New and potentially disruptive technologies come to market each year, proclaiming to improve on what came before. Many of these newcomers have virtually no evidence-based research to support claims of better, easier, or faster...
File Movement & Learning Manual and Mechanical Options & Endoruddle Recommendation
This show opens with a brief look at the top trends in dentistry, because Ruddle has his finger on the pulse. Then Ruddle does a presentation focused on file movement – Think rotary, reciprocation, envelope of motion, brushing… a metaphorical endodontic dance. Next, Ruddle and Lisette introduce “Recommended Resources”; check out the wealth of information on the Advanced Endodontics website. The season concludes with another Featured Grandchild: Eva Kershner and her beauty esthetic.
Show Content & Timecodes00:39 - INTRO: Top Trends in Dentistry 05:50 - SEGMENT 1: File Movement – Manual & Mechanical Options 31:01 - SEGMENT 2: Recommended Resources – endoruddle.com 44:13 - CLOSE: Grandkids – Eva's Art & Cosmetology
Extra content referenced within show:
Other ‘Ruddle Show’ episodes referenced within show:
Extra movie/video content:
Downloadable PDFs & Related Materials
Ruddle Glide Path Management Technique Card featuring ProGlider (rotation) & Gold Glider (reciprocation)
Ruddle Shaping & Finishing Technique Card featuring ProTaper Ultimate
Ruddle Technique Card on "WaveOne Gold"
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.
… And I think the reason we’ve gotten along so well is, you know, grandparents and grandchildren have a common enemy…
INTRO: Top Trends in Dentistry
Welcome to The Ruddle Show. I'm Lisette, and this is my dad, Cliff Ruddle.
I hope each of you are doing more than good.
Okay. So, here we are, in the aftermath of the COVID pandemic, and guess what? Dentistry survived.
Yep. Isn't that a relief.
In fact, dental spending did not drop as much as some experts had anticipated. But you might be wondering, given the current state of dentistry and the state of the world, what is currently trending in dentistry? Well, we saw a list, and I have to say that we were very pleased, because we noticed that a lot of the trending topics on the list were things we have talked about on The Ruddle Show in the past couple seasons. So, yay for us. We're being relevant.
So, let's bring up the list now. Okay. I got this list from an article by Josh Howarth, who is a cofounder of Exploding Topics, and that's a company that monitors trends through internet searches. So, we will have a link to the article in our Show Notes, but I see that number one on the list is, dentists are investing in 3D printers. And this is great, because we've actually talked about this on our show a few seasons back. They're printing all kinds of things, dentures, clear aligners, dental models, surgical guides. So, a lot of things.
What else is trending?
Get margins and freedom. [laughs]
That all relates to solo practices kinda going down. Big trend going down in the last ten years. There used to be a lot more solo practitioners. Because of that, we're seeing more consolidation of the industry with people coming together, so group practices. And of course, there's the DSO. And the DSO we've talked about several times, and I'll just say shout out to Heartland, my friend Workman. But Heartland Dental is the largest in the world, with over 1,000 practices. And I won't list the list here, but there are at least -- at least six specifically endodontic DSOs.
Okay. So, group -- practice consolidation. Another thing that's happening is that digital marketing is now the preferred form of marketing.
Yeah. It's big.
And dentists are using social media to promote their practices. Also, subscription based coverage has become popular, and that's where a patient pays either a monthly fee or an annual fee, and included with that fee is maybe a couple teeth cleanings, maybe some fillings, maybe some x-rays. But this is good for both patients and clinicians, because for patients, if they're paying the money, it kinda commits them to come in.
And for dentists, it's like a regular income coming in.
Yeah. So, I see next on the list is one of your favorite topics. What is that?
Oh, it would be lasers. You know, we've talked about lasers so many times on the show. We talked about lasers in the context of 3D disinfection. And that would be more like a Lightwalker, 2,940 nanometers of light, because it blows up the water molecule. But recently we talked about photobiomodulation, PBM. And I'm all excited about that all over again, just kinda preparing for this show. But I won't list all of the things it can do, but it's being used widely. Of course, it's not 2,940. It's more like 650 to 950 nanometers, and it can do a host of things clinically. Make you look like a hero.
Well, we'll be talking about lasers more, I'm sure. Then, there's been more of a demand for natural products like maybe herbal toothpastes or oral probiotics. And the good news is, is that some of the mainstream toothpaste companies are listening and starting to offer some options that are maybe more natural. Teledentistry is big. We've talked about on the show. And then, I see we get to another one of your favorite topics.
Well, I like AI a lot, and artificial intelligence, I got caught yesterday looking at the father of artificial intelligence [laughs].
I got off tack. Anyway, it's -- think in terms of practice management. And I just mentioned, you know, we have the solo practice going down. We have consolidation going up. We have DSOs climbing maybe ten percent. So, there's a lot -- there's bigger offices. There's bigger machines, okay? More people. Well, a lot of times you get a lot of nickel and dime stuff that comes in on the phone. So, you can get software like Chatbots -- Chatbots, and you can do a lot of things with screening emergencies and things like that. So, if they need a real voice, they can get one. But I mean, just for appointment confirmations and things, you know, I think it's -- it's something to look at.
Okay. And then, last on the list is, there's definitely a trend toward wanting patients to be more comfortable and free of anxiety and fear. So, some practices tout sedation dentistry, but there's a lot to be said for having a welcoming, inviting, friendly waiting room that's clutter free, where the energy flows like a gentle breeze.
Oh, my. You're talking about something we did earlier.
Did I say feng -- did you say feng shui? [laughs]
But if you don't know what we're talking about, we talked about it in our last show. So, check that out. But now, I think it's time to just gracefully flow into our first segment.
SEGMENT 1: File Movement – Manual & Mechanical Options
Today we're gonna talk about something that's very old that we're gonna make new again. How about that. You know, in the context of canal preparation, mechanical, you know, versus manual, I’m gonna come down to some really basic things today that are pretty exciting for me. And then, they've really helped me across my practice decades. So, I wanna share with you. And we're gonna look a lot at the motion and the movement. So, the handle of the file is going to dictate the motion, and then, of course, that's gonna precipitate a specific movement that we have in mind. So, let's get started on this.
Roll up your sleeves. This seems like it's gonna be 1950s revisited, but it's gonna be with a 2023 spin. All right. So, you look in the background, you see the roots that visit us daily in our clinical practices. They're sometimes highly curved. Sometimes the roots are relatively straight. But remember the canals are more curved than the roots that hold them. So, you might be all excited. It's 2023, you've heard Ruddle's lectures, you've heard other people's lectures, you've been reading, you've been watching, and you've been to the website, the Ruddle website, over and over and over.
And you're now really ready to see, well, why do we even need hand files? I thought that glider could get down there most of the time, and that's glider's gonna spin. So, the motion on the handle, you chuck up, and it's gonna spin in rotation. The motor can adjust the torque and the speed, and all that is done for you. So, basically, you pick it up and use it. And in more open systems, you've noticed, we've noticed, we've all noticed, about 63-plus percent of the time, mechanically, you can get right to length on the first instrument, no hand files. Okay? So, that's pretty exciting.
Reid Pullen, if you're listening -- he's gonna be on the show here in the future, and I told him he can't be on the show until he's done 500 canals with no hand files, and I wanna hear from him and share with the audience what his experiences are. Well, of course, some of you think, well, I don't wanna spin. I wanna kinda replicate that manual hand motion, and so that we can use unequal bidirectional angles, these files are gonna be somewhere about -- I'm just gonna say approximately 8/10 of a millimeter.
Kinda like in here, a little short of D16, which is up here. So, you can see, if you go from about a 16 at the tip, they both have about a 16 at the tip, we have multiple tapers, and we can use these files oftentimes and achieve length with no hand instruments. Well, then, once you have a glide path, you know the next move. A little shaping. We're not gonna argue today about is it a minimally invasive shape? Is it a more full shape? Shaping is shaping. It's up to the operator to decide what are their reagents they're gonna be using, what's the methods for disinfection, what's the filling technique, and those are gonna all be, you know, imagined, pretreatment.
And of course, that'll guide your clinical actions on how you shape. This is ProTaper. This is ProTaper Gold, still the number-one selling file in the world. You can see the most commonly employed ones. There are four of them, and they spin. And so, if you were spinning for your glide path, you're probably spinning. Now I'm gonna go to reciprocation. This is gonna be WaveOne Gold, and WaveOne Gold, there's four choices. But as you recall, it's usually a single file technique, and the angles are 150. Okay?
And then, it disengages. So, this is engaging, and this is disengaging. So, if you do the math, we can net out about 120. So, three cutting cycles is one circle. So, even the reciprocating file is ultimately always spinning continuous circles. So, that's a little bit about that. And of course, you're really excited. You're going, well, he mentioned early in the lecture that there was a little emphasis on hand files. So, if we can do almost all of them mechanically, why would we even need to go further?
So, when you look at something like this and you're thinking it's got tapers from two to eight percent, it's multi-tapered, it's got a new cross-section. Oh, my goodness, it has a new cross-section. So, if you think about the new design on the ProTaper Ultimate file, the three rings let you know it's not Gold, it's Ultimate. You can see that there's some innovation. But let's look at the tooth, and let's remember, teeth get a variety of different restorations, don't they? They might get something in here, and then they might get something in here, and then they might go like this and do an MOD. And all of a sudden, you have a lot of restorations going.
And I wanna tell you, if you watch, what happens is, you see recession of a pulp, you see constriction in the body, and oftentimes your apical one-third is relatively wide open. Isn't that something? We've talked about that in other shows. That's why there's a lot of emphasis on removing canyons of restrictive dentin to get apical one-third control. So, you might break that instrument if you try to stuff it into a restrictive canal that is not ready to accommodate its tip in a passive manner. Oh, it's really quiet. I like -- this audience is really listening. All over the world, I hear you listening. All right. So, there is, though, room for hand files.
And I wanna tell you, the more I've thought about building this lecture, it became more and more exciting, because I knew most of you are gonna already be asleep. But maybe you set your alarm for right now [alarm clock rings], because you're getting to the part that can take you to the part that can take you to the next step on your career. If you're a master clinician, you're listening. If you're a novice dentist, you're really on the edge of your seat. If you're a resident, you got to learn this stuff! This is the stuff that makes you the specialist that you esteem to be. So, we need to have the grace of the hand. And the hand can employ a lot of different motions on the handle, and that could produce a lot of different file movements.
So, what could we think about? Well, you open the tooth. You got your access. You probe with an explorer, and you're going, geez, there's just a little catch. You look at your mechanical file, and you're saying, I don't think so. That would be an unnecessary risk. So, we have to understand, we can use a specific motion in the body, okay? Oh, I love doing this. So, we have coronal, middle, and apical one-thirds. I have said for decades that each third is about three, four, or five millimeters, and that means we're gonna use body work. And that'll be the upper six to ten, the six to ten millimeters.
So, in the apical third, there's a completely, entirely different way we bend the file, and the way the motion on the handle is, and it produces a different movement. See? It's not all mechanical. Now you're thinking a little bit. There's lots of options for the manual filer. And then, of course, when you get to length -- let's clean this up right now. You're not -- let's say it wrong. You are not establishing patency. Before you ever entered the tooth, it was absolutely open and patent, so you're verifying patency. Change the language; change the thinking. You're verifying. You're confirming that the canal that was already patent isn't now being blocked or occluded with a collagenous plug of tissue or dentinal debris. The fatal flaw in endodontics is mud.
So, different motions on the handle, different movements are gonna be produced in the file. And I think it starts to really get a little bit exciting because some of those cases you struggled with, you were probably just trying to do them all mechanical. And if you're a younger dentist, it's mechanics out there, and it's a mechanical world, and I'm using my mechanical files in a mechanical way today! All right. I'm a mechanical man, I'm a mechanical man! Well, how about going back to something that's been taught by Dr. Herb Schilder, decades and decades ago, but certainly in the '60s, certainly in the early '70s. This was the way we learned.
And since I was in Boston at Harvard, Schilder was at BU, there was a lot of exchange between residents and students in going to classes with one another, and we'd begin to understand motion and movement. I don't know that any grad programs in the world really talk about handle motion and movement. That's why I’m doing it today because it's a very old topic. Schilder said, let's work in the body. Let's get the canyons of restrictive dentin eliminated. So, what'd he say? Get rid of that, and let's just think of the upper six to ten -- the upper six to ten millimeters.
How could we get that open so we could get access into the most delicate part of the system, the apical one-third? That's where you have the divisions. That's where you have the branches. That's where you have the bifidities. That's where we have the blocks, the ledges, the transportations, and all the things that we've been talking about on this show and all the ways to manage those upsets. So, if you take a file, like Schilder said -- let's just pretend it's blue. So, let's make it a 30, not a 60. So, it's gonna be 3/10 of a millimeter; it's a 30 file.
He said, take a brand-new file out of the box. And he said about D8, so there's 16 millimeters of active portion. There's 16 millimeters. D16, D0, he said D8, just put a big curve on it, right in the belly. I want you to know that I know, if you look at the end of this instrument, it's a straight line. There's no curve there. And you're thinking, oh, no, I went to West's course, I went to Machtou's course, I went to Ruddle's course, they said, put the bend towards the terminal flutes of the file! We did when we were in the apical third, but we're in the body! And the bodies of most canals are relatively straight.
So, Schilder said, based on the bend -- based on the bend you place, you're going to have a spring effect. This is Mechanics ten1. In this method of opening up the body, understand the tip of the file is never to engage. It's passive. But by putting a big curve in it and stuffing that down into a restrictive canal, when you spin the handle, you're gonna get an envelope of motion. You're gonna get an envelope of motion, and the belly will start randomly carving, randomly carving, randomly carving. So, you put the file in -- see this? See this? Just shuttle it in. Gentle. Think of a feather. Think of kissing a baby's forehead.
Shuttle the file in. It'll become snug, because this bend will bind, and then you rotate the handle clockwise as you simultaneously withdraw the file. So, watch the hand. Rotate and withdraw, rotate deeper and withdraw, shuttle it in a little bit deeper, rotate and withdraw. If you're withdrawing on the outstroke, you cannot advance the instrument. Schilder understood, no ledges, no transportations, no deviations. The file's loose at its terminal extent. And so, by going through a file -- this is just to show you how to use it -- you can produce envelopes of motion. Now, it's interesting to note that we could have bent the file even more, and we would've had a bigger spring effect. We would've had even a bigger rebound.
And it's that spring effect -- so, every time you take the file out of a tooth, you gotta re-bend it, get the spring back in, and you can open up the body. Now, let me explain something. As you begin to remove canyons of restrictive dentin, think outside the box. It's not this or this! How about, it's both! You can get a little space. It's safe. Put in a mechanically driven file and finish the pre-enlargement. That is now uniting all worlds to a more perfect outcome. All right. So, what's next? We know how to use it, we know how to bend it. We can bend it little, you know, little, thin roots, little, small bend. Bigger, bulky roots, bulky form, you can have what? A little bigger curve, and you're up in the body.
The thing to make it come home for you is, Schilder always used an isosceles triangle cross-section. So, the raw stock is triangular, and it's twisted on its long axis, and you have a fluted reamer. So, Schilder always did the body work with a reamer, not a file! Files are down here. Reamers are up here. Okay? So, Schilder didn't just say, you know, go through the series and get this thing pre-enlarged. Notice how we've got this thing opened up now, and we have greater access to the apical third. Some of you learned clinicians are always thinking ahead. You're going, my God! I can now pre-curve my little 10 file. I can pass my pre-curved 10 file through the pre-enlarged body of the canal.
We've used the envelope of motion, and my file will arrive in the curvature curved. And now I can start going with the files. Johnny West says, follow, follow, follow! John West. All right. So, it wasn't just one pass through a series of reamers. Disregard the nomenclature on the handles. These look like files to me. It's the concept I'm teaching. And I made a comment, he used a triangular reamer. Schilder said that if we're having recapitulation -- recapitulation was going through a series of files once, and they would go in and if you looked at the rubber stops, they would -- there'd be big gaps. There'd be dimensional changes from stop to stop on sequentially larger files.
But he said what? Go back and recapitulate again and go back and recapitulate again. And after about three or four passes, guess what? The rubber stops will show you the perfect shape. Each larger file is moving further and further away from length, and if you look at those stops, it's like going up a stairway. So, the work was done when the stops roughly approximated about a stop difference between successive instruments. Recapitulation. There's another recapitulation, and that's down here, and that's clearing the foramen of mud with a clearing file. We say recapitulate! Recap with a ten, please. Recap with the SmartLight Pro EndoActivator, please. Let's put these ideas together.
So, that was a little bit about the envelope of motion and going back to the Herb Schilder idea. And what some of you never knew, that became ProTaper. The whole concept behind ProTaper was the envelope of motion. That's why -- I'll just say this first. That's why these files have increasing percentage tapers -- increasing. So, as you go up the file, the file is going from like 2 percent, and it can go up to maybe 12 percent. It can go from two percent to ten percent. We built these files based on the envelope of motion.
So, they're -- these shapers, they're made to work here. They don't really do much up in the apical third. The apical third is just kinda following the glide path that you have confirmed. So, it's kind of interesting -- Schilder died, I believe it was in 2006. We launched in 2001. He said to John West, and he said it to me, that if he was a practicing clinician, it was the next logical progression, ProTaper Gold. In that case, it would've been ProTaper Universal or even ProTaper. They were all built with the shapers' having increasing percentage tapers.
You might notice this is -- this diameter right here on the SX is 1.2 millimeters. Listen. For you minimally invasive people, some of you've pulled off the SX, although it remains the number-one selling file in the world for body work. But if you think it's a little too big, then you can go to Ultimate. Ultimate -- ProTaper Ultimate has a single shaper, and that shaper is what? One millimeter wire. So, this will give you a skinner body, this will give you a fuller body. Look at the X-rays, look at the CBCTs, look at the images. Begin to think, visualize, plan, and then grab the instrument and execute.
So, at any time after hand files, or while using hand files, one can go to a more efficient instrument. Remember, in the new era, hand files are really just to secure canals. Just to have that slide path each time, every time, all the time. What else can we say except to acknowledge the author? I had a nice discussion with Robert Kaufmann. He's up in -- we call it -- well, they say “Winnipeg” in Canada, but I always know it this time of year as "Winterpeg."
But we have some good friends up there. We've had another guy on this show from up there, too. Ken Serota is from Toronto, and I'm like the third author. But we wrote this many, many years ago. It's approaching 20 years ago, and it was "From Concept to Creation," and it was all the description -- you didn't read the article, did you? Hell, I didn't even read the article. Well, I wrote it -- part of it. So, anyway, we explain how this file right here that you bend, it can have tapers of two, four, six, eight. Schilder understood that a two percent tapered file -- a two-percent tapered file, if it was bent right, if the motion on the handle was right, it would produce a movement where a 2-percent file could give you 8- to 10-percent taper. That was unheard of.
Most endodontists never understood it, most people never learned it, and most people have no knowledge of this. So, understand that that hand file can be used at speeds that approach 300 rpm's, regularly! People don’t think like this. Kids go, mechanic, are you kidding? Take forever! Did you know, if you watch the masters, they can open up a body in probably four, five minutes? They can get to the apical [laughs] one-third, establish patency. It's a few more motions, with different bends, different handle motions, different file movements, and they can get that blend of that deep shape and blend it right back up into the body.
So, before you surrender and say no more hand files, I'm a busy person, and I don't have time for such mundane things, remember the flexibility, the speed, the motions and movements, it's incredible. So, let's go on. Let's go right on. Okay. So, negotiate the apical one-third. And it's a different motion! So, in this case, you grab your brand-new 10 file out of the box. It's sharp, and you're going to use a little curve towards its terminal extent. You're going to simulate the curvature as evidenced on the radiograph. Now, you're gonna say, Cliff, I can't even see the apical thirds. Well, what if you see this?
Remember, the lesions of endodontic origin form adjacent to the portals of exit. So, there must be something coming up in here that bends. There must be something that bends. So, learn to bend your file to simulate where the lesions are on the radiographic images. All right? And if you do that, you're starting to play big ball. And now you're gonna play above the rim if we're playing basketball, and we're gonna snake that file, shuttle it down through the body. It'll be passive, and then it'll get into the curvature pre-curve, and it's now a different motion. It's a watch-winding motion.
Now, this morning, just for kicks, at 4:30, literally, I Googled it, because Phyllis and I have long ago spoke about this and said young dentists don’t even know what a watch-winding is, because their watches don't need to be wound. Go Google watch-winding, and you'll have an Endodontic Lesson 101. In fact, Google watch-winding, quote, hand files. And there's thousands of things up.
Well, Ruddle has talked about this for five decades, and it's this, it's just this. And you -- you know, it's just get back up on the handle. We're gonna show that. You guys are down here like it's tennis racket. You think you're playing baseball! It's a gentle motion. It's passive. It's light! And it's just wiggle, wiggle, wiggle, wiggle. When the file's snug, it means it's been pulled down, the blades are lightly tapping into dentin. It could be circumferential dentin, it could be two-wall dentin, based on the cross-sectional configuration of the canal.
And we're gonna wiggle that file down. When the handle's snug -- snug, not tight -- not tight -- there's a difference -- snug versus tight -- then, the operator pulls. Feed it in, pull. Feed it in a little bit deeper, pull. Every time you pull, just like the envelope of motion, you're cutting up, up, and away! TWA! You're flying now. You're not digging, you're not gouging, and you're not forcing files towards length. So, snug it in, pull, and do that repeatedly until your file reaches your desired working length. For Ruddle, that would be the radiographic terminus, recognizing the file would be a little bit long.
What's the third? So, we had an envelope of motion up in the body, we had a little watch-winding down in the apical third, and now we got to make sure the canal remains permanently patent. Say "patency" as you walk around. Patency, patency, patency, patency! I've patented on it! All right. If you're patent, everything good comes your way. Okay. Zippity-doodah, zippity-day. All right. So, now, watch. It's just in and out. It's not this, it's just linearly, in, out, in, out, in, out, in, out, in, out, until as West would say -- Dr. John West -- loose!
When the file is loose, and you could take your nose, if you could get it in there, if you could get your head inside there and under the rubber dam, you take your nose and push the file to length. That's loose. And a loose 10 means the case is yours, all good things will happen, the shape will expand as you determine, and you'll be able to disinfect, hold your reagents, pack with three dimensions, have a capture zone, all of the good things we've talked about. In and out, in and out, until the file is loose. So, if you watched the movie, notice where I'm holding the file. If you just looked at that slide for 30 seconds, you could've had another 2-hour course and gotten CE for it somewhere in the world, because there's so much to learn.
Where am I holding the file? How am I holding the file? Is it a violent move? Am I twisting the file? Oh, no, he said "in, out, in, out, until the file is loose." And when it's loose, take it out, and the case is yours because mechanical files will follow a loose 10. All right. So, we've talked a lot about this. Isn't this cool? And I think I'll leave you with the Sistine Chapel, and I think I'll leave you with Michelangelo, and he made "The Creation" and the Creator has the ability to help you keep learning and charge your endodontics ever forward! Thank you.
SEGMENT 2: Recommended Resources – endoruddle.com
All right. Well, we have a new segment to debut for you today, and it's called "Recommended Resources." And the point of this segment is to highlight either a website, a teacher, or an organization that we feel is an excellent source of dental or endodontic information and could be really useful to clinicians, maybe even game changing.
So, for this first installment of "Recommended Resources," we'd like to refer you to our own advanced endodontics website, endoruddle.com. Now, I don't wanna cause confusion, so I'm gonna clarify this right away. We have two websites. We have The Ruddle Show website, which is exclusively devoted to The Ruddle Show, and then there's endoruddle.com, which is the topic of this segment and is the home of all things Ruddle endo. Okay. So, let's -- to start, why don't you just give the audience a general overview of what a clinician might expect to find at endoruddle.com.
Okay. Well, I guess to back up a little bit earlier, having traveled the world and having many relationships internationally, I wanted to stay connected. So, I think mid- to late '90s we started some form of the current website. It's grown a lot. I'm very proud of your sister, Lori. The idea was to take the content -- clinical content -- and to give it to people so they could, you know, read, watch, and listen. And I should further break it up into, we kind of had the diagnosis, clean, shape, pack as a pod theme.
And then, we kinda have a retreatment and the breadth and depth of that field, and then surgical root canal treatment. And so, you could go there and watch this stuff and mostly it's all free. And there's a list down here, because I don't go there myself so much, but there's articles, DVDs, streaming videos, inventions, supply lists, technique cards, that kinda stuff.
Okay. Well, I wanna point out that there used to be a lot more about Ruddle courses and lecture travel, but with COVID and then the advent of The Ruddle Show, you've been traveling a lot less, and you have been focusing a lot more on The Ruddle Show. So, one thing that's on the website that I know that you're very proud of is something that we refer to as "Just-In-Time Education." So, how did you come up with the name "Just-In-Time," and what is your thinking behind it?
Taiichi Ohno! Taiichi Ohno was a really great guy in Japan, came into prominence around the end of World War II. And he -- you know, they were completely devastated and lost a lot of lives. So, they were working on their manufacturing and their whole infrastructure. And since it was completely wiped out, they could start from scratch. What would be the best way to do it? So, he leaned heavily on this thing called kaizen. Kaizen is where you are on the line, and you look at what you're doing, and you don't just do it, you study the process, and you make suggestions. And out of that came the mantra, "continuous learning."
Also, Taiichi Ohno was very big on lean manufacturing. You don't just produce a bunch of cars or a bunch of this or that. I should probably say, when I said "cars," he was the Toyota Production System, TPS, and that's famous around the world. TPS borrowed heavily from Henry Ford, and that was an industrial revolution and production, 1950, the grocery store model, barcodes and inventory on the shelves just in time. And so, he took al these ideas, Deming's ideas, he was the guru of organization and quality control, and together he came up with actually their manual for TPI -- TPI -- TPS, sorry. Toyota Production Systems. I love that story.
And I thought, well, as a teacher, I need to have just like not too much education, not all crazy, I need to have it just in time based on what dentists most wanna learn. That's the guy on the line that's telling you what the process is, to make it better. So, "Just-In-Time" was a thing that I thought would be ready to have a short little clip of something, before you walked in to see your next patient, and it was -- the theme would be watching something that you're gonna be doing momentarily. So, just in time for your next patient.
Okay. Well, that's great. We have now over 100 "Just-In-Time" movies on our website, and they range from about two minutes to there's a few that are about an hour. And they include clinical techniques with animations, live breakout sessions from Ruddle lectures, other lecture clips, introductions to new products, et cetera. There's a lot more they even cover. So, these "Just-In-Time" movies are all available to watch at no cost. Now, we also do have some DVDs that are for sale to stream. We have a Shape, Clean, Pack DVD that's 180 minutes, and then there are 4 nonsurgical retreatment DVDs. Tell us about the retreatment DVDs.
Oh, didn't you see the glint in my eye?
We called it affectionately "The Brick." There was four of them. The first one related to what? What do you do first? Disassembly, and then identifying aberrant, previously missed or mineralized canals. There was a good part in there, though, about communication, because when people have a tooth that's failing, and it was done by somebody else, they're not so happy. So, there's a lot of emphasis how to get the patient to focus away from maybe their upsetness and anger and look at the stepping stones to success. And we can all focus on what's next towards success.
So, I think the languaging in there was really good, and there was a thing on profitability, because if you're gonna do retreatment, you gotta get paid for it. The next tape was -- I'll just make it -- removing fillers, gutta percha, silver points, carriers, and paste fillers. The third tape was broken instruments. Whoa! That never happens. And post removal, and the post removal was metal and nonmetallic, and then, all the parameters you think about. And the last one was really -- you know, we've talked all around it, blocks, ledges, transportations, and perforations. So, that's kinda a little summary of what's in there.
Okay. Well, I wanna point out a couple things. First, the updated retreatment DVDs are from 2004, and the updated Shape, Clean, Pack DVD is from 2008. However, they are still quite relevant, because although technologies have changed, the concepts and fundamental techniques have largely endured. The second thing I wanna point out is that all parts of the Shape, Clean, Pack DVD are included in the "Just-In-Time" movies. The value of the DVD is that it organizes the information for you.
Now, not all parts of the retreatment DVDs are in the "Just-In-Time" movies, though. That's different. There is retreatment footage in the DVDs that is exclusive to those DVDs. So, I just wanted to mention that, if you're wondering, well, these are -- these DVDs are too old, or maybe you thought, oh, I’m gonna go buy the new DVDs, but you already have the DVDs [laughs]. So --
In the world of retreatment, you might have an occasional new tool or something, but it's the concepts that carry always forward.
Okay. Why don't you tell the audience about the inventions part of the website now?
Well, I'm pretty proud of the inventions. Sometimes I used to be a little embarrassed to talk about it, because it tended to put a little more focus on me than I wanted. But you can look at it, but I've probably invented somewhere around 12 to 15 items, and probably 10 or 12 of them are selling every day internationally. And when I say "inventor," I'm either a single inventor or a coinventor, because I had some remarkable people, as you know, in my life that have helped with these wonderful projects.
I think what Lori did that was so cool is, every invention stands alone on its page, and I think you could then read about it, and it's kinda technical. But then, you can say, well, I might wanna go to a technique card and see how to use this. So, you can go to technique cards and click. You can go off and read an article, a clinical article PDF, you can watch a movie. So, you can tie the inventions to what -- how they work clinically and what you're doing.
Yeah. I really like that about our website, how the information --
Boring [in sing-song voice].
-- [laughs] the information is so interconnected, like a network. Like, for example, if you search something, like say you search filling lateral anatomy, well, a wealth of information will come up in the form of PDF articles you can read, "Just-In-Time" movies to watch, blogs, FAQs from the website. So, a lot will come up, and you can learn in many different ways, watching, listening, what we talked about. I think you have something to show everyone, right?
Yeah. I brought them in. I got some technique cards. There's ten of them here, and you know, we wanted to have a little card. It has typically -- you know, like if you're talking about a technique -- I don't know what we wanna look at. But if you wanna look at files, as an example, or you wanna look at anything, you see the product, and the technical information's on the front, and on the back, it's how to use it in a step-by-step manner.
So, I always thought, why are we doing this? We have all kinds of handouts at courses, but colleagues love these laminated cards. We wanted them to fit, you know, right in the breast of your coat. See that? Just fits right in there. And you know, people all over the world say they use them, and they have them chairside, and they have them everywhere. I always thought chairside would be a little funny, you know, to --
-- you know, and you're sitting here, doo-doo-doo. Well, anyway.
Well, yeah. I know the people - the course attendees really love those, and they would call, and they'd say, you know, I forgot my technique cards with the ring on it. And we'd say, oh, well, they are also available on the website to download.
And then, they thought, well, I like the ring, though --
-- and -- and how they're like this. So --
Did you punch them and send them a ring?
Yeah. You could download them from the website, print them out on like card stock, and do your own thing and kinda make this. All right. Well, we also have supply lists that have been recently updated. They're on the website. There's over 50 Ruddle articles that you can download at no charge. Definitely check it out because there's -- you'll probably find some other gems that we haven't mentioned. I just wanna emphasize again that almost everything on the website is free. You only need an email and a password to create an account, and the site is also mobile friendly. So, you can navigate from your smartphone.
Now, Dad, who do we have to thank for this great website? I think you've maybe said her name a couple times already.
Well, I said it as a mystery guest, but she's not a guest. She's the producer. She's your sister, she's my daughter, she's my wife's daughter, and her name is Lori Ostovany.
Lori Ostovany. Lori, I'm looking right at you now. Kudos to you, kiddo. You've done some magnificent things. It touches my heart. You've taken the website and all these things, and you've made it personal, and you've taken them to next level stuff. So, mmmmm.
Did she do it all by herself?
No, I -- my job -- I don’t know anything about the website, everybody out there, but I -- I have to produce content [laughs]. So, I have to run hard and keep doing clinicals. We wanna thank Larry Murphy. He's the webmaster, I guess you would say. Lori might be the webmaster, but he was the guy behind the scenes. And then --
The company's Final Code.
Yeah. Ken the Coder. He's from Bangkok. He's coding over there as we speak. And I wanna say a big shout out to Glen Derbyshire, and he has an editor called Mitch Goodgion. And I think Ken, Larry, Mitch, Glen, me, stir in a big part of Lori, and you've cooked what you got.
Yeah. Lori's -- Lori is -- does all the final overseeing, the maintenance. She's -- like, anything that's put on the website has to be approved by Lori. So, she kind of monitors everything and -- and she has very, like, special way of looking at things and very clear and aesthetically pleasing. So, the design, she just -- I think she's mostly behind it, honestly. [laughs]
Well, yeah. Because if you think about it, I can give you a puzzle, a 5,000-word [sic] puzzle in a box. It doesn't make it a puzzle, does it? So, she took pieces, and that was her wonderful thing. She's got an eye, and she is really organized with her computer background. So, she's a good thinker.
Yeah. So, a big thank you to Lori for a great job managing the website. Be sure to check it out. I just wanna emphasize that you need to subscribe to both endoruddle and The Ruddle Show, that they're not -- one subscription does not cover both websites. However, we do try to link them together as much as possible. Well, that was a very informative segment. And thank you for all the information and thank you to Lori for creating a masterpiece website.
CLOSE: Grandkids – Eva Kershner
All right. Well, we're gonna close the show today with another "Grandkids" segment, because you know what they say about grandkids. They restore our zest for life and our faith in humanity.
All right. Well, you're probably already aware that my mom and dad have five grandkids, two from me and three from Lori. And you've seen them make some appearances over the seasons on The Ruddle Show, and you might also be aware by now that my son Isaac works on The Ruddle Show. So, the whole idea behind this segment was every season we were gonna devote a close to one of the grandchildren and find out more about them and what they're up to. So, we've already talked to Isaac, and we -- last season, we talked to Sophia, Lori's daughter, at Westmont College.
And today, we are joined by my daughter, Eva, and she's gonna tell us about her beauty esthetics. So, welcome, Eva.
Hi. Thank you, guys, for having me. I’m excited [laughs].
Yeah. Great to have you on the set. And we've always been like best friends.
And I think the reason we've got along so well is, you know, grandparents and grandchildren have a common enemy.
Well, anyway, yeah. It's great to have you on the set, babe.
Thanks for having me.
Okay. So, why don't you start off by telling us what you are up to right now? Like, what did you most recently accomplish, and what are you most looking forward to in the immediate future?
Okay. So, at the end of last year, I graduated from the cosmetology program and then went on to take the state board exams, and I passed. So, now I'm officially [applause] a licensed cosmetologist, and I'm just looking for a job now. So --
And what about -- what are you -- I know that there's something you're really looking forward to later today, even.
Yeah. My good friend, Leo, he is coming all the way from the UK. He's been here a few times as of last year, but he's now visiting again. And he gets along with my family and friends all super well, and he's coming tonight. So, we have to go pick him up after this [laughs]. So --
Can we say it's a big day? I mean, you're on the show, and you're going worldwide, and --
-- then, Leo's coming, worldwide guy.
I'm really happy he's coming because I'm gonna help him learn how to speak correct English.
So, we're gonna work on that. You know, they always tell me I don't speak the good English.
And then, I love talking sports with him, as long as I stay very narrowly focused to soccer or football, right?
Yeah. Right [laughs], exactly.
Well, yeah. So, we're gonna be watching a lot of the Tottenham Hotspurs, I'm sure, on the TV.
And yeah. When Leo comes, too, he comes for not just a weekend or a week. He's gonna be with us for three weeks, and that's actually his shortest visit so far. So --
-- we're excited to have him around. All right. I'm very proud of you, and I know he is, too. And we all are, for --
-- for completing the cosmetology program. That was about a year. And she does my hair, by the way. So --
Yeah. And she does my face because it's wore out two bodies. So, you know, I have Eva now.
So, secret weapon.
What -- what all did you learn in cosmetology, though, because I know it's not only hair?
Yeah. We learned a lot of basically the fundamentals of everything to know about hair. But in specific, we learned about hair cutting, hair coloring. We learned updos for weddings and stuff like that. We even went into nails. We went into makeup. We also even covered a bit of the esthetician portion, which is more facials and waxing, which I actually found really cool. And it's a whole separate program, but maybe, who knows, I can do that as well [laughs]. So --
Okay. Well, our viewers can see from this graphic that we have behind us that you -- there's other pictures that aren't just hair and nails. There's also a lot of artwork. Is this your artwork?
Yeah. So, before I did the cosmetology program, I went to Santa Barbara City College and got my Associate's Degree in Studio Art. So, yeah. I kinda like to do art like on the side, I would say. And this is some of my work up here. You can kind of see that it's very colorful, abstract. I tend to like to create pieces that are very kind of out of the ordinary, something a little unexpected. I never like the viewer to -- I like to -- the viewer to use their imagination, you know? So --
Like the one hanging on my wall in my study?
Wow, what an abstract explosion of colors! It's right there. I see it every day. I get juice out of it, yeah.
Eva's like a really good artist. She always does something that -- like, when I'm -- when I look at her artwork, I'm like, oh, I wouldn't have thought to have done it that way, but that's really interesting. So --
-- yeah. I love your art. And actually, this one with the butterflies and the pink, that was actually for me for a birthday present. That was my birthday present.
Whoa, that's nice.
All right. Well, now that you have the studio art degree and also the cosmetology license, what do you -- that's an -- actually a good combination of talents. What would you wanna maybe do for a career?
Well, I definitely think I wanna start at least just get out in the world of hair and start working in a salon and working with clients. I think the most special part to me is working with people that maybe aren't feeling good or, like, making them feel better about themselves and have self-confidence. It's like you never know what someone might be going through that day, and just like the little tiniest things can make someone feel good, making them feel pretty. So --
What about long-term?
Long-term, I have some long-term goals. I've always wanted to become a tattoo artist. That is something on my artistic side. So, that's always been really cool to me. Also, I've thought about working on sets for movies, as like the hairstylist, the hair -- like whatever, the makeup artist, the wardrobe, even. And who knows, maybe I could get good enough to win an Oscar with that. But we'll see.
That's reaching a little bit, but you never know [laughs]. Gotta keep my options open.
Uh-huh. And you're gonna be a smash hit.
Because you know what, the world of dentist-os knows, if you wanna make people feel good about themselves, okay. And couple that with training, desire, and determination, you're a smash hit.
You'll be a smash hit.
Okay. Well, you once told me -- maybe even it was about 15 years ago, 10, 15 years ago, you told me, when you were 2 -- no [laughs].
No. When you told me that your dream job was to work at the Kea Lani Resort in --
-- Maui, Hawaii, by the pool, and you wanted to do henna tattoos, and you wanted to give the guests henna tattoos. Is that goal still in play?
We'll see. I never like to say "no," but we are going to the Kea Lani this summer. So, maybe I'll have to ask around.
You gonna bring some resumes and hand them out? [laughs]
Yeah [laughs]. You never know.
[laughs] Okay. Well, thank you so much for coming on the show.
Yeah. Thank you for having me. This has been really fun.
All right. Well, that's our show for today. See you next time on The Ruddle Show.
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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Progressive Tapers & DSO Troubles
The Dark Side & Resorption
The Resilon Disaster & Managing Internal Resorptions
Advanced Endodontic Diagnosis
Endodontic Radiolucency or Serious Pathology?
Endo History & the MB2
1948 Endo Article & Finding the MB2
To Be Determined
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