There are many factors that serve to influence which endodontic mechanical file system or hybrid technique is selected to prepare any given canal. Altruistically, the most important factor should be...
WaveOne Gold Special Guest Presentation by Dr. Julian Webber
This show opens with a brief commentary on a 2022 ranking of the world’s best dental schools. Then we have a special guest presentation on WaveOne Gold, given by one of its inventors from the UK: London-based endodontist, Dr. Julian Webber. Afterward, Ruddle and Lisette follow up at the desk with a post-presentation discussion. The show concludes with another Influencers segment, this time Ruddle and Lisette will isolate a single, powerful sports moment that has forever impacted their lives.
Show Content & Timecodes01:00 - INTRO: World’s Best Dental Schools 06:42 - SEGMENT 1: WaveOne Gold Presentation by Dr. Julian Webber 46:30 - SEGMENT 2: Post-Presentation Discussion 54:40 - CLOSE: Influencers – Sports Moment
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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.
…The original is still the best. And it’s not just me that thinks this. This young lady, she thinks this as well. And she’s working with WaveOne Gold on a nice, sunny day in Taiwan…
INTRO: World's Best Dental Schools
Welcome to “The Ruddle Show.” I’m Lisette, and this is my dad, Cliff Ruddle.
Welcome! We’re glad to have you back for the second show. And I’m glad you told two or three of your friends, because our attendance is bumping up.
Okay [laughs]. Well, what we have for you today is, we wanted to talk about an article from Dentistry Today News. In June of this year, they published the 2022 QS World University rankings of the best dental schools, and although 70 schools were ranked, Dentistry Today News published the top 20. And you might be wondering, as we did, what were the main criteria that were taken into consideration to develop the list? Well, it’s largely based on academic reputation, faculty reputation, and research impact. So, looking at the list, is there anything that you wanted to point out as a highlight, or the – give us your opinion?
Well, just quickly, and you did a good job of it, but a lot of the criteria has to do with postgraduate work at the dental school. So, if you’re a dental student, applying to dental school, that would be a little different than if you’re out, and now you wanna go into public health, endo, perio, or any of the disciplines, or just study how to be a good researcher. So, they rated Karolinska in Sweden as the best, number one, and it is a powerhouse in fabulous research. And then, of course, they had University of Hong Kong and ACTA. That’s in Amsterdam.
Anyway, [Dr. Rik] Van Mill comes to mind. He probably travels over by bike and gives a few classes. Anyway, that was the top three. And then, in the United State, so the North American people on this show don’t feel left out, there were five. They weren’t in the top 5, necessarily, but they were in the top 20.
And if you start on the East Coast, if you’re overseas and you don’t know our country, East Coast, okay. So, Boston, Harvard -- just drive two hours south – Manhattan, NYU – New York University – and keep on driving down the coast, and you’ll get to Chapel Hill, North Carolina – UNC, University of North Carolina. University of Michigan in Ann Arbor was the fourth. And then, if you go clear out to the West Coast, you can go to San Francisco, University of California, San Francisco. So, those were the five. And what was kind of interesting as we were going over that list of 70, I realized probably about 85 or 90 percent of those schools, I’ve given courses at or done some kind of a CE class or just worked with the students. So, it was kinda humbling and surprising.
Well, that’s pretty neat, actually. All right. Well, this list is apparently consulted millions of times per year for assistance in making various decisions. But it really doesn’t tell the whole story. The academic reputation part, well, that -- and the faculty reputation part, that – well, the reputation is based on like people’s opinions, and that’s from what they hear and believe. So, that can be a little bit not – what’s the word I’m looking for? Not entirely reliable knowledge. And then, the research impact has a lot to do with the amount of times a study is cited. So, that can be deceptive as well. Do you remember that show we did back in Season 3? We did a segment on choosing a dental school. What --
-- were our criteria?
-- well, yeah. Number one for me was, where do you want to live? Remember, you might be single, so you can live anywhere you want to, if your parents cut the tether and let you. You also could be married and have a family, and that could have considerations with school for the – your young children, and maybe, if it’s the man, where they might work, or the woman, where she might work outside of dentistry. So, living is a big deal, because you’re gonna live there for four years, and you gotta make it work.
And then, the second thing I mentioned, in no particular order, was cost. Some of these universities have gotten to be extremely expensive, and I think it’s important to bear out that it’s led to a future that’s led to more corporate dentistry, because there’s less people going into private practice. And that’s because of the cost the student incurs going through four years.
Okay. And then, maybe like if there’s someone on the staff there that you really wanna work with.
If you’re a dental student, you probably don’t know the faculty. You might know one or two, because somebody told you about them, but you really don’t people in the school, is how I would judge it from my own experience. You meet a lot of people, so they should be friendly. They should act like they care and that they’re there for you, versus [laughs] you’re another clink of the tuition counter, and the dials spin, and they got 60,000! No, you want to make sure that you have a family feel, I would think, conducive for safe and security and learning.
And then, I think technology, as you walk around, what are you looking at? What are you seeing? You probably don’t know if you’re a dental – a dental student. But you might have asked a few questions. Kids today zoom around a lot on the internet, and they know a lot before they actually arrive, like our patients. So, maybe they do know what to ask for. But most dental students don’t know the questions, really.
Okay. Well, what you were saying about cost, yeah. Everything is seeming pretty expensive to me today, and I don’t know what kind of financial aid programs these universities offer. But just to close out, looking at the top 20 list, I noticed that 3 of the top 20 schools were located in the UK. And it so happens that we have a guest presentation today from a UK endodontist. So, maybe let’s get right on with the show.
And he’s not so bad, and he might have gone to a good school or no school, but he ended up at the right place.
Okay [laughs]. [Music coming up]
SEGMENT 1: WaveOne Gold Presentation by Dr. Julian Webber
Okay. So, today we have a guest presentation, which you will see momentarily. It is by Dr. Julian Webber, who is an endodontist from London, England, in the UK. And you might remember, we identified Dr. Webber back in Season 2 as a coinventor of WaveOne. So, that might give you a little clue as to what the presentation’s about. But first, before we get to that, why don’t you tell us a little bit about how you know Dr. Webber personally, and also reveal the topic of the presentation.
Wow, big assignment.
Wonder if I can rise up to the occasion. Julian Webber. We might’ve known each other professionally longer than – or before 1994. But 1994, for sure, was the first time I recall meeting him, and that was in Cambridge, England. The British Endodontic Society was having their annual meeting there, and I was lecturing on surgery and retreatment, but the big thing I was really talking about was microscopes and how they’re utilized and their advantages in those procedurals – procedures. Procedural procedures, very big procedures.
-- we met, and the meeting was, I recall, two or three days. And at the end of our time in Cambridge, England, we drove by car to London, and Julian’s group wanted me to come to the office with the Global rep, that’s a microscope rep. And they had a big practice in Central London, and we met there, and Kristoff was one of the senior partners at that time. And I just recall, they ordered, I don’t know, 9, 10 microscopes right on the spot. And I was thrilled the whole plane ride home because I recall these guys are really gonna take what they heard in the lecture, and they’re gonna integrate it and implement it, and they’re gonna be leaders.
And this guy – this guy is a big leader, worldwide. So, then, there were dinners. We – Phyllis and I have had dinner with Cara. She’s a lovely, lovely woman.
That’s his wife?
That’s his wife. And then, they have kids that have – you know, I knew them a little bit. They’re grown up now. Lauren’s very successful in her career. His son I believe might be [Matthew], and he’s a cardiologist, for sure. And that’s important. And then, they’ve had grandchildren. So, they have quite a tribe, a growing group. I’ve had dinner at his house, different years, different trips. He has a beautiful home, and I remember one time I was a little – we were a little late for dinner because this guy was coming, and he was the guy that was bringing dinner. He was bringing pheasants from the West of London. So, anyway, out there in the west, I guess, it’s beautiful.
So, anyway, lots of experiences, lots of memories from all over the world, dinners, and lectures together and things. So, I’m really excited, and today he is going to give us a good insight into WaveOne Gold.
Okay. So, just to tell you a little bit about Dr. Webber professionally, and I’m only gonna tell you a little bit, some of the highlights, because --
Stay to the short CV, because he has an --
-- he’s done a lot.
-- he has a – the little one, the moderate one. He has the one you pull like a paper towel. It’s reams.
[laughs] Okay. Well, he is an endodontist who has held teaching positions both at Guys Hospital and Eastman Dental Schools, while maintaining a private practice in Central London, since 1978. In 2002, he opened the Harley Street Centre for Endodontics, which is a state-of-the-art clinical teaching facility. He has published in numerous endodontic textbooks and journals, lectured extensively worldwide, and he has also been – played an important role in the development of the WaveOne endodontic instruments. Also, he is past President of the British Endodontic Society and a key opinion leader. So, we are very honored to have the opportunity today to show you the presentation. Let’s see it.
[Dr. Julian Webber Presentation]
Hello, viewers of “The Ruddle Show.” I’m Julian Webber, and I bring you greetings from London, England, and with grateful thanks to you, Cliff, for airing my prerecorded presentation on WaveOne Gold on your show today. Cliff and I have known each other for many years, since the mid-1980s, in fact, when you, Cliff, presented I believe at a special meeting to the British Endodontic Society, in Cambridge. And since then, we’ve traveled together to many meetings, given lectures and courses together, and we have now designed together, as I will explain.
So, Cliff and I are on the WaveOne Gold Team, and we worked for many years with our dear colleagues, Sergio Kuttler, Willy Pertot, in developing what we considered to be one of the best file systems around. Frequent trips to the factory in Ballaigues, Switzerland, to the manufacturing plant, where we looked, tested prototypes, where we discussed designs with R&D. And finally, we came up with a product which we consider as probably one of the best file systems on the market. WaveOne Gold is a very simple system, a super loose number 10 hand file followed by a WaveOne Gold Glider to expand the glide path, and then a WaveOne Gold primary to fully shape the canal. One single file in around 80 percent of cases to produce a perfect shape for 3-dimensional irrigation and disinfection and then, ultimately, obturation of the root canal system.
Now, when our team was looking at designing WaveOne Gold, we had a distinct target group in mind, general dentists using stainless steel hand files for shaping canals, dentists who were using too many shaping files, both hand and rotary, when only one shaping file was really needed, dentists breaking files, breaking rotary files and fearful of further breakages, those colleagues using alternative reciprocating files and looking to change to a less aggressive file, colleagues using hybrid techniques, different designs, different companies -- why mix, only one, really, should do -- and basically, spending too much time preparing canals.
I think the literature is pretty unequivocal when it comes to the question of fracture and breakage of files. And there is no doubt that the reciprocation technique, especially with WaveOne Gold, is safe and leads to many fewer broken instruments, a great concern of general dentists, a great concern for dentists wanting to get into mechanical endodontics for the first time. And believe me, there are a lot of dentists still out there who are still hand users. They want a safe technique. WaveOne Gold and its reciprocating concept is ideal for them.
And it seems, as well, than when you take novice operators, and you give them hand instruments or nickel-titanium instruments, or rotary instruments, or reciprocating instruments, the majority of them seem to opt for reciprocating files instead of a continuously rotating system.
Just a brief bit of background for you. I work at the Harley Street Centre for Endodontics in Central London. It’s in the area of London known as the West End. The Harley Street area is synonymous with dental excellence. It’s around a square mile of many old, Georgian buildings from the late 1700s, early 1800s, that have been converted into medical and dental establishments. And we are world renowned as a center of excellence for people who fly in all over for their medical and dental treatment, thankfully as well, including endodontics. [clears throat] Excuse me.
We have three operatories at the Harley Street Centre for Endodontics. These are all rear entry, with steri-walls to collect instrument trays and return instrument – sterile instrument trays from the sterilized – sterilization areas behind, into the operatory. We use Global and Zeiss microscopes. We have ASI carts from Denver, Colorado, which are customizable, which means we can put onto them anything we want, however we want, perfect for endodontics. We use Gary Carr’s TDO Software from San Diego, California. We use DEXIS Imaging, and we have access to Morita CBCT for those cases where it is needed.
But of course, COVID was a real challenge, and to a certain extent, remains so, because we had very strict operating protocols in the UK to adhere to, especially in the early days of the pandemic. And indeed, we were actually closed from March 2020 through to the end of June 2020. Every dental practice in the UK was closed. So, when we came back, we invested heavily in equipment to protect our patients, to protect ourselves. We use air purifiers. This is the IQAir, which is a wonderful device with this FlexVac, as you can see. The FlexVac goes close up against the patient face to take away any aerosol, HyperHEPA filters, which are probably the largest of their type in the air purifier range.
We also invested in shields for the surgeon and shields for the assistant. We work behind these beautiful plastic shields developed by Micah Nuzum, an endodontist in Ohio, who has set up this company, Shieldont. And he has really done a wonderful job for the profession, protecting both clinicians and assistant, as you can see here. So, when we came back from our enforced lockdown, there were many endodontic emergencies to see, symptomatic irreversible pulpitis, symptomatic apical periodontitis, and a combination of symptomatic irreversible pulpitis and apical periodontitis.
And so, seeing so many emergencies, we had to work quick, and we had to get the pulp out of the tooth or what remained of the pulp. It’s impossible to predict the extent of pulpal inflammation, and the only predictable approach to irreversible pulpitis is complete extirpation. So, we needed a quick shaping technique. And it was then that I realized, with WaveOne Gold, how impressive it was for these situations, because it gave me the opportunity to shape that canal really quickly. Shaping, of course, does not mean that we can then go in straight away and obturate. But a quick shaping technique provides us with the additional time to think about irrigation, carry out irrigation, procedures, and more importantly, to activate our irrigant.
So, file shape, as we well know, the motion of reciprocation, which we’ll look at later, is conducive to moving that file down the canal rapidly. This is a WaveOne Gold quickly and easily going to length, two to three passes, producing the perfect shape, the perfect shape, which is ideal for irrigant activation. And of course, if irrigants clean, we need to also remind ourselves that complete irrigation is only effective at the end of the shaping procedure. So, the sooner we can get to a completely shaped canal, the sooner we can three-dimensionally disinfect and irrigate the root canal system, ready for 3D obturation of the root canal system itself.
When we use WaveOne Gold, we use it in a gentle stroking motion. There’s very light pressure. There’s only passive penetration, about two- to five-millimeter cycles, as we move the instrument into the canal. We do not need to push on it. If there’s ever any resistance, we take the instrument out, we clean the flutes, we irrigate, we recapitulate, regulate, stir debris into solution. We reirrigate again, replacing dirty irrigant with clean irrigant. And we continue with two to three passes, until we get to working length. And if you’re a brusher, you can brush to eliminate restrictive coronal dentin, which helps to move the file even better down the canal.
So, irrigant activation at the end of the shaping procedure. We have this time to do it because we rapidly shaped the canal with WaveOne Gold. I really don’t know a quicker instrument for shaping the canal out there. EDTA, sodium hypochlorite, together, alternatively, one after the other, the whole procedure with the hypochlorite, finish with the EDTA, read the literature and make your own personal decision. But active your irrigant. And with WaveOne Gold and with the quick reciprocation shaping technique, you have the opportunity to do that. Spend time on it.
So, when it comes to shaping root canals, we have various philosophies, of course. We have the less tapered preparation philosophy, with a large apical stop. And we have dentin preservation concepts, philosophies, with minimal invasiveness. I’m not gonna get into a discussion on that for this presentation, but to tell you that the concept for shaping a canal is, for me and my design group, a tapered preparation objective, where the foramen is as small as is practical. This is the philosophy that guided us to the design, a philosophy based on Schilder’s Mechanical Shaping Objectives, to produce a tapering preparation.
So, we have a tapered file. The cross-sectional diameter should be narrower at every point. Apically, the preparation should flow with the shape of the original canal. The foramen position should be maintained, and the foramen should be kept as small as is practical, coincident with the natural size of the foramen as it exists in the mouth. He did not say as small as is possible. And using these objectives, we have an evidence-based objective guideline to help us when we design root canal instruments. And this was the basis of the WaveOne Gold design.
Keeping the foramen as small as is practical means understanding and a knowledge of the commonly sized foramen that we have in the dentition, somewhere roughly between 20 to 40, 45. So, if we have a range of root canal instruments with those tip diameters, then we can successfully produce a tapered preparation to that foramen size, keeping the foramen as small as is practical, as Dr. Schilder told us. So, WaveOne Gold is available in 4 sizes, a 20 tip, a 25 tip, a 35 tip, and a 45 tip. These tip sizes are respectively for the small is a seven percent, for the primary is a seven percent, for the medium is a six percent, and for the large is a five percent, a tapered preparation objective with various tip diameters corresponding to the natural foraminal sizes.
It may be worth quickly looking at a history of single file reciprocation and how it came about, bearing in mind that reciprocation, the concept of a backwards and forwards movement, has been with us for quite some time. But in the 1990s, Professor Pierre Machtou of Paris, France, identified the benefits of unequal bidirectional angles or reciprocation, and this was subsequently verified by himself, Cliff Ruddle, and John West. In 2008, Ghassan Yared, one of Pierre’s students in Paris, wrote his seminal F2 ProTaper article describing 135-degree forward movement, followed by a 45-degree backward movement. So, the instrument was moving in a forward direction, and he called this single file reciprocation.
In 2010, Dentsply Sirona’s VDW company brought RECIPROC to the market. Ghassan Yared was very much involved in this design. In 2011, WaveOne itself came to market. This was the design of Sergio, Pierre, Willy, Cliff, myself, and John West. In 2015, we had WaveOne Gold, after frequent visits to the factory, and the hard work from the R&D Team, Sergio, Willy, myself, and Cliff. In 2016, RECIPROC itself went blue, RECIPROC blue, again, working – VDW working closely with Ghassan Yared. In 2017, we developed a reciprocating glide path file, the WaveOne Gold Glider, and in 2017, later, Ghassan Yared worked with VDW on the R-Pilot.
Single file reciprocation is a specific form of reciprocation, where the backwards and forwards movements are not equidistant, versus symmetrical oscillations, where the file is moving backwards and forwards, but there’s no rotational effect, because the movement is equal. Asymmetric oscillations mean that eventually the file will complete a complete rotation. And for this, you would need a dedicated motor. Dentsply Sirona ProMark, they have products specifically designed for this. So, the movement for single file reciprocation is 150 degrees counterclockwise followed by a 30 degrees clockwise movement. This equals 120 degrees, or the fracture limit, as Ghassan Yared named it.
The asymmetric oscillations complete a full circle of 360 degrees after 3 cycles of reciprocation. Now, this is very relevant to cyclic fatigue, as it is relevant to the question of torsional failure, because the fracture limit represents the effect on torsional failure, because before the instrument has a chance to grip into the wall of the canal and bind, the motor brings it back the other way. And as far as reciprocation is concerned, reciprocation being – sorry, I apologize – as far as cyclic fatigue is concerned, being a manifestation of the number of rotations to failure, the number of cycles to failure, while our instruments are moving three times less than an instrument similarly in full rotation, 150 backwards and 30 degrees forwards, 300 in rpm. These – this movement and this speed is built into the motor.
So here are some of my interesting broken file cases. Some are mine, some are not mine. I’m not going to tell you which ones, because we all break instruments. But they do break because of cyclic fatigue, and they break because of torsional failure. And breaking instruments in continuous rotation is certainly a concern of colleagues. When it comes to torsional failure, the tip of the instrument binds in the canal, the file keeps on turning, the elastic limit is exceeded, and the instrument deforms until it fractures. But this simply can’t happen with the backwards and forwards movement of WaveOne Gold, where the backwards movement is greater than the forwards movement. And so, with this movement, we have gone a long way to reducing the concern about torsional failure.
At the same time, cyclic fatigue, which represents the stretching and compression forces of these files as they’re rotating into the canal, this is reduced up to three times, because each cycle represents a third of one complete rotation. So, cyclic fatigue has been reduced as well in reciprocating motion. But it is worthwhile just quickly looking at cyclic fatigue, because cyclic fatigue, for some reason, has become the major advertising method by all of the companies to suggest that one file is better than another.
This is a simple cyclic fatigue machine used in the laboratory. A 45-, 60-, or 90-degree curvature, just rotate the file, just reciprocate the file, and wait to see how long it takes to break. Five minutes, nine seconds, for this WaveOne Gold file. Well, that’s five minutes, nine seconds. Who on earth is inside a canal for five minute and nine seconds? And if you are in a canal for five minute, nine seconds, well, you certainly deserve to break the file in the first place! But some of these companies bash us over the head and say, well, our file is better, because it’s got a much improved cyclic fatigue life. And it’s half the cost, with twice the performance.
But performance of a file is not just all about cyclic fatigue! Are you really inside the canal that long? There’s just too much emphasis on cyclic fatigue! When we look at file design, it’s to do with performance and functionality. And the ideal file is a balance between cyclic fatigue and torque strength and between flexibility and cutting efficiency. It cannot be just one of those factors. So, I think we need to move away from cyclic fatigue, because there’s no real reality there, in my mind. WaveOne Gold consists of the glider and the shaping file, to shape the canal. In nearly 80 percent of the cases, we can get by with this WaveOne Gold primary file, 25 at the tip, and a 7-percent taper to produce a perfect shape.
WaveOne Gold is a parallelogram, cross-sectional shape, variable taper along the length of the file. It’s nickel-titanium wire that has been heat treated to give it its gold appearance. The plastic on the handle will expand if the instrument is put into a sterilizer, and we did this so that the instruments cannot be reused all the time, not just a cynical ploy, but however much we increase the cyclic fatigue strength, and however we much – we improve the torsional strength of the instrument with the design and the heat treatment, we can still overuse it. We don’t want people to overuse it. And as far as the UK and many other places in Europe are concerned, it is the gold standard in infection control to make it truly single use.
The WaveOne Gold Glider is similarly designed. It’s one size. It’s a 15 at its tip. It has a variable and increasing taper, from two to six percent, similar ABS ring that will expand, parallelogram cross section, same reciprocating movement as the shaping file itself. Produces a beautiful hole, a beautiful roadmap upon which the shaping file can go down for the perfect final shape. Small has a seven-percent tip, primary has a seven-percent tip, medium six, large five. It’s a variable but reducing taper along the length of the canal, so that by the time we get to the coronal extent of the file, we have a quite small diameter, small enough to fulfill the concept of minimal invasiveness, but enough size to produce a shape that we can irrigate properly and then, ultimately, fill properly.
The parallelogram-shaped cross-section has alternating one and two points of contact along the length of the file, one point of contact, two points of contact. The parallelogram cross-section gives you an 85-degree acute cutting angle. This enables you to remove debris in an apical-to-coronal direction. And reducing the number of contact points will obviously improve resistance to torsional failure, greater space, as I’ve said, for debris removal. There’s little to no screwing-in effect, and cutting efficiency is greatly improved. An ogival, semi-active, modified tip to improve penetration. This reduces the chance for any ledging.
When it comes to the heat treatment of WaveOne Gold, well, we are basically converting an austenitic instrument, which is the standard form of nickel-titanium, into a mixed martensitic instrument. It’s a post-manufacturing heat treatment process providing also greater resistance to cyclic fatigue, improving flexibility, ideal for curved canals, following canal curvature without straightening or less transportation. So, the blank of nickel-titanium is machined into its design, and then it’s placed into the oven and heat treated. Gives it its gold appearance, and the file is ready to go.
Now when it comes to the gold appearance, depending upon what sort of temperatures you heat these files to, they can either come out with a blue appearance, they can be pink, they can be purple. And all of these factors together changing the austenite to martensite is producing an instrument where the austenitic finish temperature is higher than body temperature, and in this mixed martensitic state, the instrument is plastic, flexible, and with controlled memory, which means if you bend it, a small force will keep it bent, as compared to regular nickel-titanium, which will always return to its original shape.
So, heat treated instruments are where all the companies are going at this stage, and gold NiTi for WaveOne Gold is no different. When it comes to the clinical steps, simple glide path to a super loose number 10, followed by the WaveOne Gold Glider to expand the glide path. And then, we can shape the canals in most cases with the primary, 25 at the tip, 7-percent taper to produce the final shape, just one file. A secured glide path allows any shaping file to pass along its root. And if there’s no glide path, I have to say to you, no rotary, please, no reciprocation. Don’t do it! It will prevent ledges, blockages, and perforations.
A secured glide path guides the tip of the NiTi file safely to length, reducing the risk of instrument fracture from torsion and fatigue. And the final preparation is more centered, with more favorable amounts of dentin removal, and overall, will enable you to shape the canal quickly. I use a viscous chelator with a number 10 hand file, EDTA, establish my working length, confirm patency, verify the glide path. Thank you, Cliff. You taught me this. And then, we go in with the WaveOne Gold Glider. We never push it, we never peck it, we never force it. Passive and progressive advancement along the secured canal. You don’t have to push, because the instrument only can go in one direction, and that’s down the canal. A beautifully and rapidly expanded glide path, ready for the shaping file that follows.
You’re gonna love these instruments! You really are gonna love these instruments! They just fall into the canal to length. So, I take a number 10 file, confirm with the radiograph to length, or an apex locator, preferably. I take my WaveOne Gold Glider into length. I irrigate, recapitulate, and irrigate. I go back in with the WaveOne Gold primary, approximately two-thirds down the canal, irrigate, recapitulate, irrigate. Take the WaveOne Gold primary all the way to length, gauge with the hand file, confirm it’s the right size. If I need a larger file, which may sometimes happen, I might go to a WaveOne Gold medium. And if I need an even larger file, I could go to the 45.
But when you get good with this technique, you know straight away that if you put a 15 or a 20 straight into the canal, and it easily goes to length, well, you could start with the medium, or you could even start with the large. You may not even need the Glider, of course. Here’s another situation. 10 goes to length. Glider goes to length. Irrigate, recapitulate, irrigate, confirm that we can get to length. WaveOne Gold primary, approximately two-thirds, confirm that we can get to length. Irrigate, recapitulate, irrigate.
Go back in with the WaveOne Gold primary, and it won’t go! It’s just too tight. I’m not gonna force it. I’m not gonna push it. I’m not gonna peck it. I’m gonna drop down a file, a bridge file, the WaveOne Gold small. That just provides me with a little bit of extra room, and then I can go back on with my WaveOne Gold primary, gauge, but I’m usually there at this stage. So, don’t be afraid to use two files. Even though it’s a single file technique, occasionally, 15 percent, 20 percent of cases, you might need that extra file.
Now, the WaveOne Gold System, with matching paper points, matching gutta-percha points, and matching carrier-based devices like Thermafil. This new generation of gutta-percha is injection molded for a better fit. It’s a micronized formula, where the heat transfer is about four millimeters ahead of the file, and they perfectly match the files that came beforehand. Of course, we have got to call the WaveOne Gold as well. When it comes to warm vertical compaction, there’s a lot of products out there. I like the coldest devices. Please don’t ask me which I think is the best one. They’re all pretty good. Use what you enjoy.
AH Plus sealer in Europe, it’s a resin-based sealer, good old pulp canal sealer that was one of Schilder’s favorites and still used by many endodontic purists today. And now, Dentsply Sirona has their own AH Plus Bioceramic Sealer, which could be used with a single-point technique. But perhaps, Cliff, you’ve been into this already. That’s a story for another day. So, WaveOne Gold. Curved canals, shaped canals, shaped to perfection, I would consider, ideal for disinfection, and ideal for obturation of the root canal system.
Long and curved, and when these cases at the back of the mouth are difficult to get to, especially in the upper, we can prebend these files to improve our posterior access, place then the file tip into the canal. We can prebend the file because it has no shape memory. So, we bend it, and it stays bent. Ideal, then, to place into the back of the mouth, start the motor. Sometimes when we’ve even got more difficult access, we can take the file out, use the file itself, place it into the canal, without the hand piece, and then, manipulate the hand piece to fit the file, and start the motor. And this is ideal when we have a ledge to bypass because we can hand place that file into the canal beyond the ledge and put the motor on it.
High difficulty long, curved, narrow canals. High difficulty long, double curved and narrow canals. High difficulty mid-root concavity. Four canals, shaped, cleaned, and the root canal system three-dimensionally obturated. Long, double curved canals. There’s not a lot you can’t do with WaveOne Gold. In fact, there’s nothing you can’t do with WaveOne Gold. There’s been about 250-plus articles on reciprocation and WaveOne Gold in the literature, WaveOne and WaveOne Gold.
The mechanical properties of reciprocating files are better than rotary files. Reciprocating files are more resistant to fracture than rotary files. The shaping ability of reciprocating files is as good as rotary. Reciprocating files facilitate shaping to optimize irrigation as well as rotary. Postoperative pain with reciprocation is equal to or less than rotary. Reciprocating files can be used for gutta-percha removal. And reciprocating files do not induce dentin cracks, a myth based on poor methodology.
But you know what? Everybody’s jumping on the bandwagon. But let’s keep calm. Reciprocating files seem to be everywhere now. Everybody wants them! Everybody wants them. But as far as I’m concerned, the original is still the best. And it’s not just me that thinks this. This young lady, she thinks this as well. [Video playing, woman speaking in foreign language] And she’s working with WaveOne Gold on a nice, sunny day in Taiwan, when I did one of my courses.
So, finally, I don’t think there’s anything better than WaveOne Gold. This endodontist of the future doesn’t, either. She seems to know. I hope you do now. So, Cliff, viewers, I hope you enjoyed this presentation, and I look forward to being with you again soon.
SEGMENT 2: Post-Presentation Discussion
Well, that was a great presentation. Dr. Webber is a very clear and organized speaker, and I thought the visuals were quite varied and interesting. He held my attention throughout, and I’m not even a dentist. What did you think?
I think he gave an excellent program. He’s always organized. He’s always very clear. He has good ways of taking a complex subject and making it understandable, and I think at the end of the presentation every colleague could go home and do it. So, that’s what I think. I think he did great.
I also like his accent [laughs]. So, last week, we talked about the ProTaper file system, and this week, Dr. Webber presented on the WaveOne Gold file system. And you happen to be an inventor of both systems. So, I’m sure our viewers are now wondering which system you prefer? So, we have been emphasizing simplicity and streamlining on this show, but maybe we’re inadvertently overcomplicating things right now by seeming to embrace both systems.
You know, that was a very important question that I have been continuously asked. So, it makes it even more important as we get further along in time, which system? First of all, you’re not gonna use both systems. How about that for an answer?
I mean, if you really wanna complicate your life and not keep it simple, stupid, then you’re gonna have both WaveOne, okay, the – any of the iterations, even up to Gold, and you’re gonna have any of the ProTaper iterations. You’ll mix and match. No! You’re gonna use one or the other. But it’s important to note that both were based on research, both were based on what kind of mechanics do we need to achieve routinely the biological objectives. We need to have a shape that anybody could clean and fill. And that’s important in these days, because a lot of times, the files are getting so skinny, we don’t get the deep shape concept that we need to exchange our reagents into all aspects of the root canal system.
So, based on Schilderian principles, based on can we clean and shape and fill, basically, we had a lot of research to support this. And he’ll get – as he went into beautifully all the mechanics and how the file works and designs -- I won’t get into that -- but the systems are very, very good, and it’s up to the colleague to decide what’s best for them. We’re not gonna try to make a bunch of little Julian Webbers and Cliff Ruddles. We’re trying to make each colleague be all that they can be, and they have to have their own discovery.
Okay. I noticed that you didn’t give a very clear answer of what system you prefer.
Ambiguous. Yes. Completely ambiguous.
[laughs] And that’s per usual, but we’re just gonna move on. Okay. I did notice that Dr. Webber talked about the WaveOne target group. And he seemed to suggest that it was primarily for general practitioners. But then, I also saw the beautiful cases he treated with WaveOne Gold, and they seemed pretty advanced. So, what did – what is your opinion on this?
If you give a master clinician virtually any file in the world, from any company, and there’s over 200, they can get the shape they prefer, and they can do it masterfully. So, definition of a master is somebody who makes the task look easy. So, that’s Julian Webber. But it is really a beautiful file, and it’s been thought through from every conceivable angle. I might just mention that the designer team, each one did several hundred cases. This is over several years. So, we had a pool of thousands of cases to look at, and it’s more of a corporate thing to say the file is for the general dentist. The file is for anybody who does endodontics, that likes it, and it gives them the preferred shape they’re looking for, and that could be anything. It doesn’t mean – it’s just a corporate thing. Don’t worry about it.
Mm-hmm. So – but maybe it has to do with reciprocation? Like, that --
Well, if you go back to corporate, corporate, see, has – just Dentsply Sirona has over 10 systems, which is ludicrous, because the reps are going out there, and they have 10 things in their pocket to show. Well, they’ve learned to put things in baskets to simplify it, so they have a reciprocation basket, WaveOne. They have a rotary basket, Ultimate. And then, they have a minimally invasive basket called TruNatomy. And they like to think of it in terms of baskets. When you talk to a clinician, they just want a file that works, that say, cuts, case after case.
Okay. Well, I did have a question about the WaveOne technique, when I was watching the presentation. After he used the 10 file, Dr. Webber used the Gold Glider to length. But then when he started shaping with the WaveOne Gold shaping file, he took it just two-thirds of the way, took it out, irrigated, cleaned it, reirrigated, and then, on another pass, took it to length. So, is this idea of multiple passes recommended? Because you think single file, maybe you can just do – go to length immediately and be done. But is it more single file but multiple passes?
Exactly. You know, when you say, “single file” you said it all. It seems so easy. So, you’re thinking just, you know, get on that handpiece and take the ride and I’ll arrive at length sometime, within 15, 20 seconds. You know something? We learned a long time ago, and I’m only gonna mention Dammam, Saudi Arabia, because that’s where I discovered it as a teacher. See, teachers learn, too. We learn by watching you. So, I learned by watching my students that they needed to take that file out at least two or three times on their way to length, so that they can irrigate, recapitulate, and reirrigate. Keep the canal open, keep your glide path going, don’t let debris start to accumulate, sludge up, and get you blocked.
All right. Okay. So, one last thing I wanted to address that Dr. Webber discussed is – and partly because it has also come up on our show a few times – and that is the misleading advertising related to a file’s cyclic fatigue and how cyclic fatigue affects performance. So, I want you to comment on it, but let’s bring up the graphic that was in Dr. Webber’s presentation that he showed to kind of balance everything.
Well, the people on the show, if you’re watching the show regularly, you know Dr. David Landwehr. We’ve talked about him several times and in different contexts. David’s a fantastic clinician. He’s an educator. He’s a KOL, key opinion leader. And he’s put this graph together to kinda help everybody understand that when we do research, behind the scenes, we don’t just – shouldn’t look at one factor. So, the company we’re talking about, they like to look at cyclic fatigue. So, for the last five years, multiple booklets every month come out with these 10-plus minutes of running time.
And not to get too detailed, but the files, when they’re testing for cyclic fatigue, they’re putting it into a device. There’s no load on the file. It’s not working or cutting. It’s simply put into a 45-degree jig or a 60-degree jig or a 90-degree jig, okay? And then it runs, and when it breaks, they write down the time. That is a very superficial way to evaluate a file, because it’s not working! It’s just spinning in the air. You have to look across that line and ask yourself, well, maybe you should take a 90-degree angle. Can we have efficiency? Can the file still cut?
Because to get files to run that long, you have to do super heating, and we call them overheated or overcooked files. And we’ve talked about that many times on the show. So, when files are overcooked, they run a long time without breaking. That’s the good news. The bad news is, when you load them, they prematurely unwind, and they stretch, and you don’t impart the shape into the canal of the file that it would suggest would be the shape.
Okay. So, when you --
You need a little bit of everything.
-- okay. All right. Well, that’s all the time we have for today. But thank you again, Dr. Webber, for that great presentation.
Julian, you’re the best! Keep it going, big guy.
CLOSE: Influencers – Sports Moment
All right. We’re gonna close our show today with another installment of our “Influencers” segment. And we just started this last season, and it’s when we talk about something that had a big impact on our lives. It could be a book, a sport, a trip, a teacher, a movie. Last time, we talked about a childhood friend. This time, we’re gonna talk about a single sports moment that greatly impacted our lives. So, do you wanna tell your story first?
Okay. I don’t know how much it greatly [laughs] impacted my life, but it’s a good memory. I’ve mentioned a couple times, and I don’t go into this very often, but I didn’t go to high school. I went to an academy. So, that just means I was sent away to high school. So, I went to an academy. I was on the baseball team. And as was normal, every year, the alumni from all over the country that graduated from that school would come back, and there’d be a basketball game, and there’d be a baseball game. We’re talking spring, and it was baseball. So, the alumni were gonna come and play the All Stars from the Academy, and I was on the All Star Team.
I was normally the center fielder. But I had to play shortstop that day, because our shortstop – our regular shortstop had broken his ankle. So, Ruddle got the short straw, and I was shortstop. Right to the story. So, it’s the ninth inning, we’re ahead by one run. That’s the school, the Academy. The All Stars of the – the alumni are at bat, and there’s two outs, bases loaded. And this guy goes into his wind-up, throws a pitch, and I notice immediately the ball is a looper down the third baseline. And I took off. I immediately took off because I knew the left fielder would never get it. The third baseman was trying to backpedal, wasn’t – didn’t have the angle.
And I ran and extended myself and I dove, and I caught the ball in the webbing of my glove. And after the collision with the ground and fall, I was so happy to see this white ball in my webbing. And of course, I was bleeding, because I hit my head, but I saved the game, and we won, 3 to 2. So, it’s not a very big story, but it’s just a moment where I think for me, I always remember you try hard on every single thing you’re doing. It doesn’t matter what it is, you give it 100 percent. And remember, if you think you can, you can, and if you think you can’t, you’re wrong. Ha! You’re right.
And I guess you had to take one for the team, kind of, because [laughs] when you told me this story, it sounded like your face got pretty scratched up.
Well, I had a date at that time. Her name was Zinita Caviness, and she told me I looked pretty ugly.
[laughs] But you also told me, when you told me this story separately, you said that she was very nice to you for a week after [laughs].
Oh, she loved it, you know, because I was getting a lot of attention on campus, and she loved being with me.
[laughs] Okay. Well, my --
What about you? What do you got?
-- well, my story is back when I was about maybe 11 or 12 years old, on swim team. And at that time, one of the strokes I did was freestyle. And I was actually pretty good at freestyle, and at a lot of the swim meets, I would win first place in freestyle, except when we went against this other swim team that had this one girl on it, and she always, like, edged me out, every time. She always beat me.
So, now, let’s fast forward to the last swim meet of the year, and all the teams were participating. And I was swimming the 100 freestyle, so that was 4 laps across the pool, and she was also swimming it. And she was swimming in the lane right next to me. So, we do the first three laps, we’re pretty close. We’re now on the last lap, and about a third of the way across the pool, towards the finish line, I can see underwater – I can see her feet on the lane next to me, kicking. So, she’s about one swimmer’s length ahead of me. So, at that time, I just started like – I remember under the water, trying to cup my hands and just pull really, really hard, as hard as I could.
And I noticed that I was actually gaining on her a little bit. And I knew how much – that I still had about a half a length of the pool left, that if I kept at that pace, I actually might be able to do it. So, I just kept pulling really, really hard, and I ended up winning. And it was the first time I ever beat her, and I actually quit swim team after that [laughs]. But – I mean because I just did other sports. But I do remember not even really feeling like – like thrilled and happy at the end. I was more just like completely surprised and shocked.
Like, I could not even believe what just happened and that I beat her. And I mean, I guess when you think, like, what’s the – like, I’ve thought of this probably I would say almost every month of my life since then. So, it did have a big impact on me.
And you know, you think, like, well, what’s the message? Never give up, never count out the underdog? But for me, it was more like --
Finding the next gear! [laughs]
-- it was – I think it – for me, I took away from it that if you really give it your all and try your best, you might actually surprise yourself and rise to a level of greatness that you didn’t even know was possible for you. So, you know, I guess if you’re out there, you know, practicing dentistry and, you know, trying new cases, don’t ever count yourself out. You might actually surprise yourself. Just keep working, working, and you may reach a level of greatness that you never even thought was possible.
Well, that’s excellent. So, I’ll close the show by saying, try hard, never give up. And if you think you can, you can. If you think you can’t, you’re right.
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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1948 Endo Article & Finding the MB2
To Be Determined
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