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…[Helicopter flying overhead] [laughs] Well, Sophia, need a new --

Wait. Let’s wait. This is ridiculous.

-- okay… [Music]

Welcome to “The Ruddle Show”. I’m Lisette, and this is my dad, Cliff Ruddle.

You look fabulous today. Are you?

[laughs] Pretty – I’m doing well. What about you?

I’m great, and I know our audience is raring to go.

Okay. Well, we’re gonna start off today talking about chores. So, usually, when you think of chores, you think of boring or unpleasant activities that need to be done regularly. But studies have shown that doing mundane daily activities like the dishes or making your bed can have significant mental health benefits, like reducing stress levels.

Oh, yeah.

And also, doing chores can also help with creative thinking and problem solving. So, some of the wealthiest and most successful people in the world, like Bill Gates or Jeff Bezos have always found value in doing chores, and they both do the dishes nightly. But I think we can agree that not all chores are pleasant and rewarding. I know that there – I have some chores I really don’t like. So, today we’re gonna talk about our favorite and worst chores. So, is there a chore that’s your favorite, that you enjoy it so much that you hesitate to even call it a chore?

Oh, yeah. In fact, if you look behind me, and you’ll see an example of many, many, many different chores. One thing you do not see there is picking roses --

[laughs]

-- and trimming the roses because it’s not a chore. All right. I love to work in the earth and get my hands in there, and I can [sniffs] smell that fresh breeze comin’ off the ocean. The lighting’s changing as the sun slides across the sky, and there I am out there with my roses, sniffing a rose at a time. Maybe I take one in for Phyllis, sometimes Lori. You’re just a little further away. It might die before I get there, but maybe. Anyway, yeah. I like that. And what I like most is, it’s outside, it’s quiet. The plants never speak meanly to me. There’s always a symbiotic relationship. They’re glad I’m there, I’m glad to be there, and I have a lot of time to think.

Yeah. I remember doing a lot of gardening with you when we were kids, a great --

Well, that was one --

-- portion of the weekend. [laughs]

-- of my highlights. It sounds like a chore, but that’s an example when people come together to do a chore, and the chore’s less difficult. And then it goes faster. But we did like to sit on the deck and say gee, it looks pretty nice out there, doesn’t it?

Yeah. I think along the same page as you regarding my favorite chore, which is orchid maintenance.

Oh, yeah.

So, I mean, that involves like watering them, making sure they’re bug free, because they get these little white bugs, and then planting new ones when some die. But you know, I have a lot of orchids, and so it is pretty time consuming. But I do think it does boost my mental health when I’m done, and I see the orchids all doing well and brightening up the house. So, what about you? Is there a chore that you really don’t like?

Well, maybe we should have a show about the orchid, start to finish, from concept to design to product.

[laughs]

It’s really amazing what she does. Uh, don’t like. I do the dishes every night, and I have for all the 50-some years I’ve been married. And it’s just – it’s actually a pleasure, but I hate doing the dishes on Christmas and Thanksgiving.

[laughs]

Because why? Because I’m in Santa Barbara. We live on the hill. We look out over the city. Then, we see the harbor, the islands out distant, and the sun gets low, about 15, 20 degrees, it seems like, and it’s coming right in the window where I’m standing by the sink, scrubbing an enormous stack of dishes, because I said Thanksgiving. And there’s a lot of people over, there’s a lot of cooking. There’s rounds of cooking! It’s like gladiator cooking. And I look, and those dishes are still there, and they’re going down so slowly, and it’s getting hotter and hotter. Did I mention the mirror effect off the water?

[laughs]

Oh, my God, it’s bright, too, the sun. You have to do dishes with sunglasses, but what if you miss something? So, I don’t really like to do the dishes on holidays, because it’s hot, it’s bright, and there’s a lot of dishes.

You know, that’s funny, because I never realized that you were suffering so --

[laughs]

-- stoically and silently there in the window area, because I’m off to the side, drying the dishes. And yes, you heard right. Drying the dishes. Because in Ruddle land, we don’t use our dishwashers. So, actually, I think Lori and Mazy might use theirs, but I haven’t used one in decades. We use our dishwasher as a cupboard. So, [laughs] --

Yeah. You can open it up and get a beer, right? [laughs]

-- mostly cleaning supplies are in there. Okay. Well, I guess my least favorite chore is laundry. And not so much that I don’t like doing the laundry, but the – what I don’t like about it is that it always takes me way longer than I thought it would, like with the folding and the sorting and the hanging up clothes.

Yeah. Because it’s not just the laundry [laughs].

Yeah. It just takes – it takes me a long time, but I feel really good when it’s done.

Well, yeah. But I think chores are not a bad thing. I think they’re actually something we should roll up our sleeves and do, because when we finish these, quote, chores --

[laughs]

-- there’s a sense of accomplishment, and there’s a sense of satisfaction. And the best part is while you’re doing the chores, it’s a time to use imaginative thinking, creative thinking, curious – stay curious, and do your chores.

Yeah. And I have to say that you know, I spent a lot of time doing just basic maintenance chores. But if you have time to do a deep cleaning of one area of your house, that actually can feel really good to like get rid of stuff, maybe donate it or throw it away. So, I’ve been actually – that’s been on my mind lately. I want to start attacking certain areas of my house.

Did you say deep cleaning?

Deep cleaning [laughs].

You know, I was listening to a show the other night, and Art Laffer, who won the Presidential Freedom Award, he’s a famous international economist, he said to fix inflation, we have to do a lot of deep root canal work. Work. Deep root canal work.

[laughs] Okay.

Deep root canal work. So, some of these chores are around that apical third, that that’s deep – that’s a deep chore.

Okay. Well, we have a great show for you today. So, let’s get going on it.

All right. So, today we are introducing a new segment, which will be recurring, called the “AAE Discussion Forum: What’s Hot & What’s Not.” So, in this segment, we will report on the hot topics that are currently trending on the Forum, also known as the AAE Connection. But not only will we report on the often heated discussions and provide the various viewpoints, but we will also give a little bit of our own commentary. And then, if applicable, we will also tell you what we notice is regrettably missing from the discussions, because sometimes what is absent is just as important as what’s present.

Now, I want to point out that you go on the Forum daily, and you follow the discussions, but you’re not on there 24/7. So, it’s possible you might miss something. You’re not on there all the time, because you do have a life, and it’s very time consuming to be on the Forum. So, I just want to emphasize that what we’re reporting today is what you notice. It’s from your perspective.

That’s correct.

So, let’s start with what is trending educationally, because I’m thinking that the intended purpose of the Forum is to be an educational source, where clinicians can go and engage in friendly discussions with the goal of advancing learning. So, what is currently trending educationally on the Forum?

Okay. Well, that was a loaded lead-in, and I’ll try to stay on script. I’m taking probably the last six weeks, because the Forum goes into a topic, and then there’s some responses, and they – it kinda beats the topic to death, and then people move on.

Mm-hmm.

So, this is kinda like a summation. So, I would say first would be, there’s been a lot of emphasis on build-ups. What there hasn’t been a lot of emphasis on is band build-ups. So, band build-ups are something that is normal for Cliff Ruddle. Across the decades of my life, I wouldn’t even say I – I might’ve done one every day, almost, if not certainly multiple a week. But the purpose of this whole thing, and they show this on the web, and I’d just like to go a little further in the Discussion Forum, is you remove all the existing restorations. You clean out caries. Now you can have a great visual inspection of what’s left, and you can determine restorability.

I think the Discussion Forum’s getting that part pretty good. And then, there’s some really nice build-ups. And I’d like to publicly announce or acknowledge Hiebert, in Oregon. Brent Hiebert has shown some very, very nice build-ups. I want to acknowledge him and his work. He might be one of the few people on the Forum that is consistently showing what I would think we should all be aspiring to do. But what the Forum doesn’t emphasize is the band. We’ll get to it next, but -- not just next, but the third one – third popular thing that’s being kicked around is fractures. But a build-up could be better protected with a copper band or an Ortho Unitek band. We were taught to do that.

I mean, you could take that copper band and get a size just a little bit too small, stretch it over the tooth, put it in a flame, quench it in alcohol, cement that on. Well, boy! That was really important. So, anyway, if you have a build-up and a band or just a build-up, you have reference points. You have a reservoir to hold your irrigant, and there’s a huge emphasis on cleaning. It’s a hot button. So, we gotta have a big chamber to hold reservoir that’s sufficient to exchange throughout the four corners of a root canal system. Okay.

So, we can now have a better cleaning. But we’re gonna irrigate better, we’re gonna bring over armamentarium better, we’re gonna have reference points, we’re gonna have protection if we do a two-visit, or even if you get it done in one visit and send them back, there’ll be a band around it to protect it, so it doesn’t fracture after the appointment. So, we have a lot of this on fractures, but I just don’t see that emphasized. Nobody even mentioned the word “band,” but there’s all these exotic build-ups and matrices and materials and light-cured materials, and they’re all beating that to death. But I didn’t see the facility of the band. So --

Okay.

-- then you can even rough prep these build-ups. And I know Schwartz, he’s another one of the big three on there. I think it’s Hedrick and Schwartz – Rick Schwartz from San Antonio, Hedrick from Florida, and then Hiebert from Oregon. But those are kinda your three guys. But he has shown some really nice work with – Schwartz – with roughing it in, sending it back to the general dentist. It’s a piece of cake.

Okay. So, the build-ups are being discussed, but they’re missing the band part.

I think the band part would be a very – specially on fractured teeth.

Now, is this something – did they teach you to use a band when you were in dental school?

In dental school, I didn’t know what a band was. And then I did a rotation through orthodontics. [laughs]

[laughs] Okay.

But I learned it at Harvard.

Okay.

When I went to grad school, my mentor said – well, there was a time where every tooth had to be banded and built up. And even if you said it had an existing crown, fine. I’m not talking about that one. But I’m talking about when we’re doing caries control, removing defective restorations. We were always taught not just to build it up, but to go ahead and band it. Now, some people argue and say, well, you know, we have better restorative materials than we had in the ‘70s. We’re on like the fifth, sixth generation of bonding and adhesion dentistry. Don’t need the band. And I would respectfully say, bull-[bleep].

Okay. So, build-ups. What else is trending?

Truss accesses. And there’s very few people really doing them, but when it’s done, it’s put out. They’re like, look at what I’m doing. And I will read something if I have permission.

Go ahead.

I’m not very technically inclined here but wow, we get this rotation, and there it is. I’m reading about truss accesses. “The very promise of increased fracture resistance for contracted access cavities lacks the foundation of both experimental and clinical evidence.” Silva et al, 2020. “In the absence of this previously perceived benefit” – notice the “perceived benefit” – “the potential compromise in the fundamental principles of root canal therapy, orifice location, shaping, cleaning, disinfection, obturation, restoration, caused by the contracted access cannot be justified. Studies” – do you hear the word “studies”?

This isn’t my opinion. “Studies evaluating these parameters” – all the things I just read – “have either found contracted accesses to be inferior to traditional ones.” Restoration, Rover et al, 2020. Lima, 2021. Disinfection, Vieira, 2020. Neelakantan, 2018. Shaping, Zhang. So, they’re not even as good as regular, conventional accesses. Shaping, Barbosa. Rover, 2017. “No study to this date has shown any superiority in the contracted access over traditional ones, in terms of endodontic outcomes.”

Well, I have a question.

And I could read on, but it goes into the errors, the mistakes, the steep learning curve. And here’s one that I just sorta said. I wanted to say this. They wonder if these accesses are due to social media peer pressure. It’s right there.

That’s kinda related to my question, because I know you don’t really advocate them. We’ve talked about accesses on our show, the various types. And it doesn’t really seem like it’s beneficial to be trying to put forth that this is the way it should be done on the AAE Connection, because it’s the learning curve and everything. It’s just --

It influences.

-- yeah. So, do you think that people are putting it out there just to show like, you know, look what I did?

Most endodontists should never do that. They don’t have the skills and the handsets. I’ve taught for too many decades – across 5 decades I’ve been a teacher, and I’ve had 1,000-plus endodontists visit Santa Barbara. I watch you. I know how you think. I know how you work. I know when you go to the bathroom. I know what you drank for lunch. I get it! But you need to get these things opened up so you can be all you can be. And truss accesses, I think for most, are limiting.

These educational issues – clinical issues that you discussed, the build-ups, truss accesses, and you mentioned fractures, say you were a clinician, and you were struggling with, you know, certain issues, and you decided to go onto the Forum in the hopes that maybe finding some enlightenment or maybe some tips or some answers to your questions. Do you think that it’s helpful – it would be helpful to a clinician to go on the Forum, to actually try to learn something?

Can I answer that in just a second? I’d like to finish that third thing. So, we had the – well, we had the -- what? The first one was what?

The build-ups and the truss accesses.

Yeah. Then we had the – what? The truss. And now the fractures. And we’ve talked about them a lot, so I fooled you a little bit, because I brought it into all these categories. The other two, because it does.

Yes, I thought you would --

But I wanted --

-- mention it in relation to build-ups and truss access.

-- but I want to come at it now from a different view. How come so many endodontists are scratching their head and trying to figure out how to manage fractures? This is something our profession is excellent at. I was most influenced by the seminal paper by Blake McKinley, Boston University, 1550. That was a long time ago. No, he’s an older guy [laughs]. His son you might know, he’s in Spokane still, practicing. But I’m talking about Blake, Senior. Blake wrote that seminal paper on fractures, and I mean he banded all these fractured teeth.

He would have them use a bite stick, and if they could rock around on that, he had permission to advance treatment. If they never really got symptom – asymptomatic with a band on the tooth, he didn’t think a crown was gonna do it. But the point is, we aren’t even talking about the kind of fractures, because there’s oblique fractures, there are horizontal fractures, there are vertical fractures. And then, we had Cherilyn Sheets on the show, and --

Well, what are they talking about on the Forum, though, about fractures?

Well, they’re scratching their head. A lot of the younger endodontists don’t know what to do – should do. Does it go too deep? What if it fails? Who’s paying for it? And they make it so complicated. You know, take your views, your CBCTs, and your radiographs. Transilluminate when possible. Probe like a mother, and really probe firmly for no surprises. If you have to anesthetize and then re-probe, do that. And if you don’t have radiographic evidence, and you can’t probe it, then open it up and look internally and further transilluminate, and I got a scope now. So, there’s all these things, and I don’t understand why it’s just talked about and talked about and talked about.

So, your question was, then, we’ve talked about the three things. But now, is there some benefits to being on the web? And is there really some things to learn? And I would say, yeah. I mean, what I liked about the Forum is – in other words, there was a discussion about big lesions, and how do you decompress them. So, there’s a whole discussion about marsupialization. Now, everybody learned how to do that, but you don’t do it very often. You might do it two, three times a year. So, there’s a really great discussion how to decompress these big lesions, and lots of people talked about different ways that they do it. So, I thought that was really helpful.

And if I’m sitting out somewhere, and I don’t get to a lot of CE, and COVID was two years, and I haven’t been around, those are helpful. The other one is, there’s a good example, Schwartz likes to show dens in dente. So, if you want to know thy anatomy – know thy anatomy – then, the Forum will have some quirky cases on, and that just goes in your bank, your library of future things you might see, so your treatment plan for no surprises.

All right. Well, these educational topics that we’ve been discussing, would you say they make up the majority of what’s being discussed on the Forum?

There’s a few gems on the Forum, but not every day and not even every week. And what the slant has turned to is more from education to products. So, I mean, just today, I could scroll and scroll, and almost 90 percent of the feedback was on GentleWave. I love GentleWave, I hate GentleWave, I don’t – I’m on the sidelines, waiting to see if I want GentleWave. It’s like I didn’t see that they had an overhead light on the website and talking about do we need an overhead light, a dental chair to plunk the patient in, do we need stools to sit on, do we need armrests, no armrests. GentleWave, GentleWave, GentleWave.

And you know, it’s just an adjunct for cleaning. Why is it the center of everything? No, it’s not because I have an EndoActivator, and I’m commercially involved. I don’t care if you use an EndoActivator or not. But for 2,500, and for $2.00 a patient, yeah. You can clean root canal systems. So, I’m not upset about GentleWave. I’m gonna say this. Many, many clinicians rarely saw lateral anatomy, loops, anastomosing, fins, sheaths, bifidities, trifidities. They didn’t seem to care. People that bought GentleWave, they never cared for decades.

Suddenly, a tool comes along. There’s no reason to get it except to clean better. And now, they’re thumping their chest because they got their first lateral canal. So, if that’s how GentleWave people can treat the anatomy and maybe the only way, then I’m happy for you. I really, sincerely think that made you a better clinician. Good for you. But then, we don’t want to use this dispiriting superiority that I’m doing something that nobody else is doing.

Okay. Well, I’ve heard you talk about the heated arguments that are happening on the forum lately between the GentleWave users and the non-users. So, what is each side saying? Like why are they arguing?

Well, basically, if you’re a GentleWave user, you’re telling me the cost justifies it. The cost is $70,000 for the current machine. There’s quite a bit of talk now, but nobody seems on the Forum to know much about the G4. I haven’t even talked to you about it. The G4’s coming out. It’ll be $110,000. Did you notice we didn’t go this way. We went this way. And presumably, it can [laughs] take out caries. Okay. Maybe that’s a breakthrough. I didn’t know we were having trouble with caries. Anyway, I – okay. So, they like it.

There’s new products coming out. They now are filling more anatomy than they’ve ever filled, although I rarely see GentleWave cases on the Forum that really show thrilling anatomy. Every now and then, you get your loops out. Yeah. They got something. I’ve had people that took my classes in the ‘70s that did that. So, it’s not a ticket for GentleWave. So, they’ll tell you, it’s clean, and the advertising is, it’s superior clean, superior treatment. And that has caused a lot of anger. So, that’s what they would say.

The non-users would say – what? It’s expensive, it’s a $100 throwaway handpiece. I didn’t even talk about insurance yet. They talk about GentleWave says, well, I can do in – more in one-visit. Most of us have been doing one-visit since the ‘70s. They say the lesions heal faster. Really? Nobody’s ever shown that. But the – it’s just said constantly. Lesions heal faster. Look at the six-month recall. Healing begins four days after cleaning and shaping. So, when you go in there and take everything out, it’s starting to heal. I can show you lots of cases if you just want to see fast healing.

Come on “The Ruddle Show”. We’ll do a segment, fast healing. I can show two- and three-month recalls, and the bone’s filling in. So, it doesn’t heal faster. They say they get more anatomy. Nobody’s ever demonstrated that that’s even true. And we also say there’s postoperative problems with bleeding and post-op pain. So, you know, that’s what we would say, and then we would say, where’s the literature? Because I’m gonna be hard on some of these guys that are from academics. They’re big guys. And I like them. Geez, I give a lot of them hugs when I see them.

But if we get into this topic, and you see this paper that was done, and it’s published, and then you look at all the people that wrote the paper, and then you see that the head guy on the paper is on the Board of Advisors for Sonendo. That’s a conflict of interest. So, we need unbiased research, transparent research, and we need schools really to get their hands on machines and have permission from the company, publish whatever you find, not what we like! And of course, they need to be using the correct protocol.

Well, I think that it’s interesting that they’re arguing so much with each other, because you know, it’s – I don’t think it’s normal for a single product to cause so much divisiveness. I mean, if you just think that, say, you’re for ProTaper, and then, the other clinician – another clinician’s – uses a different file system, it’s kinda just live and let live. You don’t really try to push, push, push to get them to use ProTaper, and they don’t push back saying, stay away from me, or show me the literature, or whatever. So, I think that the fact that the non-users are so upset with the users, and it seems to be like you take a side. Are you pro GentleWave or not pro GentleWave?

Now, there’s another really neat thing they would say. GentleWave people would say, Lisette, Cliff, I don’t have to shape as big. I can do single cone with BC Sealer. I guess you heard Camilleri, Josette, on this show last week, give a lot of cautions about how irrigants can interfere with the physical properties of the tricalcium silicates. In terms of reduced tooth structure, that’s just not true. People remember things the way they want to. As an example, when ProTaper came out, the back end was 1.1 millimeters. The new ProTaper is one millimeter.

If you talk about the active portion, which is 16, and the part that actually goes below the orifice, it’s about 85/100ths. It’s about 8/10ths of a millimeter in the body. That’s not any bigger than they make. So, they would tell you, their righteous thing beyond getting the anatomy is they’re saving precious tooth structure. And that’s driven the trust accesses, the constricted accesses, the small, skinny shapes, and a lot of them can’t even get to length. A lot of GentleWave users will post a case and say, can’t get to length, but I thought the technology might be able to, you know, suck something out of there, pull something out, make space so I could push materials in.

That’s a really stupid way to – we – where’s the AAE Discussion Forum talking about negotiating canals, patency? That’s a flow channel. That’s a flow channel. Now, lasers are gonna work. Now, GentleWave’s gonna work. But when you can’t even get a flow channel because you’re deficient in your instrumentation, and you’re an endodontist, let’s not get angry with each other. Let’s just accept the fact. How many – how come there’s so many cases and people can’t negotiate the foramen? These are endodontists.

Yeah. Well, it sounds like from what I hear from you that the GentleWave is taking – and you said probably maybe even today about 90 percent of the discussion was about GentleWave. It sounds like a lot of these discussions, though, are kind of more mean spirited and confrontational, that there’s even like – it has even degenerated to some, like, bullying a little bit. It sounds like the – you know, people have just been behaving more poorly on social media in general.

[laughs]

And it sounds like this bad behavior is now spilling over to the AAE Discussion Forum. So, we talked about what’s hot in terms of education and – the educational topics and some controversies. But what is notably missing from the discussions?

The discussion itself. That sounds funny to you, but I’m now getting into a little bit of censorship. But you can’t have a discussion if I mute you. So, the way this works, everybody, and I’m making this up. I don’t know it exactly, but there’s probably – I wrote their names. Hiebert, Schwartz, Randy Hedrick, they’re probably the three guys that pump cases in, and that keeps the dialogue going. And they do – and they do a good job. Okay, you guys. Good job. Then, there’s a few others, five, six, seven, that are always chiming in, me-too type people. Okay. Fine.

What about the rest? We don’t hear from very many people. So, if you really want to have a true forum, you gotta have people coming in from all over the world, presenting issues and problems or things they’ve learned in their markets that we don’t know about, because the AAE doesn’t know everything. In fact, the more [laughs] – the more we know, the less we know. But I think we need more people in involvement. And then, how it works is, if there’s a post that somebody doesn’t like, anybody out there can say, remove the post, or it’s inappropriate. Well, now there’s police people in the AAE that then look at those critiques and see if the posts should be altered. They haven’t been giving people a chance to alter their posts.

As Brent Hiebert said, he had three posts. They were taken down. Nobody even contacted him and said, repost it and alter it a little bit. So, then, if they can’t agree, it goes up to the AAE in Chicago, and somebody up there is – or people are the police. You know what? We’re all professionals. We didn’t get here by accident. God put you where you are, where – right now, to do what you’re doing. If you can’t say what you want, say it civilly, say it professionally, that’s called dialogue, and we learn through the conversation.

So, when some side is cut off -- I mean, what if the people upstairs are GentleWave users or are not GentleWave users, and they’re not being neutral. Are they being neutral, as they make these big decisions? So, I think a real forum needs to have a dialogue. And when you don’t like something, you shouldn’t be taking it down unless it’s insulting, mean spirited, bullying, you know, bad language, that kinda stuff. But a difference in opinion is science!

Yeah. I think that probably is what the AAE is trying to do is get more of an educational focus on the Forum and not so much of a product focus. So, I mean, I don’t know. I’m just speculating, because it sounds like they could benefit by placing more emphasis on education and less emphasis on products. It sounds like there are a few well-respected leaders that kinda moderate discussions, but probably they could benefit from having a few more.

I just want to come back to training. It’s a little sad to me today, having watched the profession over five decades, and I’ve been with endodontists, I’ve had them come to Santa Barbara, I’ve been to schools – I’m on staff at five different places. I think I know exactly what’s happening internationally in the field. And I can tell you, it’s a lack of training. The technologies are all fabulous. I mean, I’m gonna say it again. Why did everybody start using GentleWave? It all started with minimally invasive endodontics. And so, smaller this, smaller shapes. Gee, we can’t clean very well anymore. But were they even clean in the first place, because these people weren’t typically getting anatomy.

Okay. Well, that’s all the time we have today, but thank you for giving us the Ruddle perspective on what’s hot and what’s not on the Forum. And I wonder what we’ll be talking about the next time we do this segment?

Well, what I’d like to see on the Forum, in summary, is some critical thinking. All right? I’d like to see a little bit more curiosity to what we don’t know, to find out what we might learn, and I’d like you to use your imagination. Try those three things.

All right. Well, thank you.

Well, welcome back. I’d like to talk today about 3D irrigation. And of course, when we were doing our first segment, we were talking a lot about the Discussion Forum. And of course, the Discussion Forum oftentimes is heavily focused on how can we better clean root canal systems. And as we said, much discussion on GentleWave, lasers, but not as thoroughly, even though they’re probably a bigger part of the future. And then there’s different kinds of lasers. So, today I’m gonna talk about a technology that’s much, much more affordable. It’s easy to use, and there’s no big learning curve.

But I want to build a case for why we need 3D irrigation. I think everybody knows that, but it’s good to just have a little reminder. So, let’s go back to 1925, and we had Walter Hess. He published his book, 10,000 Sections of the Human Pulp. So, he digested away the cementum and the dentin, and then he was left with these Vulcanite rubber recovered specimens, and he showed brilliantly massive amounts of loops, anastomosing, lateral canals, fins, isthmuses filled with Vulcanite rubber. So, it was pretty exciting when we saw that. And when it came out, I think it was not so exciting, because back then, there was no expectations we could do it. So, it kind of went away.

And many dental students, even ones I’m speaking to right now, never got endodontic anatomy when they were taking their endodontic courses. You know, he talked about the permanent teeth. And this guy, Ernst Zürcher, he talked about deciduous teeth. So, in this book, you can see a lot of anatomy, and it’s like the Bible. And when we’re doing endodontics, what are we doing? We’re treating the anatomy. That’s what the anatomy looks like. That’s the whole point here. So, let’s have fun with this. This anatomy shouldn’t be intimidating. It should be an opportunity.

So, I’d like to just come back and say, when you look at these things, you start to see, wow, anastomosing, loops, fins, sheaths of tissue flying like flags in the breeze between MB and ML systems. Let’s look at this. That says to me, files shape a tooth. So, if files can come in here and create a nice shape, but your files certainly aren’t getting off the body of the shaped canal. So, how do we get into all this deep lateral anatomy? And that means we have a rationale for 3D irrigation, and that’s my topic today. Probably another color they’d like a little better.

But if we have 3D irrigation, that’s a good thing. However, it’s not just sitting there and soaking. That’s how we did it in the ‘70s. It was – chair time was longer, so cases were soaked longer. But now, in the modern era, everything’s like boom, boom, boom, click, click, click, we have to activate it. And I’ve talked about already, just in this short segment, multiple ways that you could consider doing that. So, we want to get an appropriate shape – a root appropriate shape, not too big, not too small. We emphasize now a very small body -- okay – to conserve dentin. I agree with all that. But ProTaper, WaveOne, Ultimate, all these systems, ProTaper Gold, they all give you deep shape of about seven, eight, or nine percent. Okay. So, you can get enough volume down there.

Think about it. 17.04 file. A 17.04 file, 5 millimeters up, what is it? About a 31? Okay. Well, we’re 5 millimeters up, we’re almost like a 60. We’re almost twice as big, but then having a conservative body. So, shaping is going to be the main reason you start to pick up lateral anatomy. So, we’re gonna go to a little movie, and I’m gonna show you the SmartLite Pro EndoActivator, which is brand new on the market in the last few months. It’s replacing the original EndoActivator that Dr. Bob Sharp and I created back in 2007, when it was launched. We actually started in about 2000, but we launched it in 2007. We had a great run with that.

So, this is what we’re gonna talk about today. Why? Because it costs less than $2,200. Why? Because it’s about $2.00 U.S. per patient. So, it’s the SmartLite Pro, and it works in a shaped canal. It comes in a caddy, a platform. You have a handpiece. This handpiece is what’s gonna power everything from your – if you choose, you could have something for a curing light. You have a transilluminator. And we’ll stop. And then you have the EndoActivator head. These three devices snap on the handpiece. This is how you turn the handpiece on or off. There’s a battery up in here, but let’s keep watching.

Because we’ll get about one day -- if you’re a general dentist, and you’re curing all day long like you do, you can get easily one day on one battery. So, we got rid of the old batteries, those old lithiums, and we’ve gone to an advanced battery. This is called lithium iron phosphate. So, it’s the latest in technology. When it’s green, it’s charged. All right. So, you got this platform. It’s to improve your workflow. If you take the battery out because it’s spent, it can go back in, and it’ll start charging. Notice that you can swivel the snap-on head in 360. There’s a big improvement. The old EndoActivator used linear motion.

We’re now using an elliptical -- elliptical – I can’t even spell it – elliptical motion. The elliptical – it’s an elliptical motion. That means it goes 12:00, 6:00, 1:00, 7:00, and it’s going around the horn, but it’s going like a figure 8. So, it randomly hits more walls. That’s a big improvement. So, one thing to mark on your mental notes, we have a different movement in the head that receives the tip. Okay. What else do we have on here? Got these tips. The tips come in different sizes and configurations. The tips have been remade. They’re redesigned. We’ll look at it closely.

But probably what you did notice is there’s a – now a longer one, because the market said, what about canines? Mandibular and maxillary canines are long, towering teeth. Sometimes we don’t have the length with the shorter ones. So, you can see their sizes. I won’t repeat it. You can see we have a longer one. And this – and these are polymer tips. Okay? These are not metal. These are Delrin polymer tips. It’s the highest medical grade polymer that’s used in medicine and dentistry, and they – it has the elasticity properties. You can’t just use nylon or this or that. They’re all a little different.

So, we’ve chosen the tip and the chemistry to work the best to give us 2 Alpha. You remember 2 Alpha from another show. But that represents your back-and-forth tip movement. All right. So, there’s your tips. There’s your chance to get a little bit better. You put those down in a shaped canal. Notice the tip. Notice the tip is a parallelogram. Why? I had only two comments in one year since its launch and that – two of them said it seems stiff. It seems like I – it’s – I can’t bend it as easy to snake it into a tough-to-get-into second molar. You can cut the tip anywhere you want. It won’t destroy the sinusoidal wave that goes down through the tip. This is not like ultrasonics, where they say tips are tuned. Okay?

So, if you need to do that, shorten it. It might not be as flexible to you because a parallelogram is not as flexible as a round, tapered cylinder. But a parallelogram can catch – it can catch more solution, and it’s like a paddle. It can displace that solution and exchange that solution more effectively laterally than a tapered, conical tip. So, that’s why it’s a parallelogram tip. So, different motion, different length on the one, and a different cross-section of the tips. Each tip is about $2.00 U.S. So, the tips will go on the old EndoActivator that’s not being sold anymore.

You can bag it. I would suggest, take the tip off, go ahead and bag it, place the bag over the whole sleeve. And now, you snap on the tip that you’ve selected. You snap that on. Once it’s snapped on, you’re ready to go. One click, you’re for disinfection. Two clicks, adjunctive procedures that I’ll explain in a little bit. But we have two speeds on this thing, by just adjusting that. So, we’ve emphasized shaping. Shaping facilitates cleaning, and shaping facilitates filling root canal systems. I just think this is fun. How would you last 40, 50, 60 years in this profession if you were treating white lines 2 millimeters short?

So, here’s the protocol. You’re gonna irrigate the whole time with your irrigant, sodium hypochlorite dominantly – sodium hypochlorite. Then you’re gonna take an EndoActivator tip and it needs to be placed through the access, into the orifice, and within two millimeters of the length. And the other requirement is, loose. Two things. Two millimeters short, loose. It needs to be able to move. It can’t be frozen. So, that’s your tip choice, and one of those three tips will work in any kind of a shape, unless you’re doing minimally invasive, and you have almost nothing going on except a 10, 15 file in the apical third.

The protocol starts right here. It’s down now. It’s very simple. Vacuum, suck out, sweep off all your sodium hypochlorite and fill the tooth brimful with EDTA 17 percent – ethylenediaminetetraacetic acid. That is going to remove the smear lawyer. It’s gonna open up the lateral anatomy so we can now flush that out and top off with sodium hypochlorite. And you can see your times here. So, the disinfection is 1 minute, 60 seconds plus 30 is 90 seconds per canal. That’s the protocol, 90 seconds per canal. You can activate sodium hypochlorite, and now that you’ve got the smear layer off, your sodium hypochlorite now can move laterally into all that fun, Hess-type anatomy.

So, that’s a little bit about the protocol. Protocol was made by five university professors. Each person’s lifelong work has been in disinfection. I didn’t set the protocol. Other shows can tell you who those people were and what schools they’re at. It’s fun to know these guys. They’re very smart guys. So, that’s our protocol, and if you’re doing that, you’re gonna get a lot of anatomy that maybe before you haven’t seen. Let’s take a look at how to use it. We’re gonna look at a mandibular bicuspid, because they’re complicated teeth oftentimes. They’re known to harbor crazy anatomy. It’s not usually so straightforward. And when you start to look at them in workshops, and you look at your own practice, and you have that library of experience, and then you start to – working them on the bench, you begin to see they’re pretty complicated.

So, we’ll choose that one, get it opened up, get a nice access, not too big, not too small. And I think if you do the shapes we’ve talked about, the shapes are gonna be awesome for encouraging a reservoir, encouraging exchange. When the tip comes in, I want to introduce a new concept. Listen carefully. Crown down. Say, “crown down.” Crown down. We used to just sail through the whole length of the prepared shape, and we’d hang out in the apical third, doing our one and a half minute protocol. Now, I go 10, 15 minutes to the coronal one third – 10 to 15 seconds. 10 to 15 seconds. Oh, you’d sure have a clean canal if it was 15 minutes.

10 to 15 in the coronal, 10 to 15 seconds middle one third, and finish your protocol deep. What are we doing? We’re making a vortex! And this has been shown in our laboratory work, and the vortex creates a much more powerful wave and cleansing activity on the walls. So, don’t forget the crown down. Don’t forget the crown down. First, I want to talk about mechanical. The tip serves to slap the walls. Well, let’s like taking the bristles of a toothbrush and brushing your teeth. Mechanical. Also, though, the tip, as it moves, it fractures liquids. And the liquids are unstable because of heat and pressure. And as they expand, they eventually implode. And when they implode, you get these jets. And these jets spray just like you were using a power hose, and you were trying to knock paint off of a masonry block wall. So, it’s just like that.

So, you get down in this loop area. You may or may not know it’s there from CBCT, but if you’re crowning down, you’re improving your vortex. The bubbles are always being generated, because the moving tip fractures liquid, and these bubbles are going to serve to strip rods and cocci off of these shapes, because they’re there. If the teeth are necrotic, you’re gonna have bacteria, microbes. And this is kind of a poor man’s way of cleaning a root canal pretty damn good! Okay? This is not a laser. In lasers, that’s a steam bubble. That’s different than a mechanical bubble. I get it. But then, we have a lot of money to spend on lasers, and we have problems with ablation and energy and thermal burns. We’ve talked about that.

But as you go through the protocol, remember, this isn’t an irrigator. I’ve heard papers that have been published on this say it’s an irrigator system. It’s an agitator. It’s agitating existing systems. What’d I just tell you? You need a pulp chamber brimful. Some of the people have cut off the crowns, in the research, decoronated. And then, they’ve done the protocol on just the root. And now, you take the tip, and you put it into a shape, and you displace what little liquid was there. So, really, you know, you don’t get a favorable paper. But you need a pulp chamber. That’s why we talked about the Discussion Forum. I was so pleased with the emphasis on bands and build-ups -- I’m emphasizing bands; they were emphasizing build-ups -- because that gives you the pulp chamber.

I hold the syringe. There’s a couple little wings here. You’re very aware of them. These little wings stick out. You put your index finger and your thumb on those. And when I pull – when I pull towards my palm, I’m irrigating! All right? I’m irrigating. When I push – when I push – so, I’m not pulling. Now I’m gonna push. Guess what? I can get just the opposite flow, and I can begin to suck. I can vacuum six to eight millimeters apical to my cannula in a well-shaped canal that’s patent. The literature says you can only do that one millimeter. Well, Ruddle just announced, eight millimeters. If you look over here on the block, you can see it. Irrigate, vacuum, irrigate, vacuum, irrigate. That’s a 25-cent syringe, everybody. No, it’s not the Pulp Sucker by Buchanan. No, it’s not GentleWave. No, it’s not a laser. It’s 25 cents. And everybody’s got one, and everybody can do it.

If you go below the orifice, you can see all this activity. The implosions, the bubbles, the shockwaves, stripping stuff off of walls, vital and detached tissue. And I want to stop here for just a second. It’s too late, but we’ll stop here. I wanted to acknowledge Caron. Gregory Caron did the big pieces of research just behind these reference notes. He did it at Paris VII under the tutelage of Pierre – Professor Machtou and got beautiful results, just like you can see. There’s been 50 papers over the life of the EndoActivator, and those 50 papers, most of them were pretty good. Some of them were not so good. Some of them who decoronated the crown said it wasn’t any better – wasn’t any better than handheld irrigation. Some people didn’t shape. Basically, didn’t even shape.

So, how can you not have a flow channel to stick your tip in? So, if we get rid of the stupid papers, we have 50 papers, and some of these are my favorites. And you can see different people, Machtou and Caron, you can see Haapasalo, different ones. They’ve compared it with lasers, up in here. We did very, very well. So, I’m just saying that for a low amount of investment, for not having to really change your technique, Pileggi -- this is work I did in Harvard when I was a resident, but this is looking down the tubules. This is where the files work.

So, the files were working right in here. The files shaped the canal. The EDTA opened up the tubules, and we could look back through the tubules, and we had cleaned to 4-, 5-, 600 microns, in the ‘70s, with no lasers, no GentleWave, no EndoActivator. Pileggi was looking at the EndoActivator SmartLite Pro. Okay? And she could see the perfusion of dye way out into the tubules. And now you can see the stain that she’s showing was all out in here. It was off the shape. So, this is the shape, and look at how the EndoActivator can show reagents deep into the lateral anatomy. So, that’s pretty exciting, if you’re a clinician, to see how it works.

I talked about some adjunctive procedures. Well, we talked about this a lot today. Most of clinicians out there do use calcium hydroxide. It’s amazing. It’s used widely internationally. You can adapt your calcium hydroxide by throwing it up against the walls, by sputter coating. And when the next visit comes around, it’s an effective way to remove it. It’s been shown in the literature. Mud, MTA, you can throw it into root defects, open apices. Very good for vibrating at the lower setting. And then, finally, we all take out obturation materials, gutta-percha, silver points, carriers, and paste fillers. And once we get the bulk of those out, there’s still eccentricities off the rounder parts of canals, spins and loops and stuff like that.

And again, we can use a solvent with the EndoActivator tip, the Delrin tip, to agitate that solution, and that would be very, very useful. So, that’s just a little bit about the adjunctive procedures. And so, I’m gonna leave you with a challenge. Why don’t we do some active irrigation? Why don’t you think about what has been missing maybe in your endodontics over the last years. But if you’re not seeing a lot of anatomy on postoperative films and almost on every case, you can always get a little bit better. And don’t pout and sulk about it, just roll up your sleeves and say, what can do where I’m at right now, to get a little bit better. And for about $2,200 and about $2.00 per patient, you can be the best you can be. So, good luck on your future 3D irrigation.

All right. So, here we are at a mystery location with a mystery guest who you will find out who it is shortly. So, you probably know by now that my mom and dad have five grandkids, two from me and three from Lori. And you’ve seen them make some appearances on “The Ruddle Show” over the past seasons, and you probably are aware by now that my oldest son, Isaac, works on “The Ruddle Show.” So, we thought it would be cool to every season feature one of the grandkids and let you know – in the close of our show – and let you know what they’re currently up to. Because you know what they say about grandkids? Grandchildren restore our – what is it? They restore our zest for life and our faith in humanity. So, last season --

That’s true.

-- we talked to Isaac, and we talked about his 3D printing and clone helmets – Star Wars clone helmets. Today, we are with Lori’s middle child, Sophia Grace Ostovany.

[clapping]

Hello, Sophia.

Hi. Thank you for having me.

Well, I’m just delighted you’re on the set – away from the set.

[laughs] Yeah.

But mainly, I’m so happy you took the time, because I know how busy you are with your curriculum.

Yeah.

So, welcome to the show, and where the Hell are we?

So, right now, we’re at the tennis courts of Westmont College. It’s only about 10 minutes away from the studio in Santa Barbara, California.

Okay.

Excellent.

And is – so, we’re at the tennis courts. And you play tennis here a lot. You’re one of the top players on the tennis team, right?

Yeah. I’m on the tennis team currently.

And so, you’re also a top student. So, how is it to be – well, actually, I think we should tell everyone that she is here on a scholarship. What scholarship is that?

It’s just called the Presidential Scholarship. It’s just awarded to students who have put a lot of time and work into their academics throughout high school.

She’s now sending checks my way.

Well, how is it to be a – like, I have always – like, I watch college football on the weekends. And I always think like, gosh. How can they do this? How can they travel to these games and still, like, get good grades in school? And you’re a top student and a top tennis player. So, how do you manage being a student athlete? Is it difficult?

It definitely can get difficult at times, when exams can pile up on each other and all of a sudden, you’re traveling for matches and stuff. But I think just the most important part is the time management aspect, just making sure that you’re not I guess like being on – like, being off track with your work and stuff. When you do have free time, you just have to use your time really strategically.

Do your teachers work with you like if – on anything like – if the assignment is due, for example, is it definitely due on that day? Or do you get a little extra time if you’re an athlete?

It really just depends. Some teachers, I can turn it in digitally or after I come back. Other ones want me to turn it in before. But really, teachers, though, are really nice and accommodating if something does come up. And I can always go to their office hours and stuff to make up any work that I missed that I need help on.

I picture you like on the – sitting on the court, about ready to start a match, and you’re just like finishing up a paper, and you’re like, “Submit.”

[laughs]

Is that how it happens? [laughs]

Luckily, no. When I’m on the tennis court, I try to only focus on tennis. [laughs]

Well, speaking of demands, I just want our audience to get a little better picture of that. When I speak of demands, she’s taking 18 units.

Yeah.

And you’re a Psych major, and then there’s Physics lab and the whole stuff. But it’s the travel. And I know a little bit about travel. She has to go on these trips. Sometimes you’re gone a week, aren’t you?

Yeah. That’s usually the longest we’ll be gone.

Yeah. So, I mean, working that all around with your collegiate work – and it’s not just you go play a match. There’s practice. There’s all kinds of things.

Yeah. It’s like a – it’s a full commitment of your time.

What’s the farthest you’ve gone for a match?

I think the furthest I’ve gone is Glendale, Arizona. That was just about a little over a month ago, and we were in the van for about – over seven hours driving there. So, yeah.

And you mentioned you’re a Psych major, and I assume that’s Psychology.

Yes.

Okay. And do you know what you want to do with that?

I have kind of – I don’t know. I’ve just been thinking about a lot of different topics I can study, but one I’ve been interested in recently is forensic psychology.

Oh, that is interesting. I was actually talking – Eva said, well, what do you do if you’re a Psychology major? And I was trying to think of different jobs that you could possibly – that was actually one of them that I had thought of --

Yeah [laughs].

-- that could be really interesting. So, okay.

Wow.

So, going to school here, what would you say is your favorite part of the day?

Probably my favorite part of the day is just getting to go down to practice after all my classes are done and everything.

And to practice every day?

Practice is from Monday to Friday, from about 3:30 to 5:30 or 6:00.

And I know – just thinking of all these other questions as you speak. But are your friends pretty much on the tennis team, or do you have friends from your other classes and then tennis friends as well?

Yeah. I have a lot of good friends on the team. And then, I also have a few good friends off the team. So, it’s a good mix.

You probably get to be pretty friendly when you’re out there at 5:00 in the morning running the stadium steps down at City College.

Definitely [laughs] character building, team bonding experiences. That’s for sure. [laughs]

Yeah [laughs].

And that actually is probably a bonus of being a student athlete, because you have to spend so much time with your fellow athletes that they become like a family.

Definitely. And especially being a new student and stuff, it’s nice to go and immediately have a team, which is just an automatic community that you get to be a part of. So, it’s been really nice.

Mm-hmm. So, I asked you what your favorite part of the day is. What is your worst part?

My worst part of the day, I don’t know. I mean, I’m not a huge fan of homework. So, probably just when I have to do that.

Now, we did talk earlier on our show today about chores. Do you do any chores here? Like – because – do you stay in a dorm?

I do [laughs].

And do they have like community chores, or does someone come in and clean stuff?

We don’t really have community chores. I mean, my roommate and I will vacuum every so often and --

Nice!

-- take out the trash [laughs].

Very good for your mental health, by the way.

Yeah. I try making my bed every day.

Excellent! [laughs]

That usually helps. [laughs]

Do you have a question you want to ask, Dad?

Well, I can relate to Sophia’s life in a very strong way, because she’s working really hard. I’d call that endodontics in the clinic. And then, there was all that travel that Phyllis and I did, and I know when she travels, I’m always thinking about how proud I am because she’s sucking it up. Because everybody just sees you on the court, and they see the match. They see you on stage. They don’t realize all the hours and work –

Ugh.

-- and effort that went in behind the scenes. So, I’m really proud of that. Any final advice?

Speak up. We have a helicopter above us. [Helicopter is loud]…

And so, we’re back. We had to pause a second because of the helicopter overhead.

[laughs]

But I just wanted to ask you, you’re a sophomore this year, correct?

Mm-hmm.

What advice would you give to like a new college student?

I think – I mean, not only just for student athletes but also just for incoming just regular students, I just think the most important thing that I’ve realized is just seeing the fun, even in bad situations, and not being too hard on yourself.

Excellent. Yeah. So, have a little bit of sense of humor about yourself and not take --

Yeah.

-- things quite so seriously.

Yeah. I’ve been trying to do that a lot more this year, because it was kinda something I struggled with last year, especially with competitions and stuff. And I just feel like I’ve just been a lot lighter and I’ve just – I’ve been having a lot more fun this year [laughs].

Oh, nice. Okay.

Well, I’m really, really proud of you.

Thank you.

And it’s just a delight to have you here with us today. And I guess I’ll say, go, Warriors. [cheering in background]

Yeah. And I just wanted to add, too, that Sophia is one of my preferred hiking partners, too.

Yeah [laughs].

So, I’m happy that she’s going to college in Santa Barbara.

I can keep on her pace.

And the – and the mountains start right there.

Yeah [laughs].

The mountains start right there.

All right. Well, thank you so much, Sophia, for talking to us on the show.

Thank you.

I know not all of the grandkids are excited about doing it, but --

[laughs]

-- [laughs] I definitely knew you would be good. So, thank you for coming on.

Thank you.

Thanks, hon.

See you next time on “The Ruddle Show.” [Music coming up]