotten caught in airports and we’ve had planes cancelled and I worked a little bit with you on that article we got submitted in the JOE, the review article on post and broken instruments. But one thing I want to say about Ken. When you talk about Ken, he is a really kind and brilliant person. In fact, if you talk with almost anybody anywhere in the country, and his name comes up, what do you think you always hear? He’s a genius. He’s brilliant. The guy is all those adjectives, and more.
So, I’ve learned a lot about pain management, because when we were at Mackinaw Island, Ken, you spoke, I spoke, I listened to your lecture, and it made me think about pain management. So, thank you. And listen, for the audience out there, a lot of you guys and gals get into trouble and you have post-operative problems or how people present, catch Ken, he’s going to put some truth into it so you kind of know what to do and when to do it.
Okay. So, that was the last video we have from a presenter. Now, looking through all the presentations, I thought it was kind of odd that I could really only find myself personally one presentation that had either 3D disinfection or irrigation in the title, so it doesn’t really seem like there’s a lot of presentations on disinfection. I did find one by Dr. David Jaramillo from the University of Texas at Houston, and it was called, or it is called “Histological Study of the Efficacy of Advanced Irrigation Techniques of the Root Canal System.”
So, I was a little wondering about the word “advanced.” Like I thought what does he mean by ‘advanced’. I was wondering if maybe he meant maybe higher end like because he’s talking about Gentle Wave, a multi-sonic disinfection device, and lasers, so – yeah, so that was the only one I could find personally.
Well, I actually – I don’t even know if I should say this. David is – I consider him a dear friend. He’s brilliant. In fact, for those of you who don’t know and probably a lot of you won’t even know what this means, but he actually did a lot of work with a guy named Costerton at USC. Before all this was really coming out, this disinfection game and, you know, what we’re trying to do, Costerton has passed away, but he brought a lot of fabulous thinking and was an AAE speaker. So I know David in that context. And I actually thought David would want to maybe join us today, but he said he couldn’t for contractual reasons. So, I don’t know if that’s Gentle Wave or his school. It can’t be his school; the shows are free, and we’re just promoting the AAE and we’re promoting people that we want you to see.
So, maybe – but to answer your question, there isn’t a section that is called 3D disinfection, yet it’s probably the most riveting topic right now internationally. It’s where almost all the groundbreaking research – it’s driving regenerative endodontics. We have some other people from the Gentle Wave advisory board. They’re speaking. I don’t know why they don’t just come out and say we’re talking about 3D disinfection. But one of them was Asgeir Sigurdsson, NYU. He’s speaking about non-instrumental technology. Well, that’s Gentle Wave. So, it’s all good. And catch these speakers, learn a lot, because 3D disinfection is the game.
So, looking through the list of presentations, was there anything else that stood out to you that you found particularly interesting that you might want to catch?
Oh yeah, help me out, what’s her name? There was a lady Asma Khan, right?
And she’s from where Ken Hargreaves is, University of San Antonio, Texas. Okay. She’s going to talk about artificial intelligence, and you and I have done a couple shows on artificial intelligence, and what she’s going to point out is that medicines have moved quickly into this realm. Dentistry is a follower but not so fast. And I think they’re going to spend primarily how with the huge databases, and we can start to look at radiographs, panorexes, CBCT, maybe even MRIs, and through data from all over the world, we can start to get better agreements. Because as you and I know, there was a lot of disagreement, even between and among operators that were looking at films. They weren’t seeing the same thing.
She’s also going to be speaking with Dr. Frank Setzer from the University of Pennsylvania.
So, I want to give him credit, too.
You know, Frank, maybe drop me a line. I Googled. I couldn’t find it. I didn’t know if you were a relative or any relationship to the famous Sam Seltzer.
This is Seltzer and Bender, and this is Setzer, I think.
But I’m not sure.
Yeah, maybe I just didn’t get the “l” in there. Well, I wanted to hear Shanon Patel. You’ve heard him on this show, and he’s speaking I think more than once, but he’s going to bring a lot of information with how to interpret and read CBCTs. Very good on the microcrack stuff, and if you liked him on our show, go catch him again and get another little educational value out of that. They’re going to talk about microcracks, and I noticed even O.A. Peters, when I read his synopsis, he’s talking about a whole new way to prepare a canal with a piece of metal, might be an elegantly machined piece of metal, but you can put names to files and it doesn’t make it true, biologic files, biological preparations.
So, we’ll hear what he says. He’s done a lot of research work. A lot of these academic guys, they’re done research their whole lives. Some of them are just recently clinicians, and so they’re excited about the files, and we’ll hear what they have to say, but I wanted to hear what he said about microcracks, because we just found out from Gustavo De-Deus, our friend down in Brazil, that there is no microcrack propagation with instrumentation. But we’re going to probably hear that there is a component.
Yes, well I –
Maybe it’s cognitive dissonance.
I personally have very intrigued by the cognitive dissonance track, and maybe we should probably do a segment in the future on that topic. It’s pretty interesting, I think.
It is. I had a hard time even getting over here today because of dissonance.
Well, it sounds like it’s going to be an exciting meeting, and I’m not really sure about the cost and registration, how that all works, but we’ll at least have a link in our Show Notes to get you to their meeting site. Also, if you need CE, it’s a great way to accumulate some CE at the meeting. So, definitely check it out.
Well to wrap it up for me, in closing, I’d just like to really thank our five guests, Isabel Mello from Dalhousie, Bettina Basrani, Toronto, Shimon Friedman, Toronto, John West, University of Washington via Tacoma, and finally, Ken Hargreaves at the University of Texas. So, you’ve got a team in there in the Final Four, so I guess you’re okay with that, right?
Yeah, so definitely check out the meeting, and thanks for our presenters.
SEGMENT 2: Q&A – Glide Path & Working Length, Part 2
Okay, so a couple of shows ago we started a Q&A on Glide Path Management and Working Length, and we only got halfway through it, so we’re going to finish it up today. So, today is Q&A, GPM and WL Part 2, to speak in letters. Okay. So, here’s the first question for you. What reagent is best to have in the canal when performing GPM and establishing working length?
Okay, that’s a question that’s really important because it is my belief if we don’t have the right reagent of the tooth, it’s led to a lot of blocks, ledges and transportations and perforations in iatrogenic events. So, when you’re working on a tooth, and let’s do another tooth, let’s pretend we can do a tooth, let’s do another tooth, I’m working on teeth. But no, if we get serious, a lot of times, you know, your canal is quite tortuous and quite narrow. And so, when colleagues, you know, make their access, and come in here, they a lot of times are thinking they should use a reagent such as sodium hypochlorite.
Think about this. When she was little and she was on the beach playing by the ocean, the Pacific Ocean, I would say, “Give me a bucket of water.” So, she’d go get a bucket of water. I’d say, “Put your fist in it.” When she put her fist, her little fist, in the little bucket of water, she would displace a lot of water. In other words, there was less water. When you fill this up brim-full and you think it’s really full, there’s almost no reagent even, you know, coronal, middle, apical third, there’s maybe a little reagent in the coronal third.
Now listen to this. Like the fist, when you put the file in you’ve displaced what little reagent was actually there. So, you’re working in a dry environment. It might be blood, purulents, things like that. So, I’ve always said, let’s use a viscous, a family of viscous chelators, and that would be Glyde, that would be one example. Another one could be Prolube. And another one could be something like R.C. Prep. Those are like the viscosity of toothpaste. I actually put it inside the pulp chamber. So, I cut my access, and you’ve got this little canal. I have my pulp chamber brim full with one of these reagents and you’ll drag it by surface tension on the flutes of the file sub-orifice level and you’ll be working in a moist environment that encourages slipping and sliding and sliding and gliding.
Okay. I think Glide is with a “y” maybe? I’m not sure.
Oh, you know what, I don’t know much. I didn’t go to school so long. Is it that? I think it’s this.
I think – okay, this is how you spell it, but I’m wondering if the product might be with a “y”, but I’m not sure.
Okay, so the next question I have for you is what position do you deem to be the optimal position for working length and why?
Okay. Let’s do a little terminology first. So, we have, you know, a canal that comes up and it terminates. We get confused, so I’m going to introduce the radiographic apex. Many dentists around the world say they work to the radiographic apex. Sometimes they do; sometimes they don’t. Schilder said when we see the file, when we see the file and the edge of the periodontal ligament, he said that would be called the “radiographic terminus,” so that would be the radiographic terminus. So, we have the radiographic apex, we have the radiographic terminus.
And the third thing is the physiologic terminus, and the RT does not always equal the PT. In other words, canals go up, they have a little constriction, and sometimes if we start this all over again, we can have a canal that will end over here like this. This is the radiographic terminus. This is the radiographic apex. And then there’s a little reverse fluting, so right here could be called the physiologic terminus. And most schools around the world teach students to work about one to two millimeters short, and that’s because we know that this constriction is back a little bit from the edge of the root.
The problem is many students have started working a little bit short. They made these box preps that we talked about earlier. This is known as a shelf and a ledge and then they drive debris into this area and now we have, I don’t know, dentin, remnants of pulp, bacteria when present, it’s unpredictable. So, Schuler said, you know what, let’s clear it all up, let’s just work to a known place. So, the known place was the radiographic terminus. Now when you work the radiographic terminus you should recognize that the file is a little bit long. The file is a little bit long. That’s analogous to in medicine when physicians do surgery, they make broad incisions to include complete enucleation. So, they want to get everything out at the expense of even a little healthy tissue.
So, working a little bit long with the smallest, most flexible files, like a 10, maybe a 15. I don’t even like that anymore, keeps this open, and you want this open. Remember, it was open before Ruddle opened the tooth, because there was a neurovascular bundle that came in here, a neurovascular bundle, and it fed in. So, if it gets blocked, it’s because of the dentist. So, keep it open. So, we have the radiographic apex, we have the radiographic terminus and then we have the PT, which is this construction, the PT.
One last thing about the PT. Nobody knows where the PT is, and I know you have electronic apex locators, but the PT – it’s supposed to be to the cemental dentinal junction. This is only available to a histologist. This is never an anatomical landmark that a clinician will ever know. Apex locators get us really close, but the thing is the cementum crawls in unevenly. It will go up one wall a few microns. It may go a few millimeters. If you look at the histology, the discrepancy from the north wall to the south wall, from the east wall to the west wall, it varies from wall to wall. So, the CDJ is not a uniform landmark perpendicular to the long axis of the canal. It’s a scalloped landmark. So, it’s unattainable.
So, Schuler said always work to the RT and with the smallest, most flexible files and then you can develop your shape coronal to that being appropriate with root protection. You want to maximize dentin, so our shapes are all smaller. But that’s a little bit about the anatomy. So, in closing, we have the radiographic apex, we have the radiographic terminus, and we have the physiologic terminus, but this is where Ruddle packs to. So, I instrument to the RT. I instrument to the RT, but I pack to the physiologic terminus and I determine this using paper points.
We talked about this in the 80’s. That part of the paper point is clean, white, and dry, is inside the canal. That part of the paper point that spots red or a clear exudate it’s beyond.
Okay. So, the next question I have for you is this. What electronic apex locator do you recommend and in general, are some better than others?
Okay, that’s a good one. Under the family of electronic apex locators, we basically have three that I will talk about. There’s probably scores of them, but the root ZX is the most frequently used apex locator in the North American market. The company is J. MORITA. And then we have one called Propex. It’s getting very, very good reviews. It’s made by Dentsply Sirona. And then we finally have Raypex, and Raypex is made by VDW. We’re going to talk about these more later because there’s ways you can get false positives and stuff, so we’ll have a whole segment on that if everybody wants.
But that’s the three that fall under here, and according to the April issue of 2018, and it was called Endodontic Practice, this was rated number one, this was number two and this was number three.
Okay, all right, so then the last question I have for you is I’ve heard you emphasize the importance of quote, “owning the glide path”. What does this mean exactly?
Well, there’s nothing to draw, so owning the glide path is really simple. A glide path should be in somebody’s mind, very clear. So, it would be, repeat after me, smooth.
So, when you have a smooth and reproducible glide path, that means you can take a ten file, you can push it with your nose, if you could get your head in their mouth, or you could just take your finger and push the file easily right to length every time, each time, all the time. If you can do that, you own the glide path. If you own the glide path, shaping follows very predictably, very efficiently, very quick. And then, of course, then we can clean the root canal systems and fill the root canal systems. So, I’ve often said, “He who owns the glide path wins the inner game of endodontics.”
Okay, thank you. That was a great Q&A. And I do think in our next season we will do a whole segment on electronic apex locators. So, stay tuned for that.
CLOSE: What Does Phyllis Think?
So, we’re going to close the season with another episode of “What Phyllis Thinks” and this segment has become a fan favorite, so everyone wants to know your opinion, mom, so are you ready to give it?
Okay. Here’s the first question for you. So, you are an avid reader. Do you prefer to read actual books that you hold in your hand or do you read electronically like on a Kindle?
I do both. I’m currently reading an old – it’s called The River Road, and it’s only in hard cover and I’m reading that one. I read about 10 books at a time, and I shift around from different ones.
Yeah, she does.
Just because I’ve always done that. So, Kindle, I had to graduate to that with our travel, because I was packing 10 hardcover books in my suitcase to last the trip, because I tend to read quite fast, and so I had to convert. Now I have probably 1,000 books on Kindle, and if I had bought 1,000 more books for our house, it would have been a problem.
Yeah, that’s true actually because there are a lot of books in your house.
There are already.
What is the latest book you have read, and do you recommend it? I think you were just saying what the latest book you were reading, one of them.
Yes, that’s one of them, but the main one I’m reading is called The Huguenot Chronicles, and it takes place in 1685 in France, and it was the French persecution of the Christians. They wanted everybody to be Catholics, and so, basically you either died or fled the country, and it’s fascinating, and it was a series of three books. So, I’m almost finished with that one.
Is it like historical fiction?
Yes, historical fiction is my most favorite genre. I love history, but to sit down and read a history book is not me. I need to have the story that kind of goes with it. So, I read a lot of historical fiction.
Okay. What is your favorite book and/or author of all time?
The one, and this is an odd choice, but the one that sticks out in my mind, the very most is Shogun by James Clavell. I read it when we lived in Boston, and I remember sitting in the rocking chair by the window looking out at the woods behind the apartment and it stuck in my head forever.
Okay. That’s surprising. I thought for sure you were going to say Stephen King.
Well, he’s right up there. I read all of his, too.
I mean I read a lot of Stephen King books that I just took from you, but you own them. Okay, what is your favorite genre of music and how is it that it is your favorite?
Country music. And it started with my mom. My dad didn’t allow music in the house. He didn’t allow a lot of things in the house when I was growing up, but when he was gone on a Saturday night, my mom would listen to the Grand Ole Opry. And I just absolutely fell in love with it from an early age. And she also made popcorn and we had ice cream, which he also didn’t allow. So, that stuck in my head.
Okay. And what musical instruments do you play?
Past tense, the piano, the French horn, and a guitar.
I just haven’t kept it up.
Now I’ve seen you play guitar. I’ve never seen you play the French horn.
That was band.
I was in band through high school, and then it went by the wayside.
Were you in a band?
I was, in the high school band.
So, you marched with your French horn?
No, no marching. These were band concert things. The marching bands were different.
Okay. Who is your favorite musician of all time? Maybe pick one man and one woman.
For male, Merle Haggard, and female, Dolly Parton.
Okay, I thought you were going to say Joan Baez.
Oh no, she’s right up there too. Different genre, but yes, I wanted to be Joan Baez.
What is your favorite genre of film?
It’s a toss up between romances and spy movies. I really like a good spy movie, but romances are just relaxing. I enjoy those.
You love to just sit back and watch a good romance movie with Dad?
And I like the Hallmark Channel. It all ends happy every single time.
Okay. Your favorite movie of all time?
Doctor Zhivago. For some reason has always, the feeling of that movie, and the love story, it’s always stuck in my head.
Okay, I think probably I would have thought you might say something like The Thomas Crown Affair, the original one with Faye Dunaway or something.
That’s a good one too, yeah. Those were all good. We saw tons of movies back in that era, but Doctor Zhivago was probably my favorite.
Okay. Who is your favorite actor and your favorite actress?
Favorite actor, Sean Connery. Actress, Bette Davis.
Yeah, she’s good.
It’s just hard to beat Bette Davis. Lucille Ball comes close. I really liked Bette Davis.
Okay. Do you ever watch documentaries or read nonfiction, and if so, is there one movie or book you would recommend?
For documentaries, I love any of the musician documentaries, like the history of the Go-Go’s or the Bee Gees or Gordon Lightfoot. I’ve been, you know, since we got the new fancy TV system, I’ve been able to watch a lot of those things, and they’re fascinating to me, how hard and how long they worked to get to where they got. That’s fascinating. Cause I know how hard we worked, and I relate to that. So, I like that.
And what was the other question? Oh, nonfiction. My favorite currently – I don’t read a lot of nonfiction, but Bill O’Reilly has done the killing series, Killing Kennedy, Killing Lincoln. There’s a new one coming out, Killing the Mob.
Fascinating. Fascinating, historical book. They’re not novels at all. It’s all history. And he has done an excellent job on those. I highly recommend anybody to read those, very informative.
Okay. For the documentaries, I actually just walked by our TV and the Go-Go’s one was on, so that must be recently out.
That was really interesting for me.
And Dad has mentioned several times in our Zoom meetings about the Bee Gee documentary, so I know Dad wouldn’t have chosen that on his own. I know you must have had it on, and he saw it.
Well, we both like that music, and there just was a lot of information that we didn’t know. It’s really good.
Okay. Now the last question I have for you relates to Dad. And Dad can tell you if you’re correct or not. What do you think is Dad’s favorite book?
I actually have a prop I brought.
Oh my. I’m going to be outed. Peter Pan?
Peter Pan, yes, how did you guess?
John Eagle? Oh my, yeah, I liked that book a lot.
Snow Treasure. It’s the first book I think he ever read. Maybe is the only – second book he’s ever read.
No, it’s not. But actually, that is the only book of this size that he sat and read to me and Lori when we were little.
Yeah, I had to buy a new copy because I have no idea where the old one is in the house. There’s too many books.
Yeah, that is a good book.
That is a fabulous book, probably the best in the world.
Do you want to tell about it a little bit?
Yeah, tell what it’s about.
Well, it happened in Norway and it was the start of World War II and so the German paratroopers were flying over, and they dropped out of the sky in the middle of the night, and they landed in the forest, and they started taking over the country. And they needed to get the gold out of Norway, so anyway they used little kids and sleds to sleigh up from way up high in the mountains and get that gold down to the harbor where Uncle Victor could take it to the United States and save the Treasury.
That’s where I learned about fiords. Like cause I didn’t know – I remember you lecturing us about fiords and the geography of Norway. And then, so what do you think is Dad’s favorite movie?
The very first movie we went to together was Battle of the Bulge, and I think we saw every single war movie that came out after that. He loved war movies, and that was back in the 60’s and 70’s. And spy movies. We saw a lot of spy movies together. So, one particular movie I would say Battle of the Bulge we remember the most together, but I don’t have another title that would be his favorite.
He probably does, I would say, maybe James Bond movies.
Yes, we saw all of those.
Just in general. And then what do you think is Dad’s favorite song?
Well, he told me he wants the Beatles played at his funeral, so I put Beatles, because we both liked the Beatles music up until the White album, which wasn’t one of our favorites. But up until then, it was Beatles.
But we did some of our best work at 1:00 and 2:00 in the morning listening to the White album.
Well, that was kind of you and Rob and your friends. That wasn’t really me. I was trying to sleep.
Okay. All right, well thank you, Mom, for coming on the show again and giving us your opinion, and thanks, Dad.
Thanks for everything you do, and glad we could close out the season with you.
The content presented in this show is made available in an effort to share opinions and information. Note the opinions expressed by Dr. Cliff Ruddle are his opinions only and are based on over 40 years of endodontic practice and product development, direct personal observation, fellow colleague reports, and/or information gathered from online sources. Any opinions expressed by the hosts and/or guests reflect their opinions and are not necessarily the views of The Ruddle Show. While we have taken every precaution to ensure that the content of this material is both current and accurate, errors can occur. The Ruddle Show, Advanced Endodontics, and its hosts/guests assume no responsibility or liability for any errors or omissions. Any reproduction of show content is strictly forbidden.
DISCLOSURE: Please note that Dr. Ruddle has received royalties on and/or continues to receive royalties on those products he has designed and developed. A complete listing of those products may be found at www.endoruddle.com/inventions.
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