Ruddle “ProTaper” Technique Card
The ProTaper Story - Part 2 ProTaper’s 20+ Year Journey as Told by the Creators, the 3 Amigos
Ruddle reflects on the great past experiences he has had hiking with family and his future plans for hiking this summer. Next, in Part 1 of The ProTaper Story, Ruddle gives us an insider’s glimpse into how ProTaper got started and its 20+ year journey. Then co-creators Dr. West and Prof. Machtou join for a Zoom interview in Part 2 and give their unique insight. This segment is followed by a Just-in-Time® segment on how to shape a canal with ProTaper. Enjoy the ‘story’!
Downloadable PDFs & Related Materials
Many times over several decades I have described various concepts, strategies, and techniques for shaping root canals. Although the concepts and strategies have essentially remained the same, the techniques have evolved...
It is generally recognized that root canals can be predictably prepared when shaping files have a reproducible and sufficiently-sized pathway to follow. The secret to shaping success is glide path management (GPM)...
By far, the vast majority of commercially available files utilized to shapre root canals are manufactured from NiTi and are mechanically driven in continuous ratation...
Dr. Ruddle describes the invention process from the idea to developing a market-version product...
There are enormous differences in opinion regarding the best methods for shaping root canals and cleaning the root canal system. A review of the literature reveals virtually no agreement on a variety of fundamental clinical issues...
The ProTaper NiTi files represent a new generation of instruments for shaping root canals. This article will briefly review the ProTaper geomearies, then describe the ProTaper technique and finishing criteria that may be utilized to fulfill the mechanical and biological objectives for shaping canals...
The purpose of the “RUDDLE ON ROTARY ” series of articles is to provide useful information that will enable dentists to predictably shape root canals for three-dimensional obturation. The information in these articles is intended to help clinicians better understand how to...
Ruddle on Shape•Clean•Pack
ProTaper’s 20+ Year Journey as Told by the Creators, the 3 Amigos...
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.
...CONTINUED FROM S02 E06
So, let’s tell them how it all started in Singapore.
Remember, regressive tapers, everybody. Regressive tapers means that after the fixed taper of 3 – of 9 percent in the first 3 millimeters, then, as an example, it’d be 8, 7 ½, 7, 6, 6 – okay. So, it got smaller.
When did you first all get together and start working on the project?
SEGMENT 2: Zoom Interview with ProTaper Creators
[Introductory music] Welcome to The Ruddle Show. I’m Lisette, and you can see my dad, Cliff Ruddle, and our guests, who I’ll introduce momentarily. But on our last show, we heard about how ProTaper came to be, and we talked about how it evolved, over the past 20 years. And then, now, today, we have Drs. John West and Pierre Machtou with us, and they’re gonna – they’re the co-creators and have been part of the ProTaper team since the beginning. So, we want to hear their unique perspectives as well. So, you guys Zoom together all the time, so this is really nothing new for you, except for today I’ll be asking the tough questions, and there will probably be some time constraints. But other than that, it’s business as usual. So, welcome, both of you. We’re really glad you could join us today.
Glad to be here.
Well, l know my dad is excited to have you guys all together, talking about this – how – the whole journey of ProTaper. So, I just wanna say, on our last show, we talked about how, John, you had the idea in the U.S., in the early ‘90s, about variable tapers on a single file. And then, at the same time, across the Atlantic, in France, Pierre was working on developing prototypes for variably tapered files. So, it’s interesting – this kinda reminds me a little bit of the pyramids being built in Mexico and Egypt at the same time, with zero communication between the continents. Obviously, I mention this a lot on the show, because it’s a fascinating concept for me.
But I want each of you to have the chance to talk about how you thought of the idea. So, John, why don’t you go first.
First, Lisette, may I offer congratulations to the year number two of The Ruddle Show.
It’s a dream come true, and I certainly wanna acknowledge that. It’s humbling to be part of it.
[laughs] We’re really happy you guys are here.
We are, too. So, the idea to me, Lisette, came first in the year 375 B.C. --
-- when the Greek philosopher, Plato, in his work, The Republic, wrote six words that have lasted through the English language as a proverb. And those six words are, “Necessity is the mother of invention.” And really, ProTaper, for me, was born out of necessity. I trained under Professor Herbert Schilder, at Boston University, and he just didn’t have the tools that we have today. We had Gates Gliddens, we had files for smoothing, we had reamers. And when we were all finished, many times, these shapes were funnel shapes that allowed us to clean from top to bottom and seal predictably and with control, but sometimes there were rough spots.
And in the – about the mid-1990s, we had two big stories in endodontics. One was the microscope, which really helped us, because as you know, Lisette, we work in the dark. And so, it enabled us to see. But secondly was nickel titanium. And the issue, though, with nickel titanium in the beginning is that these files could break. There’s nothing worse for a dentist, to have something break in a person’s body. This is like the ultimate crime, the opposite of the Hippocratic Oath. And the reason, mainly, because of it was the unsophisticated metals, but mainly, Lisette, the tapers of these files were fixed. So, they could have taper lock. They could grip inside the canal, in an unknown spot, and break.
So, it was a revelatory thought I had, because Schilder taught us to progressively make shapes. Don’t just drill in there, that you have to do little bits at a time and create the final result. And because of that, I started to think, “Well, what if we could do this, on a single file?” And so, literally, the idea was written on a paper napkin. And that paper napkin became, at least in the – America, the first prototype of a variable taper finishing file. And the rest is history. I was able to serendipitously join with my colleagues here, Pierre and Cliff, and with the magic of metallurgy and precision, in Switzerland, we were able to make something that has been extraordinarily, in the marketplace, sustainable.
And I don’t think that I necessarily – popped into my – I – my brain. I think maybe I have a little heritage of creativity. One example of that is my great-great-great-great-grandfather, George Stephenson. You can Google him, S-T-E-P-H-E-N-S-O-N. And he is the father of the locomotive, the steam locomotive. And he – if you Google him, he’s in the top 20-plus engineers of all time. He’s in there with Archimedes, Ford, even Elon Musk, now, and Vincent Van Gogh, some of these incredible inventors of the past. And he’s right in there, and so, you can Google him and check it out. But the reason I bring that up is because the technology of the locomotive, in those days, was sustainable for 150 years.
Now, ProTaper’s a good product. It won’t be around for 150 years, but it has been around and overcome hundreds and hundreds of imitators and copycats, simply because, Lisa, it works. And we have one prototype and then, we have two prototypes and three prototypes. We have three generations of ProTaper, and I will tell you now that we’re still writing the story of “what if.” And the last chapter, the next chapter of ProTaper is yet to come.
Yeah. We talked a little bit about how that it’s actually an ongoing story, on our last show.
So, what about you, Pierre? Like how did you think of it?
You know, unlike the – John, my father was a dentist, but he did not invent anything [laughs]. So, regarding my pathway with the file, I think – you know, I was involved with Maillefer. It’s a Swiss company, for – I’ve been involved for a long time. They manufacture some pluggers for me. They manufacture some files for me. For example, the Flexotaper, I get a variety of the Flexotaper. So, when the first NiTi file went on the market, Maillefer asked me if I could give us some idea, in order for them to manufacture some similar files. And like John, we have been trained with the same concept, and it is not amazing that we, at about 9,000 kilometer of distance, we end up with the same idea, finally.
And for me, it was quite easy, because, you know, I was discussing with the engineer at Maillefer, at the plant, and I emphasized the idea about the shape I wanted to get. I knew what is the size of the foramen, I knew the size of the coronal orifice, so it was easy to know exactly what was the taper. So, we discussed about crown-down technique, you know, but with the crown-down technique, we had to use many files or three or four files. So, I said, “But, you know, the dentists – the general dentists like to go straight to the working length.” So, if we use a step-down fashion or crown-down fashion, they are going to be lost.
So, I said, “The only way for a file to reach the working length, if we want to get this kind of shape, is to add multiple taper on the active portion.” And at that time, it was in the early ‘90s, the engineer, Francois Aeby, at that time, he told me, “But we can’t do that!” [laughs] And that way, finally, we designed the first variable files or Flexotaper that were ready to be launched when Dentsply bought Maillefer. And at that time, the policy was to stop any R&D, and the goal was to launch ProFile and promote ProFile worldwide. That’s the reason why we had to wait six or seven years, before the ProTaper could be launched.
Well, what I’m hearing from you both is – and all three of you are master clinicians, but that you guys have an idea in mind of the kind of shape you wanna create. And so, you’re thinking of how to get a file that’s more efficient, to help you create the shape that you envision. So, I know, Dad, that you said, on the journey, when – what was motivating you to go along, and –you weren’t thinking about royalties or anything. You said that you just were hoping to get a file that you could use! [laughs] So, is that correct?
I think, for all of us, I think it might’ve been mentioned in the last show, but we were like kids. We didn’t even [laughs] know the word, probably, “royalty”. We were – we thought what we were gonna get out of it is something that we could use in our practice and then, something we could use for education! So, that was enough!
And then, maybe some of you also had some inventing genes in you, and you all came together. So we’ve pretty much established, like, how the – where the idea came from. And then, we heard my dad tell the story of his perspective of the journey. But I wanna focus more on John and Pierre, how you view the file. So I know, John, over the years, many of your teaching presentations have been titled, “The Practice-Changing Magic of ProTaper Gold”. So, can you tell us what you mean by the word “magic”.
‘Magic’, it’s a big word, isn’t it? I mean, it’s – sounds like an arrogant word, almost. But if you look it up in the Merriam-Webster Dictionary, you see things like “mojo”, “bada-bing, bada-boom”, “abracadabra” --
-- “cheating”, and, you know, when we have doctors that we teach, they soon in the teaching, begin to experience this, “Man, it feels like I’m cheating!” We wanna get, actually, the idea of not just a file. We wanna get this idea that it can really change your experience of yourself, and therefore, the experience, of course, of the patient and the result. But we want to really get to the point of, when you’re doing the treatment, you actually begin to feel guilty, especially doing the easy cases, easier. And you might wanna turn to your assistant and say, “Mary, we have to reduce the fee, because it’s going so easily!”
And of course, you have to resist this [laughs]. Reynaldo and Tiger Woods and Michael Jordan, they didn’t reduce their fees! Why? Because they had value, they were doing it right. I will use a simple example now of I’m asked the question most often, and after 35 and 40 years of teaching is, “Is it predictable? And when are you done with the files?” And let’s do a simple example.
Let’s say you wanna make a hat rack, and we have a three-inch wall. And so, I’m gonna make a – drill a hole maybe about a third of the width. That wouldn’t weaken it. So, I go to the local hardware store, I buy a drill, I buy a one-inch bit and a little tiny one, for a pilot hole. When I get back, I drill that little pilot hole, the glide path [laughs], so that I can augur the bigger drill. So, I take the one-inch drill, I have a one-inch dowel, also. I drill in – because I’m asked, “When do you fit the cone?” You drill a hole, you take it out, you clean it, irrigation, and then, the dowel, 100 times out of 100, fits.
And that’s what happens in this kind of vision of shaping, Lisa, is that you have, when do I fit the cone? When do I seat the crown? I seat the crown when the crown fits. When do I seat the cone? When the cone fits. When do we seat the cone? When the blades of the finishing files prove evidence that it has cut that exact shape. And so, in summary, what happens is that we really begin to experience a different level of control, a different level of confidence, and a different level of consistency.
And then, when you’re kinda doin’ endodontics, that little swagger, that feeling of confidence, like, “Gosh! 10:00, I got an endo. I’m right on it. It’s my best part of the day!”, what happens is, [laughs] --
-- I got the swagger [laughs]. That’s right, Cliff. I got the swagger. And you know what? I guess in three letters, Lisa, when it’s all said and done, doin’ endo this way, the plan, and a tool that gets you there. I remember my dad, as a finish carpenter, always said, “Son, you do – when you do something, you do it your best. And secondly, use the right tool for the right job!” And this results in three letters, and it adds up to FUN.
[laughs] Well, that – you know, one thing you said is – that I got out of that is that it can sometimes feel pretty effortless, to get the results that you want, and that is something – like, when you watch somebody that’s very skilled do their job, they make it look easy. And it looks effortless, and I think that’s probably part of it, because they’re confident as well.
You know, I’m really glad – I’m really glad you used that word, “effortless”, because I didn’t. But that is it! It is effortless. My God, this is – or my gosh, this is – this is easy-peasy! Lemon Squeezy!
1951, Polo Grounds, Willy Mays, back to the plate, basket catch! Effortless!
It looked that way, didn’t it?
[laughs] Okay. Well, Pierre, I’ve also – from hearing some stories that – of things that have happened to you over the years and even recently, I’ve gotten the impression that ProTaper is maybe more durable than one would think [laughs]. So, why don’t you tell us your story about what happened at Charles de Gaulle Airport?
[laughs] Yes. It’s a fun story now, but not exactly when it happened, you know?
In fact, in the ‘90s, I used to take the plane every week to go to Montpellier, a city in the South of France, to do my research on the forces and torque inside the root canals. And at that time, I was testing the ProTaper prototype, before they were put on the market. But I arrive late at the airport, because of a strike – big strike and a big demonstration in Paris, as usual.
And I miss – yes. And I miss my flight. So the hostess at the counter, she offered to take a plane to Nimes, a city near Montpellier, a better flight, which was supposed to take off five minutes later from the counter and exactly at the opposite end of the terminal. So, I run away, and I could catch – it was a flight, a plane, at the last moment. So, the plane took off, and after a while, suddenly, I realize that I had left my school bag [laughs] at the counter, in front of the counter, on the ground. So, I call the hostess and explain the situation. So, she said, “Don’t worry. I’m going to call the counter and inquire.” So, I was waiting, and maybe 15 minute later, she came back to me and said, “Sorry. We blew up your bag.” [laughs] “But – but you can recover what is left, at the police station, when you return.”
That’s what I did. And on my return, I went to the police station, and I was very badly received by [laughs] – by a policeman, in fact, he was very moody!
And [laughs] – and – yeah. He handed me a plastic bag full of dust and debris. And he pulled out some ProTaper from this bag.
He inspected them with big suspicion, you know, and he ask me, “What is this!?” The ProTaper were perfectly [with emphasis] intact.
And maybe it is, I think, the first example in the world of a treatment for rotary files. That’s a story! [laughs]
That’s excellent! That’s absolutely durable!
They were absolutely intact.
[laughs] And you also have another story about the – that kinda speaks to the durability of ProTaper, because your students --
-- were using it --
-- where you were at Paris 7.
Yes, yes, sure. And it was always before the release of ProTaper, and I was testing the instrument on my patient at the school, at the university, with two of my post-graduate students. And I used to spend two full days a week with them. And when I was done, I asked my students to clean, sterilize, and store the instrument in my personal locker, because I needed to reuse them. And at that time, I did not have a large number of instruments. So, long after, finally, they confessed to me that when I was away, they reused the instrument many, many, many time.
So, when I ask them, “How many time?”, they calculated that they use the same sequence about 30 times, 30 times. So, this durability maybe could have set a new definition for multiple use!
So, and they were still working, yeah?
You’re still using them, I understand.
I guess – I guess you –
You’re still using them, routinely.
[laughs] So, they’re single-use files, but if you have to use them --
Lisa, thank you.
-- a few more times [laughs] --
Now, they are single-use, but at that time [laughs] –
Desperate times, desperate measures!
-- yeah. I use this story a long time after that.
Okay. John, I wanna go back to you now. [laughs] Okay. So, John, I wanna go back to you, because not only – when you speak and when you write, you – not only do you say that “ProTaper is magic”, but you also have, like, quote, said, “It’s more than a file.” Now, I just wanna say, on our show, this has come up many times. We’ve talked about how we don’t want to count on technology to make up for deficiencies in training. Like, you still need to be proficient in the fundamentals. So, why don’t you explain to us what you mean, “More than a file”?
I gotta quit saying these things. [laughs]
You know, Lisa, really, ProTaper is not a file. It’s a philosophy. It’s a thought process. It’s a way of thinking. It’s a way of being. It’s a way of doing. It’s not the bat; it’s the batter. You’ve heard that kind of a comment.
And probably the best example of that, Lisa, is I’m gonna read you several testimonials from classes that Cliff and Pierre and I have given in the last couple years. And I think it’ll speak for itself and my point about “ProTaper is more than a file.”
“I’m leaving this class to start a journey of excellence that I didn’t imagine before. I know I will achieve it.” Ruby, from Concord, New Hampshire. ProTaper’s more than a file, Lisa.
“This class has energized and pushed me to grow as an individual as well as a dentist, to serve my community” -- wow! – “with passion and excellence.” Evelyn, from Richmond, Canada. ProTaper’s more than a file.
“I’m leaving this training a different and improved person.” Wow! Ben, Greenville. Thanks, Ben. ProTaper is more than a file. Couple more.
There are only a – so, what I want – there’s a trend here. It’s not like a aberrant comment. This is like, “Hey, thanks for teachin’ me how to drill a hole’, but it’s far beyond that. There are only a small handful of courses that have literally changed the kind of dentist I am. This is one of them.” Robert, from Bloomfield, Colorado. ProTaper is more than a file.
Two more. “The philosophy of this kind of thinking and doing endodontics goes well beyond endo. It goes to the core. I’ve learned the confidence and skills that have changed the way I enjoy my practice.” Pretty big. That’s John, from Torrance, California. ProTaper, Lisa, is more than a file.
And finally, “This presentation was the best Firestarter of my life!” Dracena from Canada.
We do and have changed lives, and it’s not just – it’s not the file. It’s the whole thought process. It’s the education. It’s all the Ruddle animations and reality, the teaching, the passion of Pierre is, like, incredible, and his science, maybe the innovation and creativity of Cliff and myself. And the Swiss precision and commitment to excellence is staggering to me. And one of the reasons the ProTaper has had such a phenomenal success is the reasons it is more than a file, but also its capacity to adapt.
And I wanna talk – just speak a quote from Darwin. When we were in the Galapagos, this sign was right above where he did all of his research about the origin of humans. And he said that “It is not the strongest of the species that survives, nor is it the most intelligent. It is the one who has the greatest capacity for change, to adapt to change.” And that’s true in endo, heck [laughs], and it’s true in this day and age. We’re not in unprecedented times. We’re in an unprecedented rate of change, and we have very little capacity and skills in the human race that have adapted to those skills.
And we have done a great job with endo, and we’re gonna keep doing that. We’re gonna adapt, listen to the marketplace, but mostly, we’re gonna listen to ourselves and what do we need to do, to do a better job and be better dentists, Lisa.
Yeah. I’ve – I know my dad has gotten a lot of feedback from his courses, too, from people that basically describe it as lifechanging. And I think it is a similar type of thing, because it’s not just the – it makes sense when you describe it to me the way you do, that it's actually a philosophy.
Did you wanna say anything about that, Dad?
I wanna hear from Pierre.
[laughs] Okay. Well, then, let’s go to Pierre, because you’ve also received a lot of feedback that has kinda kept you motivated along the whole journey as well.
Absolutely, we have received hundreds and hundreds of messages, letters, clinical cases, to express from dentists – you know, dentists, specialists, to express their gratitude, in fact, after the – our training session and courses. And what was amazing is, in fact, the word used were always the same, as John mentioned. They mention magic, they mention unpredictable, they mention exciting, they mention, beautiful shapes, beautiful files, discover their new-found confidence, and lots and lots of – “Changed my life”. “Changed my life”, many said that.
So, I think from a teacher standpoint, it's quite – reading this testimonial finally is really rewarding. Rewarding! And we have experimented the feel first exactly, the same feedback, the same feedback. And still, still, still.
Why don’t you also tell us a little bit about your relationship with Dr. Herb Schilder, and how this has also motivated you on the journey.
Yes, because, you know, when I read the Schilder article, it changed my life. So, my initial goal was to ask him the permission to translate his two seminal articles. So, I wrote a – I wrote him a letter, and I asked him the permission. He was very kind, and he give me the permission to translate. And I did. And I did. I translated his two articles. I – at that time, I ask an English teacher to check [laughs] the translation, and I sent it back. He was very, very happy with the translation, because, you know, you receive a lot of Canadian people from Quebec, and these people did not speak good English.
So, the first thing he did was to give them the translation, you know? And there is something interesting regarding the translation. He called me, and he said, “I like it very much, the translation, but there was a mistake!” “Oh”, I said, “I’m very sorry. I’m very sorry.” “But”, he said, “it’s not your fault. It is our fault, because in the text it was written “in the bed of the canal”,’ and I translated, in French, “[speaking in French] du canal”, Lisa, you understand? You know?
So, he said, “I never said bed”. I said, “in the body [with emphasis] of the canal”. [laughs]
So, he read exactly each word, he controled each word. And after that –
It’s in the detail. That was [crosstalk]
-- and we started my relationship with him very close, like a son, and he called me, and he said, “Pierre, I want to meet you. So, please, come to VU. I want to meet you.” Of course, I went . One month later, I went [laughs]. And we started a very, very special and close relationship. This was the story.
It’s a great story.
And Dad, I think you told me yesterday that Dr. Herb Schilder said that he – like, it’s – you know, one thing that he would’ve always wanted to do is try out one of those files.
Yeah. I – I think these guys would probably have their own versions, their own interactions. But I was talking to Professor Herb Schilder on the phone one day. We were pretty good friends, at that point. I actually, at that point, was calling him “Herb”. But that took decades. Anyway, he said – he made some comment, he wished he was in practice, because he would like to try the files!
He said, they perfectly recreate my envelope of motion, my pre-enlargement, and the apical prep last. He didn’t say it exactly like that, but that’s what we ended up taking from the Schilder ideas, these guys. I wanna say one thing --
So, it sounds – okay.
-- one thing we’re all three the most proud of is our teaching, our educational model, is transferable. I don’t have to say a lot more. But if only Sam, Jim, Mary, and Martha can do it, then, it’s probably not so good. But all over the world, wherever we’ve gone, whether they are a genius student, a very average student, which is most of our students, and whether there’s people still growing and trying to get up to speed, if they follow what we say, they can carve the shapes, and it’s evidenced by the cases they send us, from all over the world. That’s probably our biggest joy, transferability.
So, the producibility of it and the transferability.
Okay. I now wanna ask each of you if you could just tell us what your favorite memory or your most inspiring moment along the whole journey might be. Like, Dad, maybe you start, because I know you have something that was pretty inspiring for you.
Well, I had to call John yesterday, so he wouldn’t say it, because we’re gonna probably all have the same memory. I didn’t call Pierre --
-- because I thought Pierre probably forgot [laughs].
[crosstalk] because he forgets his underwear, and he forgets stuff around the world. There’s legendary stories, like he forgot his bag at the Gulf. Okay.
One time, after many years -- it was about 2007. So, we started our ProTaper journey in 1995. That’s when we formally all three came together. Even though you heard their story, they were working on the intellectual property before I became involved. But – so, some years have gone by. ’95, now it’s 2007, and we’ve been out in the marketplace since 2001. That was the launch. So we were about six years in. And one day, the owner of Maillefer, it was a family-owned, Auguste, Michel, long lineage of Maillefers. Well, Pierre-Luc Maillefer was the General Manager at that time, and he said he had a special evening for us, and we needed to be at the plant, you know, by 6:00, because we were gonna go to the “hut.”
Well, I didn’t know what the hut was. None of us knew what it was. But we knew anything with Pierre-Luc in the Swiss Alps was gonna be a memorable Swiss winter evening. So, we went probably, Pierre’ll tell us, two or three kilometers from the plant. It wasn’t so far. And up against the forest was this little, nondescript hut, and I won’t go through all the things, but we had a beautiful evening. And it was a celebration that we didn’t understand until he gave us these little medals and little diplomas of achievement for what we’d done in the marketplace at that time. So, we looked out the window. The escarpment was falling off towards – in the night, it was like abyss, and we could see the stone faces across the valley, with the moon on ‘em.
And I think – I think we all felt a great sense of reverence, friendship. I thought of the airports that we’ve all ran through, the transfers, the hotels. Phyllis and I had 5 million educational miles last year. But the reverence of this setting was so quiet, and it was such a joyful moment. That’s what I’d like to share. With my friends!
What about either of you? Do you have a memory you wanna talk about?
Similarly, I – this moment, we were – Pierre-Luc, when he gave us the diploma, and when he thanks our work for achieving what we have done, was really a very, very important moment in this – if – in this journey, if you want. So, I share with Cliff this unforgettable moment.
What about you, John?
Two brief stories, Lisa. I certainly have that same feeling for the hut. That was a really special moment. One was when the three of us were fantasizing about what – if and what could be, at the plant, in the late – or mid-1990s, I guess. And we turned to Gilbert Rota, the engineer, not just then, but still, now, and we asked Gilbert what – on a single file, can’t we make these progressive and regressive shapes? And the kinds of things we were asking for, he said, “That can’t be done!” And I remember one of us asked him, and he looked him right in the eye and said, “But if it could [with emphasis] be done, how would you do it?” And Gilbert paused, and he said, “Well, that’s a different question.”
And then, he thought outside of the – you have to – he stood outside the box. We have been blessed by being – standing outside the box, in order to see inside the box. The other one that jogged my memory, just about Schilder, and I’d like to close with him. Without him, I certainly wouldn’t be here. He taught me passion and value and predictability and fun and all that stuff and doing our job.
But I remember when we first had the prototypes, probably the same ones that Pierre tried to burn, and I had a little package, too. And my son, Jason, was a second-year student at Boston then, and I was teaching in a few months there, for a couple of days. And so, I sent the samples to Jason. Now, Schilder would never let you use anything [with emphasis] but what he used. If he found out you were using an apex locator, you were gonna be fined or fired or sent to the time-out room, you know, that kinda thing.
So, he started making these shapes, and Schilder said, “Wow! Where are these comin’ from?” And I showed him the instruments, and he really said he wanted to take credit for them, because he understood progressive shaping, a little bit at a time, patience, and do it right.
Well, that’s – yeah. That’s – I like you guys’ stories. Okay. So, I just also wanna go, just to close with, I know probably it can be difficult to be a team, sometimes. Like, maybe there’s been some upsets over the years, maybe you guys have had to work through some things, maybe you’ve had different opinions. So, I don’t wanna say, “Who on the team would you replace, if you could?”, [laughs] because that would be, like, not good. But would you – what would you say about the other – each of you would say about the other two. Like, maybe qualities that made them really easy to work with and you, like, can’t imagine the team without them, and then, also, maybe like what is a challenging thing about the other teammates? Who wants to start?
John, go ahead.
You know, that’s really a good question! You didn’t tell me you were gonna ask that question. But, you know, I think the greatest thing, between the three of us, is the strength of our differences. Like I said, Pierre is a thinker. He has passion. He has a love for teaching and transferable skills. I guess I never say ‘”no”, and that’s sometimes a positive. And Cliff, of course, he created this moment, and his ingenuity and love, also, for education. So for me, I just really can’t answer the question, you know, in a negative way. It’s a serendipitous blend that is, to me, a real gift.
What about you, Dad? Do you – what would you say are the strengths of John and Pierre, that you can’t imagine having a team without them?
Well, this isn’t even a sound honest, but it’s right from my heart, at this moment. I’ll probably change, five minutes after the Zoom meeting.
I don’t recall ever having a fight with Pierre and John about anything to do with files or most anything else in life. In fact, we might’ve saw things different, but it was so amazing. We might have a meeting that starts at Monday. So, I would fly Friday, arrive Saturday. Pierre and John would come in a Saturday evening or Sunday morning. We’d spend all day brainstorming the first moments at the plant. We already could see the result in our mind. And whatever small differences, we worked ‘em out in the pre-meeting, amongst ourselves, and we went with one voice. And I think our strength was, we never confused the engineers, we never confused Marketing, we didn’t confuse anybody.
But who would I replace? That’s pretty easy! It isn’t the three amigos I would replace or touch, because we have been central with the engineers and marketing and all the reps. I wanna acknowledge all those people around the world that actually, when the plane leaves the ground, they’re still teaching. I might replace some managers, because when you work in a corporation, all three of us started when it was Maillefer. We were Maillefer men.
Maillefer was acquired, and suddenly, through the acquisition, we were working for big corporations. And so, people come and go. And when people come in, sometimes they don’t respect or appreciate the past. And so, there’s a tendency to set their own vision and their own direction. And sometimes that’s really hurt our innovation. I think some of my family pleaded with me not to say the word [bleeped], but I would have to say, he was a person who came and went, but we didn’t – we lost a lot of momentum, but now we’re back on track.
Okay. What do – what about you, Pierre? What do you think about John and my dad? [laughs]
I can only say that it was so easy to work together, because we are exactly on the same line, you know? We think about – exactly about the same thing. So, I can say that Cliff is my brother, I don’t know, because [laughs] when I have something in my mind, I call him, and I ask him [laughs] what he’s thinking about something. And at the end, we always, always reach the same result, always, always. So, it’s very nice.
And John, my friend, too, my second brother, I like to talk with – with you, John, because you make me laugh. And you always are in good humor. And I know we share a lot of things. We share good moments. We share good sessions, good working sessions together. I remember the session we spent at the plant, talking and changing and discussing. This was so nice. So, for me, it’s unforgettable memories.
Well, you know, just from interviewing you all – this is a really fun interview, by the way. But I can see from your energy and just from stories I’ve heard over the years, to me – and just from doing this project with my dad, about going the whole ProTaper story, I can – for me, it’s like really obvious that I see that you guys are a perfect team, like what you each bring to the table is like – it’s – I – it’s really – I think John used the word, “serendipity”, and that is exactly it. Like, that you three were not brought together, it’s not just chance. But anyway --
And the – Lisa, the table is to make dentists and dentistry better. That’s what the table is all about. [crosstalk]
-- well, I personally want to thank all of you for bring – oh, okay. Go ahead, Dad. You wanna say something?
You know, I know Pierre’s gonna be mad at me, if I don’t say this. And we’ve stepped around the whole thing. But what we’re so proud of, going back to the ‘70s, is that we have a system that makes a shape that can be three-dimensionally cleaned in all of dimensions, and root canal systems can be filled. So, we always started with the end in mind. It was never about exactly what this was. We always wanted to go towards, “What’s the goal? The goal’s 3D disinfection.” So, thanks.
Well, definitely, the dental profession is very lucky to have all of you as leaders. So, thank you very much for participating in the interview, and that was a great interview. Thanks.
Thank you, Lisa. It was a really enjoyable. Thanks.
Thanks, boys! [Music playing] [Countdown]
SEGMENT 3: Shaping with ProTaper Gold
So, now that we’ve heard the ProTaper story, we understand a little bit better the concepts behind ProTaper, I can see how it all evolved over 20-plus years. We had that great Zoom interview with all the three of your guys together. That was fun.
So, now, we’d like to show you how to actually shape a canal with ProTaper.
Well, when you take instruments to the clinic, that’s when the rubber meets the road. So, let’s see how ProTaper can shape a difficult, multiplanar curvature canal.
[Recorded] This instrument series has become the number-one-selling file in the world, because of three things. Number one, it was the first system in the world to offer active cutting blades. Number two, it was the first system in the world that changed the taper on a single instrument. And number three, it was the first system that recognized the importance of having shaping files distinctly different than finishing files. Let’s take a closer look. The shaping files work dominantly in the coronal two-thirds. Notice the SX is short. It’s 19 millimeters in its overall length. This helps us introduce it, when there is narrow interocclusal space. This helps us remove triangles of dentin and to pre-flare the body of the canal, so we have greater access into the deep apical one-third. We use the shapers with a brushing motion on the out-stroke.
The finishers are completely different, in that they cut dominantly in the apical one-third. The finishers most frequently used are the sizes 2007, 2508, and 3009. These instruments, then, can expand the terminal diameter of the canal, and expand the deep shape, without overpreparing the body of the canal. The finishers, then, work just opposite of the shapers. We follow into the canal, and we brush on the out-stroke. Remember, the shapers were brush follow. The finishers follow brush. So, together, the instruments work in concert. The shapers work upstairs, to remove restrictive dentin, and the finishers work downstairs, and serve to blend the deep shape into the body of the canal.
The advantage, then, of having shapers and finishers is, you have the ability to increase your terminal diameter and apical one-third taper without continuing to prepare the body of the canal. Now that we’ve looked at the ProTaper family of instruments, let’s look at what might be an appropriate shape. The shape that most of us that use ProTaper Gold utilize is, we finish somewhere around a 2007 and – or a 2508. And of course, that’s based on 50 years of research, and if you look at these review papers, you can kinda see that these were the shapes that were noticed, where we could exchange reagent.
So, the only reason to shape a canal is so we have irrigant that can be exchanged into all aspects of the root canal system. Of course, if we can clean a root canal system, we have the opportunity to three-dimensionally fill this root canal system. Well, now that we’ve reviewed the ProTaper Gold family of instruments, and we’ve reviewed what might be an appropriate shape within the canals of the roots that hold them, let’s put this to work in a plastic block. And again, I like a plastic block, because it gives you the visual ability to see what we’re doing, when any file cuts, where it cuts, how it cuts, where’s the debris, and all the little steps that help guide each case to successful conclusion.
If you look at the straight-away portion, we have our first curve, just apical to that, and a tangent line to the first curve, relative to the straight-away portion, is about 30 degrees. If you drew a tangent line, from the second curve, relative to the first curve, that’s a little stronger angle, as that canal swings back around and recurves at about 35 degrees. So, this is a good, little challenge, and it’ll give us an opportunity to see the family of instruments working. Of course, all shaping procedures can only start once the canal has been fully negotiated to its terminal extent.
A little bit of watch winding draws the stainless-steel file down. When you get about one millimeter short, or a little more than a stop, then, begin to think about sliding to length, versus reciprocating. A straight slip-and-slide is much kinder to the patient, as it doesn’t tend to transport or rip the foramen. Once we’re at length, establish working length. In this case, it’s obviously visual, but clinically, it would be a working-length film or an electronic apex locator. Once we’re at the full working length, we need to confirm that the canal is in fact patent. So, we move the 10 file in and out, back and forth, repeatedly, deliberately, until the instrument is completely loose. That’s one of the great secrets in endodontics.
Never remove the file, until the instrument is loose. So with a known working length, and in a patent canal, we now need to make the decision, “Can we use a mechanical instrument to shape this canal? Would it be safe?” So, how we decide is, we confirm or verify the glide path. Simply withdraw the file about one stop and see if you can slide back. Now, pull the file back about two stops, and see if you can slip and slide back to length. Now pull the stop back, three, four, five stops, and if you can slide, slide, and glide, over the apical one-third, then you have a secured canal, and we can begin to think about expanding that canal, using a dedicated mechanical glide-path file, such as ProGlider.
Traditionally, dentists have used a size 10 and 15 stainless-steel hand file to negotiate and secure the glide path. The greatest innovation in the last two or three years is to use a dedicated mechanical glide-path file, instead of the size 15 stainless-steel hand file. The advantages of ProGlider in this instance is that ProGlider has progressive tapers, so it’ll cut a pathway significantly larger than a size 15 file. Because the ProGlider is heat treated, it’s significantly more flexible and resistant to cyclic fatigue, as compared to the size 15 stainless-steel hand file. And finally, this instrument has been shown in over 15 peer-reviewed papers to be safe, highly efficient, and again, highly resistant to cyclic fatigue.
So let’s return our attention to the plastic block that we have already negotiated with a size 10 file, and here we go with the ProGlider. Insert the ProGlider in the orifice, and let it begin running towards length. Before resistance, begin to brush a little bit. Brushing makes the instrument more efficient. By cutting into the eccentricities off the rounder parts of canals, brushing makes lateral space. Lateral space allows those larger Eiffel-Tower blades to move down, so the instrument can achieve length. Notice there’s not a lot of cutting on the terminal extent of that file. But do [with emphasis] notice, there’s a lot of residual debris after using it. So, we would wanna irrigate and remove the gross debris.
If we recapitulate with a size-10 file, we can kick out most of that gross debris, and if we do a little vacuuming and irrigation and vacuum and irrigation, you can see how effective we can bump that solution, over 6, 7, millimeters of the canal. Now we come back and recapitulate, to break up that debris, move it into solution, so that when we reirrigate, we can liberate that debris. Now that we’ve just cut an exquisite glide path, using ProGlider, we’re ready to commence with shaping, starting with the file that’s identified with the purple rubber stop. So here we are, inserting a S1 into the canal, before resistance. Repeat after me, “Before [with emphasis] – before resistance, begin to brush with intentionality, in a lateral direction.”
Brushing laterally makes lateral space and allows those bigger Eiffel-Tower blades to move progressively into the canal. Let the instrument run, as it goes towards length. When we’ve achieved length, kiss and say good-bye. The instrument has just done its job. So, there’s a lot of debris that you can notice. So that’s a big reminder to irrigate and kick out gross debris. Then, grab your 10 file, and slide it back into length, and work the instrument to break up debris, move that debris into solution, so that when you subsequently reirrigate, you can liberate that debris.
We go to the white identified instrument. That’s shaper 2. It’s gonna cut more in the middle one-third. Again, we use it in a brushing motion. Brushing is a big secret and allows these instruments to achieve length in one, two, or three passes. Again, when you’ve achieved length, irrigate. Look at all that debris in there! That’s what oftentimes leads to problems is it gets pushed down into the narrowing cross-sectional diameters. To prevent that, we recapitulate with a 10 file, to break up debris, to move it into solution, so that when we reirrigate – and notice we’re doing a little vacuum, a little irrigation, vacuum, irrigate, vacuum, irrigate. We’re bumping those solutions, and you can see how they’re traveling back and forth in that apical one-third.
Moving right on, we go from shapers to finisher. And our first finisher is a 2007. When you remove this instrument, check its apical flutes. If they’re loaded with debris, in a small root form, you might consider yourself as complete. On the other hand, if you have sufficient root structure, most of us like to go to about a 2508, because it’s very easy to exchange irrigant with a polymer tip in a well-shaped canal. The polymer tip agitates that solution, breaks up the debris, moves it into solution, so that when we irrigate, we can liberate that debris. Notice again, a little irrigation, a little vacuum is quite effective at clearing this model’s canal. Here comes the F2. It’s a 2508. Watch it crawl around the curvature. A thing of beauty! That’s how flexible it is, with heat treatment.
So, we’ve just cut the shape. Now we can irrigate, recapitulate, and reirrigate. I like to use the EndoActivator after every shaping file, as a preliminary to my disinfection protocol. But again, you can see how effective it is at breaking up the debris, so that we can flush it out of the root canal space. The final shape is always confirmed when the cone fits. So take a system-based cone, slide it through multiplanar curvature, and if it reaches your working length, and you exhibit tug-back, the shape is confirmed, and you’re ready to pack! [Music playing]
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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.