The mechanical objectives for endodontic canal preparation were brilliantly outlined almost 40 years ago. 1 When properly performed, these mechanical objectives promote the biological objectives for shaping canals...
ENDO 101: WAVEONE GOLD Product History, Description & Technique
The show opens with an exciting book recommendation, Into Thin Air by Jon Krakauer, which recounts the May 1996 disaster on Mt. Everest. Next, Ruddle gives an insider’s glimpse into how WaveOne Gold came into existence and describes the concepts behind it. Further, he explains the features of WaveOne Gold and shows how to shape a canal utilizing WaveOne Gold. Enjoy the wrap-up with a humorous Ruddle Flashback featuring a set of dentures!
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Ruddle on Shape•Clean•Pack
This transcript is made available by The Ruddle Show in an effort to share opinions and information, and as an added service. Since all show text has been transcribed by a third party, grammatical errors and/or misspellings may occur. As such, we encourage you to listen/watch the show whenever possible and use the transcript for your own general, personal information. Any reproduction of show content (visual, audio or written) is strictly forbidden.
INTRO: Book Recommendation – “Into Thin Air”
Welcome to Season 2 of the Ruddle Show. I'm Lisette and this is my dad, Cliff Ruddle, and we hope to even give you a better season than last season. We've been practicing a lot and hopefully we're getting better. I was hired on again, so that's encouraging for me.
I retained my position, barely.
We thought it would be good for the first show of our second season to start off with a book recommendation, and we'll do this every now and then, not a lot of the time, so you don't have to be reading all the time. But we just picked a book that we both really like. We both have not even read it recently – it's just a book we read a while ago – but it's always stuck with us and it's come up in conversations a lot. And here's the book, it's called Into Thin Air and it's by Jon Krakauer. Maybe some of you have heard of it. And just to give you just a really brief description of it, this author, Jon Krakauer, worked for Outside Magazine and he was hired by them or commissioned by them to go and to summit Everest, to join an expedition and summit Everest, and the main point of his article or book or whatever he was going to write was he was going to talk about the growing commercialism on the mountain. Then while he was up there, they had their worst disaster in May of 1996 that they had ever had. A lot of people died; a storm came in unexpectedly.
This is interesting that we're doing this now, because when this show airs it's going to be April or May, so that's like the time of the year, the only time of the year that you can actually summit Everest where the weather is good enough. So we all saw those lines last year; did you see those pictures of those lines?
Yeah, I was thinking that since this will air about the only window you can climb Mt. Everest that many of our dental friends out there that are prolific climbers, they might get excited about this book and be better prepared when they make their assault themselves, right?
And climbing Mt. Everest is not so different than being an endodontist, because if you think about it, you're going to a place where very few people have been before, whether it be the summit of a mountain or inside the canal of a tooth that's never had endodontics before. You need the latest technology; you need a lot of training. So there are some similarities there. I mean who would not want to read this book?
Well you know, one thing that I liked about the book is some months ago Lise showed me a picture on her iPhone and it was like all these people that were ready to make the final assault from I think Camp 4 to the top. Which - how long did that take? It was a short distance but it was an enormous amount of effort.
I think from the highest Base Camp you have about 24 hours of oxygen to get up and back. Or maybe it's even less, maybe it's 12 hours. But you don't – you can't stay at the top, so you have to start from below the top, go up and back, and get back there by a certain time window before you run out of oxygen.
That's exactly right. Because if you've watched any climbing in your life, every step at the top is like laborsome. It's like walking becomes almost crippling. What I thought about though when I saw all these people in a queue, I started thinking about the politics of the mountain and I started thinking well why are so many permits issued? And the other thing that was startling is it used to be climbers that got Sherpas and did these assaults; and really quite good climbers. Oftentimes they had done some of the other great peaks on the earth.
So then I started realizing some of these people were out of shape, they weren't conditioned, but they had the money so they could buy the Sherpa and sometimes two Sherpas to help carry all their gear so that they could say they summited. And I thought that was –
You know there's different – there's some expeditions, and the politics is around it – some expedition groups require that you've already climbed another 8,000 meter peak; that you're an experienced climber. There's others that will take on near beginners because they basically think the Sherpas are going to just chauffer you up to the mountain top and back and carry all of your things. So I think that the people who are experienced are concerned that the beginners are going to hold them up and put other groups in danger. So I guess that's similar to a general dentist that might get all inspired with the latest technology and hoping that that's going to work for them, and maybe doesn't have the training or whatever.
Yeah. They can surround themselves with all the technology, but if we don't have the training or we're a little short on experience – because that's earned – we can get into very tricky situations very, very quickly. Just like the last window from Camp 4 to the summit was not to be started after 2:00 p.m.; that was it. So if you weren't on your way to the summit by 2:00 p.m., finished. Well there were guys in Camp 4 that took off at 4:00 p.m.
Well I think it's like you start in the middle of the night and then you have to leave the mountain top by 2:00 p.m. So you – if it's 2:00 p.m. and you're just 100 meters away you should turn back and not finish.
Right. So I was surprised because discipline broke down and risks were taken and groups split up and people got separated. And I started thinking as an endodontist, a lot of these kinds of things with much less gravity happen to clinicians every day in the big city.
Yeah, like maybe you have enough training and enough experience to do the case if everything goes super smoothly. But maybe if something happens that is unexpected, then maybe all of a sudden you're like way in over your head. And I think that's kind of what happened on the mountain. You know a storm came in and a lot of people were way in over their head.
But you know what? It's a great adventure story if you like hiking, and we love hiking. We've gone on many hikes. And I do think that just getting out into nature and breathing the air and hiking where there's not a lot of people around can inspire you when you get back to work.
Yeah. We had a show last time, last season; last show of the season, Stress Management. And one of the things we learned in Stress Management is change your perspective; change your context.
Change your environment.
So we went up Mt. Tallac, that was almost 10,000 feet; that changed our perspective and it changed our environment and it made for a lot of great memories.
Well so this is our recommendation. And also if you're an endodontist or a dentist out there and you've actually summited Mt. Everest, we'd actually be interested in hearing your story. So get in touch with us because this is a very interesting – the mystique of Everest is just really something that we are just always talking about and it's just really interesting to us.
So we're going to start our show now and today we're going to talk about WaveOne and the concepts behind it, how it all got started. And then my dad's going to show you how to use the file system. So here we go.
SEGMENT 1: Endo 101 – History & Concepts of WaveOne Gold
The WaveOne single file shaping system came to market in 2011 and has quickly become the file of choice for many clinicians, dental schools and endodontic residents, largely due to its simplicity and predictability. Today we're going to talk about the WaveOne System, the concepts behind it, and then my dad is going to show you how to shape a canal using the WaveOne technique.
For those of you who are using WaveOne, you might pick up some tips that you weren't thinking about or weren't aware of. And for those of you who don't use it, you'll appreciate its simplicity and you may want to try it out.
But first, you're co-inventor of the project, of the WaveOne System, and there were others that worked with you. So why don't you tell us more about who were the people involved and a little bit more about the whole idea behind the WaveOne Gold Single File Shaping System.
I'll be happy to. It was kind of a messy start because usually projects are three or four people, but this was eight people. I'll explain briefly.
So Pierre Machtou, Professor Machtou, which many people know internationally; very, very smart guy; had been doing quality endodontics for decades. And you stayed in his apartment in Paris you might recall for probably more than a year when you were taking language; but that Pierre Machtou. Anyway, Pierre Machtou had a very interesting idea of using unequal, bidirectional angles. No momentum happened; the company, Dentsply Sirona, at this time it's called, wasn't really interested. So I want to bring in Ben Johnson, because Ben Johnson which many of you know internationally – we could probably call him the “Father of NiTi” – he, on our behalf, went to corporate on our behalf and convinced corporate over many, many years that it was a worthy project and there was a market for it.
So Ben asked me to choose the team so I chose. We had Ben, Pierre, Cliff, John West, Julian Webber, Sergio Kuttler, Willy or Wilhelm Pertot, and finally Ghassan Yared, so there were eight people. But after about one year, VDW wanted Ghassan Yared; he went that way and some other guys went on to other projects. But we could probably look right now and see the four principals.
So here we are at the factory in the foot of the Alps, just in a little village called [Name? 10:37], and you can see Willy Pertot here on the left in the Levis, Sergio from Florida, Willy's from Paris, and the little guy, the third guy from the left – I think he's standing on a box – but his name is Julian Webber, really good guy; and then I'm with my team. And then there was a new factory, part of the plant built, so we had hard hats and had some fun. And Willy must have stepped out – probably bad behavior – but anyway, the three of us then were able to get our thoughts on paper and with the engineers, the project really did commence. And of course we were looking to do something that would be superbly safe and incredibly efficient and super simple.
Okay. Well why don't you tell us a little bit more about the system and the concepts behind it?
Okay. Okay, let's look at WaveOne a little bit deeper. You need a dedicated motor. You might have one already; if you don't, the X-Smart Plus is really a good one. The IQ will allow you to get your own instrument sequences and it's got a touch pad, it's Blue Tooth to your hand piece so they can talk to each other, and you can do amazing things. You might want to look into that a little bit more.
Regarding the four instruments... We have a primary instrument that is usually the first one that you would select and use. It is oftentimes the only one you will use; oftentimes means about 85% of the time if you are a general dentist. That will do about 85% of all teeth and canals that visit your office. You have a smaller instrument, a 2007 if this one's too big and you can't proceed easily in advance to link. If you discover that your foramen in a younger patient, maybe a maxillary anterior is bigger than a 25, we have other sizes and tapers to handle that. Understand most importantly that the 7, 6 and 5% taper is confined just to the last 1/3 of the instrument. And that's important because a fixed taper is what allows us to irrigate safely and to fill root canal systems.
So if we go then to how we decide to make a file, well you look at the literature. You go back and look at maybe 60, 70 years of papers; you look at maybe their bibliographies and that might take you back to 1000 peer-reviewed papers. And at some point, the edge of the truth begins to show up. And what Jim Wallace and his guys discovered is that if you had a 40 at link – that's pretty big, but that was in that era – with a 6% taper, you could clean; you could get your irrigants down there; you could affect warm gutta percha in the apical capture zone. Baumgartner had a whole different idea; he said let's emphasize keeping the foramen a lot smaller. That's 100% smaller than 40. But he said let's emphasize deep shape, more taper. And what he showed is you could get irrigants down and there was no difference statistically in cleanliness between these two shapes. So 20 is a lot smaller; it'll go in a snake tube, microanatomy, more safely, less ledges and blocks, transportations and rips. So somewhere in between these numbers is what our file builder should be thinking. So if you look at our WaveOne Gold instruments, they're all falling in between these parameters.
Well, so how do you get from a virgin pulp that needs to be removed for whatever reason, and how do you get to a fully shaped canal with one instrument? It has to do with design, metallurgy and movement. We'll take a look at that.
So here's our primary file, 2507, and we can basically catheterize this with a hand file; and then we have a pilot hole, a glide path for this tip that's flexible to snake through and follow passively and carve out a final shape that can be cleaned and filled. Let's look at some of those design features.
Per usual, the diameter – that means the diameter at any given cross-section, 3, 6, 9, 12. So we have an active portion and our file is progressively decreasing and tapers like I mentioned earlier. Our fixed zone is only in the apical 1/3. Now this is interesting because by decreasing the tapers you decrease the cross-section diameter, and it's important to note that about 9mm up and 12mm were .85 and 1mm. Hey, half the orifices that you encounter – so you cut your access, now you're looking at an orifice – half the orifices in the human mouth are over 1mm. So we already have a conservative instrument. If you divide your radicular portion of the root into thirds – coronal 1/3, middle 1/3, apical 1/3 – then you can see 3, 3, 3. You're at 9mm at the orifice and if you're 4 mmm, 4, 4, 4, you're at 12mm. So we have a file that's going to maximize remaining dentin. And that's one of the concepts of minimally invasive endodontics.
Also we notice that furcated teeth oftentimes have furcal-side concavities so we have to be very careful that we don't have preparations that begin to drift – as we shape and as we shape and as we shape, we don't want our preparations to drift into the furcation area. Because that then will weaken roots and predispose a longitudinal fracture if not an overt fracture or strip perf. So we have a pretty good design.
There's another design that's very interesting that I think you'll all like. Maybe this is a little bit technical, but we use the concept of alternating offset machining. So if you look at the file and you go up the file millimeter by millimeter by millimeter, what you'll notice in offset machining you will have two points of contact. You go up 1mm you'll have one point; 2, 1; so look at the file. And what you'll notice is we have tremendous chip space. We have chip space and only one point is in contact. And when we have two to keep the file centered in the root, you can see we have space here, we have space here, but there's a lot of space for hauling debris up and out of the canal.
Okay, well I know that the file underwent some changes in 2014. So I know the parallelogram shaped cross-section that we just saw was one of the changes. I'm assuming this gold metallurgy that I'm seeing behind you is another thing?
Thank you. Maybe to be a little better teacher, we have an 85° parallelogram and that is a proprietary cross-section, and that has to do with this chip space. The alternating offset machining gives us more chip space and more ability to auger coronally, so you're right; we talked about that. And then we talked a little bit about the metallurgy now needs to be discussed. It's all three; it's the design, the metallurgy and the movement that together are synergistic. So very good.
Were there always four files in the system, or was it one added?
Oh! Well compared to the original WaveOne, that was a convex triangular cross-section. So we went to the parallelogram – that's very good – and then we had three files in the old days and now we have four files, so we could do a little bit more of the anatomy that presents in our offices on a daily basis.
Yeah, very good. So if you have questions out there too, be sure to ask them; it's fine.
So back to metallurgy; it's a post-machining event. So the files are machined, the handles are put on, they're put in cassettes thousands at a time, they're put into ovens, they go up to a proprietary temperature and then they're allowed to cool down at room temperature, and they get an oxide that's gold colored – hence "gold" – and this improves compared to WaveOne Gold; WaveOne Gold compared to its precursor. These are engineering reports; we got 80% more flexible. If you are still using original WaveOne, you will be massively impressed how flexible this metallurgy has allowed these instruments to snake through multi-planar curvature. Not so bad; not so bad! 50% greater resistance to cyclic fatigue.
I mentioned in other shows that a file could be considered to be like a man's suitcoat. So when you bend the file into a curvature you have compressive stresses, and on the outside of the curve you have tensile stresses, pulling stresses. So when you're going around a curve, reciprocating or rotating, it's like taking a paper clip until failure. So you can see we've massively allowed these instruments to work in curvatures and have a safer experience. And of course not so bad; not so bad that it reduces your shaping time by 23%. That's staggering! ,That's staggering if you're talking efficiency.
So you had mentioned – I see now it's coming up that the movement for WaveOne that uses reciprocation versus continuous rotation. So how does that differ from reciprocating files of the past? And what are the advantages of reciprocation versus continuous rotation?
Very good. You know, reciprocation isn't new. Blanc, the French dentist in the late '50s, introduced a reciprocation angle. It was big angles, 90° clockwise, 90° counterclockwise – 90, 90, 90, 90. And then I'll skip. But through the decades three more companies came in; Essential Dental Systems out of Manhattan, SybronEndo Kerr, they did a reciprocation, and finally Ultradent in Utah and they did 30, 30, 30, 30. But what was important is the angles were always equal.
Well what happened – and this is a great question, because nobody ever asks this – why didn't equal angles take over? It's because as a file goes clockwise, it's pulled in, but when it goes counterclockwise, it's pushed back. So the colleague has to press inward firmly to make the file advance. The problem is a lot of debris was collecting and getting pushed apical to the file, which caused blocked canals, increased torque and increased cyclic fatigue, and we had broken instruments. So Machtou's idea was to have unequal bi-directional angles, and I think we can look at that right now. So this is the whole key to WaveOne or WaveOne Gold.
If you look carefully at the movement, we're going to make an engaging angle that's 150°. And incidentally, that 150° has been calculated to be just beneath the elastic limit of the file, so we are never over-engaging. Then the disengaging angle is 30°. So what happens? If you think about 30 from 150, the net is 120. So after three cutting cycles the file will have moved one circle or 360°. That means we are effectively auguring debris up and away from length up into the looser part of the canal into the pulp chamber where the debris can be cycled off.
So that's pretty much the story with design – it's a short story. I have other things that you can look at, but the design was a big factor compared to its precursor WaveOne. Of course the design led to a definite improvement in metallurgy. That wasn't available back in the earlier days. but most companies now have some kind of heat treatment on their file, either pre-machining, post-machining – ours is post-machining – and finally the movement is everything. So we're the only file in the world that uses unequal bi-directional angles; it's not infringing on IP. And as you said earlier, it's one of the fastest growing – it is the fastest growing file in the world because it's perceived to be super simple. And with some of the technical things worked out behind the scenes, dentists don’t really need to know all that. They oftentimes don't care – not to be rude, but they just want to put the keys in the ignition and drive the car. They're not interested in what's under the hood.
Just to clarify; those unequal angles will allow the file to advance more passively and not – you would have to use less pressure? Because you were saying you would have to push if it was equal angles.
Exactly. So when you change the angles and make them unequal – and I should probably do a little yell out to Ghassan Yared – so if Pierre is the father of unequal angles, Ghassan Yared is the father of dialing in the 150/30. And you're exactly right. If you have equal angles you're going to push inward more and not manage your debris. But by changing the angles, you're continuously making circles like a rotational file; and that then is going to advance easier and also pull debris out more effectively. Like a continuous rotation.
Okay. Well that gives us a nice overview of the WaveOne system and the concepts behind it. Are you going to now show us how to shape a canal using WaveOne?
Oh I've been wanting to show that. Put the file to work!
You know it's fun to make files and you learn a lot about metallurgy, design, rank angle, heliocal angle, cutting angle, tips, tapers, progressive tapers, increasing, decreasing. There's a lot to learn and I learned so much and it's influenced me as a teacher. So I have a lot of fun with it. But yeah, let's take them to the plastic block.
SEGMENT 2: Endo 101 – How to Shape a Canal with WaveOne Gold
Okay, before we get started with the shaping, one more comment about when you're done. I'm asked all over the world, when am I done? Do I stop here? It says primary, you said take it to length; but what if I want to keep going? When do I stop?
Look at your file when you take it out of the tube and especially after you've reached the working length, and when you withdraw the file look in its apical flutes. If they're loaded with debris, the file is telling you this file just cut its shape, your work is done. You now need to think about disinfection and on towards filling root canal systems, okay? So anyway, that's a little bit about how you know when you're done. And you have bigger files if you have bigger parameter, but look for the loaded flutes; that's what is a big distinction.
Okay, let's go into this block. I'm using a block because a lot of people use tooth; a tooth is actually easier. A tooth you can see nothing. You see the file go in the access cavity and you see the doctor pull it out on stage, live demos. Right? But you don't see when the file cuts, how it cuts, where it cuts. So I'm choosing a very tough model. This is actually much more difficult than a natural tooth. And if you look at this model you can see that the canal ends actually right in here. So anyway, if you draw a tangent line to the coronal part, and then we have our first curve so we can draw a second line. And you can see we've got about a 33° angle. So that's the first curve. And then if we draw a tangent line to the more apical curve relative to the first curve you have another 35°. So this thing is pretty tough and we're going to watch how a single file can move down, passively cut a shape, and give us a shape which can be 3D cleaned and filled.
Okay. I think you're ready to go. Ready to go? Ready to go. Always catheterize the canal. I'm reading a lot in different magazines and blogs and videos online that we can maybe not even use files anymore. Please! Come on! If you catheterize the canal, you're going to be assured that your shaping files can – repeat after me – follow. You want your shaping file to follow a glide path. So once you've catheterized the canal, let's go get a film, let's use our electronic apex locators, and we'll knock down the length. Everything's looking good.
The next thing I want you to do is deliberately, intentionally, move the instrument in short, 1/4mm to 1/2mm amplitude strokes, and move the file back and forth until – say it out loud – loose. I want a loose 10 at length. A loose 10 is already almost a 15 file. So if you use the file and length until it's loose; it could be 10 strokes, it could be 100 strokes. The great clinicians that are listening know, there isn't a trick. The trick is until it's loose.
So now that you have working length and we have a patent canal apically, check the glide path. How do we know if we can use a mechanical file on this patient at this moment today? How we know is, withdraw the file about a stop, slide it back in, withdraw it two stops, three stops. If you can slip, slide and glide over the apical 1/3 of that root, not only do you have a glide path, you own the glide path; and instruments, mechanical files, will follow. So you have a really nice setup now to bring it home. The block is coming along very nicely.
Okay, this would be Gold Glider. You've heard of Pro Glider. This is a dedicated, mechanical pre-shaping file – I've written an article and you can go to the website and download it. But the international protocol for using mechanical shaping files is to have a 15 file or equivalent at length. So this is a 15 at the tip, but it's about twice as big as a 15 hand file. So I bring you good news and better news. The good news: it's heat treated so it's not stiff like stainless steel 15. The better news is it's going to make a hole, a pathway, a pre-defined pathway significantly bigger than your 15 stainless steel hand file. That's really important. And you're going to do it in an economy of time.
So after we do work we always know what? We always know what? We have an enormous amount of debris. So that debris has to be removed; we have to remove that debris, okay? And by removing that debris I'm really talking about irrigating. So clear out the canal and now we're ready to take on the primary. Not the small, not the medium, not the large; it's always primary. Primary – there were four clinicians, you saw their faces – but we did over 10,000 clinical cases and we found out that in a referral driven practice, over 85% of all teeth that came to our offices could be shaped with one single file. So when you talk about a single file, obviously sometimes it's a 2-file sequence because if a primary won't achieve length, you're going to have to drop down to the small to finish the shape. Sometimes we call the small a bridge file; because maybe the clinician prefers a little more deep shape and a little bigger apical diameter. So you can then get small to length, take your bridge back, take your primary to length and you're finished. On the contrary, you might take the 25 to length; it's loose at length, there's no debris on the file; this would suggest that the doctor could move to the 35.
Okay, so here we are with our primary. We have a bath of sodium hypochlorite and we should be ready to roll. I want to really emphasize three passes. You know I would travel a lot and when I was in Dammam, Saudi Arabia, I didn't emphasize the three passes and colleagues thought it was pretty easy. And so they just started pushing, pushing, pushing, and we saw ledges. So let's work these files in, and when they've done a little bit of work take a 3rd, coronal, middle, apical. Then let's take the file out, irrigate, recap with a 10 and re-irrigate; always fresh reagents. And as our shape improves the reagents are beginning to penetrate laterally off the body of the canal.
Second pass. You can brush a little bit to remove interferences; to work out into eccentricities off the rounder parts of the canal. We can better metal/dentin contact by brushing into fence. So after every file – this is like endodontic religion – irrigate, recap with a 10 and re-irrigate. Vacuum, irrigate, vacuum. Notice that little bump right there. That was going to be removed in the third pass. Notice how it's smooth and flowing now. Look where the file loaded up; did you see those apical flutes? Oh, if I was a little bit more clever here I'd take you back and show you; that apical part of that file was packed with debris. It just told Ruddle the shape is done; I don't have to go to a bigger file. All right. Irrigate, vacuum, irrigate, vacuum. I'll have another episode and show you this 25¢ syringe can do something the literature says it can't do.
I'll just give you a tip. All the literature says you can irrigate only 1mm in front of the cannula, its maximum depth replacement. I have shown for years that you can irrigate 6, 7, 8mm apical to the placement of the cannula if you do a little vacuum, irrigate; you pump your solutions, you get them to move back and forth, you get better cleaning.
Cones slide into these shapes. This is a Nathan Li cone sold by Dentsply Sirona. Tolerances are magnificent; they're going to go to length 99% of the time. And of course when the cone slides to length, it confirms the shape. How do you know when you're through with shaping? Okay, so you might want to know; how do you know when you can pack? When you can fit the cone. How do know when you can fit the cone? When you've got the shape. How do you know when you've got the shape? When the last file is loaded with debris.
So we have a nice shape, good cone fit. Notice we didn't transport, didn't zip, didn't rip. I have a few cases. Julian was one of the co-inventors. London, England, on Harley Street, still doing – look at the recurvature. That MB is like swinging up and then that little eh; back to the mesial, back to the midline. That's world class endodontics and it's the post to your abutment on a bridge.
And Willy – I'm just showing you some cases from the developers – but notice the recurvature. Notice the shape is sufficient to allow for 3D irrigation and filling root canal systems. Hey, how about David Landwehr? This was the old WaveOne; this wasn't even gold. It's not very curved, so we could probably do that, but notice; hey look at this, notice this. Lesion, lesion, something up in here. At six months, notice all this bone regenerating and repairing and coming back in because David is filling root canal systems. So listen! The trifecta is shaping canals, cleaning in three dimensions and filling root canal systems. WaveOne definitely gives you that opportunity.
So what else? Well, we'll get to the next thing by just showing you that online there's some reference material. My daughter who is with me constantly, she's mainly the author of these articles – on a piece of toilet paper, I use a little pencil and I jot down some bullet notes; I think one-ply for each note – and then she assembles the notes and we have a roll of toilet paper and it becomes an article. So we have great graphics that you can refer back to; mainly what I just showed you. And then of course around the world we like to pass these out – these are laminated technique cards – but it basically shows you the step-by-step; step 1, step 2, right to the very end. So we're proud of this, I'm proud of this and you can download this for free.
Well I think our audience is probably wondering, considering you are inventor of both Pro Taper Gold and WaveOne Gold, that what is your personal preference? What do you use?
Well as long as you're using one of them, I'm very pleased. No, I'm asked that question Lisette, all around the world. Everybody thinks they're going to get me on this one. And here's how I always answer, and I know this maybe sounds political; it's not; it's right from my heart. Everybody that I've noticed that's pretty good at something, they have their own self-discoveries. It's not teaching to say here, I want you to use this. You're here today to train to do this. So if people came to Santa Barbara for decades and decades and decades, well, I said let's get a mandibular molar. Why? Because the mandibular molar has an MB and an ML. The MB and the ML in a mandibular molar, the mesial root, they're going to have about the same length, about the same diameter and about the same curvatures. So what we always did in the seminars is I said do the MB with Pro Taper, do the ML with WaveOne Gold. Zip, don't say a word, and they would all some up and probably say you know, I did several canals with both and I'm really liking this one.
So it was funny who would like what. I probably prefer Pro Taper because I like to distribute the work out over maybe 3 files and I can have a little better tactile sense. The Shaper 1 and the Shaper 2 are just like a wet noodle; they'll snake into any glide path and progressively open up the shape. But I'll tell you, you go to a dental school and the kids love WaveOne because it's one file most of the time. And universities that have to worry about infectious diseases – and I guess we'll have another segment on Coronavirus you told me – but we can go back to England and look at where the home of Mad Cow Disease originated I believe. And of course the Minister of Health there demands that anything that goes below the orifice is used one time and thrown out. So they're encouraging patients to know about this because they take out spot ads in prime time in the UK, three countries, and they say to the patient did your doctor do this? And what they do is they show an assistant – nice, she's cute and she's dressed up in her little outfit – and she takes the file promptly from the sponge, the doctor's sponge, puts it in a bag and gives it to the patient. And this is to say did your doctor give you the file? So it says at the end of the file does your doctor do this; in other words give you the file so you know they're not going to be used on the next patient.
So if you're talking about single use, one file is intriguing. Cost-wise if you think of a hospital where you might have 100 students going through, can you imagine sterilization and the thousands of patients that are being served and the instruments going through cassettes, through sterilization processes? So a lot of times it's just simpler. It is fast because you're not changing files. So it's a faster technique because you're using typically one file.
So who is it really intended for? Like obviously if you want to save money and throw away less files, because you only have one to throw away versus several. Or you said it was used in dental schools, so it must be good for people who are learning, beginners, because it its simplicity. Are there cases or are there canals where a WaveOne would be contra-indicated?
You know those are good questions, and I'll probably say something that won't upset you but it would probably upset people out in the field because I'm going to speak very bluntly. I love it when I start talking to a really highly trained endodontist and he'll say well you know, I'm looking at that pre-operative film and then I went and looked at my CDCT scan, and I thought you know, I'm going to use Vortex. The very next case he's looking at the scans and he's looking at all this imaging, and he's going "Pro Taper".
I never, ever could make that distinction from a radiograph. A radiograph is 2-dimensional picture of a 3-dimentional object. Pro Taper Gold will treat every case on planet Earth, and if it doesn't, it's because the apex is blow out with internal resorption and we have to use a barrier technique, blah, blah, blah. WaveOne really doesn't have any restrictions either, because when you start to get bigger than a 45 diameter of length you have to start thinking about blocking the foramen with MPA or some kind of a barrier technique or surgery or anything like that. So to me, I know you're trying to push me into that box, but I really want everybody – and I'll look right into the camera – you should have your own discovery. Have a rep come out and show you both systems, you have the motor, have some teeth already open, have them be mandibular molars, try one in the MB, one system; try the other system in the L; you'll know what to do; you won't have to tell me.
Well there's a quote I really like and we used it at the end of the paper that you just showed. It's by John Naisbitt, and he's the author of Megatrends, which was a best seller several years ago. And he says, "We must learn to balance the material wonders of technology with the spiritual demands of our human race". And it seems like WaveOne really takes into consideration the clinician and what the clinician wants. It seems like it's almost like you could say it's the file of the people.
Very, very good. You know I heard something. I sent you and Isaac a little clip from the internet. It was a TED talk, a technology entertainment design, and the featured speaker talked about why and what. So for me, my close would be people – we think as owners of something, we want to sell them this; this is a what. What do you want? You want the car. But people don't buy what as much as they buy why. So the why is that spiritual part. People don’t even know in a workshop; they sit down and they just go "wow". But they don't know about heat treatment. They don't know about the rake angle or the helical angle; they don't care about all that because it's in tune with the harmony of just the focus of the clinical procedure.
Well that's great. Thank you for that presentation. I think we all learned a lot.
CLOSE: Ruddle Flashback – Grad School & the Flying Dentures Story
Okay, so we'd like to close our segment today with something that we call Ruddle Flashback. And you may not know this, but my dad is actually a very good storyteller, so we'd like to have this be a recurring segment where he tells a little story, and usually it's funny or maybe has a lesson, but a little story from his past. And so today, he's going to tell us a story, and why don't you tell us.
Well I don't know that I'm a storyteller, but I guess because I'm 72, I have a lot of stories.
Okay, so the story I have today hopefully will have a moral to the story, or there will be something that the audience can benefit from. It had to do with us relocating from the West Coast to the East Coast. I had finished dental school in San Francisco and Phyllis had worked in the city. And Phyllis had been a computer programmer – was – and had then put us through dental school. So she said if you want to go to grad school and be an endodontist – I've got two little kids; I think you said you were?
I was 4 and I think Lori was 3.
4 and Lori was 3. So she said I'm going to be taking care of them and you're going to need to work. So that meant to me I was going to need to take the Northeast Regional Boards so I would be licensed so I could practice in the evenings and on Saturdays.
So we went to Boston about a month early and we all loaded in the car – you remember the trip or parts of it – and you were a good sport. Very big car wasn't it?
That's going to be another Ruddle Flashback story.
Okay, that's another one. So we arrived in Boston and of course I needed to get patients. And in that era, dental schools were closed pretty much the month of August, but Boston University School of Goldman Undergraduate Dentistry was open. And so I went down there; they accepted me to come down and look for patients. So I hung out in oral diagnosis and treatment planning to find caries so I could do a restoration, and then I needed to find a crown and bridge patient so I could do that, and I needed a denture patient; and that was the three parts of the Practical Board that was going to be at Harvard on a Saturday.
So I had my patients lined up except the denture. And I didn't have a denture patient so I kept waiting and waiting for a denture patient, and there was none, and it was Thursday and I was starting to panic because the next Board would be in six months and I needed to get my license so I could start practicing as I went to grad school.
So anyway, finally with panic, they said call the Chairman of removable and fixed prosthodontics at Boston University and he might be able to help you. And I didn’t think that that guy would call this kid, who wasn't even a licensed dentist in their state, and would maybe help me, throw me a lifeline. So I gave the secretary my number, and sure enough that night he called me. He called me and he said he had good news and he had bad news. And I said well what's the good news, and he said well, he said I've got a patient for you. He said his name is Clem Daniels; he's a professional denture taker; he said he's done many Boards before and I thought that would be really good news because of all that experience.
That's odd that he's done it many times.
He probably had a top dresser drawer that was full of dentures from all the previous Boards. Anyway, I said what's the bad news? He said he's a severe alcoholic and he said he gags like nobody you've ever seen in your chair ever. He said he is a bona fide gag reflex guy. Because you know for a denture, we have to have the posterior flange of that denture go pretty much back towards the soft palate and ending on an imaginary line between the hard and the soft palate, and that's called the vibrating line, so that's where you extend the denture. So him and I were talking about that and he said you might want to relieve it a little bit so that Clem doesn't eject the denture.
So sure enough, I got the impression, I’m down in the lab, I'm making dentures, and the radios are going and everybody's riveted doing their job because we're all trying to finish by 5:00 p.m. So I get my denture made, I get all the teeth set, and I get the articulation on the typodont, and it's a thing of beauty. And I go in there and I ask the instructor, I said I'm ready for a try in, and he said go ahead. And I said I think I have it extended like you want it, but I think I should relieve it. He said you guys from California, you're all the same. He said give it to me. So I gave him the maxillary denture and he said Clem, open. So he jammed that thing in, and Clem threw his legs up and I mean every vein in his neck was distended and he got red and purple. And that denture shot out of his mouth and no exaggeration, it cleared Clem's feet and it landed on a granite floor of the clinic and broke into three pieces. And I was like devastated, and it was like 4:15.
So I had to get permission to leave the floor to go in the lab, so the same guy that participated in the event said yes, you can go repair the denture. So I sped to the lab and I basically came back in about 20 or 30 minutes later and I had the denture repaired. And I spoke to the instructor and I said I'm ready, but this time – he said relieve it! Relieve it to the phobia palatini and extend out to the hamular notch. I said okay, so we did that. And he said go ahead and seat it. Notice he didn't seat it? I seated it and I got it in there, and Clem bit down and it was a thing of beauty. He was relaxed. And the instructor came over and told me to stand back and he went through all these nathalogical moves that we have – work, balance, protrusion, all the different excursions that the mandible can do – and he finally said okay. And so Clem was dismissed.
When you went down to the lab were you just panicked? I mean what were you thinking?
Well fortunately that day I had worn a diaper in anticipation; if things can go wrong they will. You know O’Toole has a corollary to Murphy's Law. He said that Murphy was an optimist.
Well to finish the story, I got bolstered – I'll cross my life; I think you do too – with quotes from famous people or no-name people; because quotes are – they can be embellished, they can be part of your lifestyle, they can take your mood to somewhere else, they can be inspirational, they can be magical. So I'm known around the world to have a lot of quotes. So the one quote I'm going to say today that has to do with this denture story is from Giovanni di Pietro di Bernardone. You might know him as?
Francis of Assisi?
That's it. Okay. So he had this famous quote. He said – think of this in the context when things go wrong – he said, "Immediately start with what's necessary; then proceed with what's possible; and suddenly you're doing the impossible!" So break this down. Like a football game, we'll break it down. So what was necessary, immediately? Get the three pieces off the floor, less traffic, somebody could step on them and crush the denture into a thousand pieces.
So I got the denture off the floor, I got permission from the instructor so I didn't fail the exam to go back to the lab and do the repair. When I got to the lab what was possible? Well I had my cast that I still – it was perfect. I had repair materials, polymers. I had a grinding wheel so I could anatomically polish and smooth the denture. So basically in the process of doing what I could do, at a quarter till 5:00 I was running back with this little denture in my bucket and I was going back to the patient and then he saw me. I was kind of panicked because there weren't a lot of people there. A lot of the docs that were taking the examination were gone. A lot of the examiners were gone. But my guy was standing by Clem like a sentinel.
So anyway I nodded, he nodded, and he said you seat it, and I seated it and I told you that part. So anyway, that quotation is how I handle a lot of problems. Because a lot of times things happen and we're going oh, why'd that happen to me? Or I can't believe it; it's impossible. Well do what's necessary; then the possible; and suddenly you're doing the impossible.
I think a lot of times, like when we're confronted with a project, or even maybe a workday that's just really full; you just get kind of overwhelmed. Like oh my gosh, I have so much to do. But when you just start on one thing at a time, eventually it starts to seem like you know what? I'm getting this done; it's working now. Almost like when we decided we were going to do The Ruddle Show. I mean where do you start? That's such a huge, overwhelming project. But then just one step at a time and here we are.
Well maybe on another story you'll tell the camera and all your friends out there a little bit how you managed yourself this morning during the whole set and how you pulled from a famous quote so we could get through the sound, the lighting and all that.
Well anyway, in closing, I would like to just say you know what? You can't change the wind, but you can always change your sails and you can get to where you want to go.
See you next time on The Ruddle Show.
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Tough Quetions & SINE Tips
Who Pays for Treatment if it Fails & Access Refinement
Assessing Case Difficulty & Clinical Findings
CBCT & Incorporating New Technology
Zoom with Prof. Shanon Patel and Q&A
Best Sealer & Best Dental Team
Kerr Pulp Canal Sealer EWT & Hiring Staff
Ideation & the Covid Era
Zoom with Dr. Gary Glassman and Post-Interview Discussion
Medications & Silver Points
Dental Medications Q&A and How to Remove Silver Points
Tough Questions & Choices
The Appropriate Canal Shape & Treatment Options
Q&A and Recently Published Articles
Glide Path/Working Length and 2 Endo Articles
Hot Topic with Dr. Gordon Christensen
Dr. Christensen Presents the Latest on Glass Ionomers
Annual AAE Meeting and Q&A
Who is Presenting and Glide Path/Working Length, Part 2
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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.