Dr. John Flucke is in private practice in Lee’s Summit, Mo. He also serves as technology editor for Dental Products Report magazine and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.

Dr. John Flucke

The Future of Teeth Whitening. Photo courtesy of Kurhan / stock.adobe.com. 


I think at some point in the future we will look back on our practices and remember the unusual stories generated by dentistry during COVID-19. Sort of like 

I had a very nice lady come into the practice. She has been a patient for many years, and we have developed a great rapport. She has always been very fastidious about her appearance with the latest fashion, hairstyle, and an amazing, well-kept smile.

On this day she had called because she fractured tooth #10 and wanted options for restoring it. Because we had just fully reopened after the pandemic shutdown, we were very busy with trying to catch up. When this patient made the appointment, she knew we had a brief slot to do triage and then we would have her back as soon as possible.

When I stepped in, my team had already taken a periapical x-ray, and intraoral images and had given her an idea of what to expect. What I saw was a gorgeous #10 with about one-third of the clinical crown fractured from the incisal edge down. Full coverage was the only practical solution, but I had 15 minutes.

I tried to figure out whether I could somehow use composite until we could have her back to do the crown. I told her a crown was her best option. Then I segued into what I would need to do immediately to get her back to “presentable.” I began to explain that I would try to rebuild the missing part with “white filling material” but she would really need to favor it until the crown appointment. She laughed and said, “Dr Flucke, that’s sweet of you to be that concerned, but you don’t have to do anything today. I’m living my life in a mask.”

I was seeing things from the doctor’s perspective and had forgotten that those of us in dentistry were the only ones, other than relatives, who were seeing individuals without masks.

During the past 12 to 18 months, masks have spared practices a lot of stress. However, masks are starting to come off in some areas, and eventually we will probably be back to a minimal mask environment. That means patients are going to start looking for ways to flash a bright smile.

One of the things we have found to be a good low-pressure marketing tool is the wallpaper on the patient monitor. For the past 6 months or so, we have been using that space to promote our whitening program. We have several different images that rotate on the screen: one with a model in a mask, one with a model wearing a mask with a cutout so you can see the smile, and some with our usual whitening images. We have gotten positive feedback on this and have had quite a few patients decide to whiten based on it.

The most common whitening process still involves the custom tray. Nowadays we are scanning patients with our iTero Element

 5D Plus intraoral scanner and then printing the models with our SprintRay Pro Dental 3D Printer.

One thing I love about technology is that it basically markets itself. People are fascinated watching their teeth appear on the screen as we scan their mouth. We usually take the time to move the images around on the screen, rotate them, and zoom in just so they can see and appreciate how amazing the scanner truly is. When we give them their models and explain to them that we have taken their digital scan and printed it using the office 3D printer, they have a greater understanding of how we are using technology to make things better.

When Procter & Gamble (P&G) brought its Crest Whitestrips to the market, the dental industry was less than pleased. There was a great deal of concern that patients would forgo professional teeth whitening in favor of the lower-cost P&G option. What eventually happened was that patients tried Whitestrips, and those who did not get the desired results turned to their dental office for brighter smiles.

Along those lines, in addition to custom trays, we also offer our patients a couple of strip options. Our recommendation for a strip system depends on what we glean from the patient as we discuss the options.

Many complain that white strips were flimsy and difficult to keep in place. For those individuals, we recommend Sheer White! from CAO Group. The system uses 20% carbamide peroxide. What sets Sheer White! apart from other strip products is its adhesive. Other brands can slip, but once Sheer White! strips are applied to the teeth, they stay in place until the application time is met. After about 2 hours in the mouth, the adhesive begins to break down, making the strips easier to remove. Our other choice is Opalescence Go from Ultradent. These strips come in 10% or 15% hydrogen peroxide. Go comes in packages for each arch, and the strips are easy to place. The strip is contained inside a mouthguard. The patient creates suction in their mouth that pulls the strip against the teeth, and the mouthguard is removed, leaving the strip in place.

Since the idea of teeth whitening came into existence, the profession has been looking for a simple in-office system that will provide bright results within a single appointment. Dentistry has tried different ways to provide this service. We have tried activating the whitening agents with lights, heat, lasers, chemistry, and sometimes a combination. Now there is a new company in the in-office teeth whitening market called Mavrik and their product is TheraSmile.

TheraSmile is an entire automated system. It consists of a device, a mouthpiece, and chemistry. The device is freestanding, connects to the mouthpiece, and circulates the chemistry through it. The chemistry is warmed and circulates so that there is always fresh material coming into contact with the teeth. The mouthpiece creates a fluid seal, utilizing a vacuum that keeps the chemistry from escaping into the mouth.

Often with in-office systems, the patient must keep their mouth open for the entire treatment time, which leads to dehydration. Although the teeth appear whiter at the end of the appointment, they often rebound and lose much of the whitening as they rehydrate. Because of this, many offices provide take-home trays as an adjunct to make sure the whitening remains. With TheraSmile, the teeth do not dehydrate, which means that the shade achieved at completion remains. Because the liquid chemistry constantly rehydrates the teeth, results are much more predictable. Also, the chemistry is provided in unidose treatment kits that prevent cross-contamination.

We’ve been beta-testing the device for about 3 weeks. The initial results have been very nice. My wife is always my test subject for whitening products. She tends to develop sharp sensitivity when whitening, so whenever I get a new product to try, she is always the first test subject. I am happy to say that she had a beautiful result from the treatment as well as no sensitivity issues.

I am not sure who thought of the phrase, but it’s true that “a beautiful smile never goes out of style.” As we reenter a world where people can show their smiles, many of our patients are anxious and excited to do just that. Offering them even more reasons to smile is one of the great things about our profession. After all we have been through, we all need a reason to smile.

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Patients can receive the teeth whitening that works best for them through a variety of products and methods.

The Future of Teeth Whitening

My job as “Technology Evangelist” is to find the latest and the greatest game-changing products for our profession. I am on a constant hunt for anything that can make our work easier and give our patients better clinical outcomes.

Sometimes these things are technological breakthroughs and sometimes they are simple improvements, not tech-related but capable of changing our profession for the better. I’ve always been fascinated by the newest products.

We all tend to remember moments when someone gave us a smidgen of advice that perhaps to them didn’t seem that profound but that changed our lives. Normally those moments are extremely positive, but occasionally, looking back, we are grateful we didn’t follow their advice.

I had an instructor in dental school who was an incredibly nice man—but he had never actually practiced. He graduated from dental school and immediately became a faculty member. He spent his entire career on the school faculty.

One day he told me, “The education you get at this school will let you practice your entire career without ever having to learn another thing.” I’m incredibly grateful I made the effort to keep learning. I bring this up because as I was brainstorming for this article on products I no longer use, I was hard-pressed to think of almost any product or procedure I am still using or doing the same way as when I graduated.

So, this month, let’s take a quick look at some of my new favorite, frequently used products.

When I was in school, the fiber-optic, highspeed handpiece was the newest and coolest thing in dentistry. I was trained on these air-driven handpieces and had used them for years. I concluded—as many people do when arguing against change—that “I’m performing just fine doing it this way. Why should I spend a bunch of money to change?” The simple answer was that I didn’t know what I didn’t know.

I was working on a project with Bien-Air Medical Technologies that required me to install and use one of their electric systems. Once I began to use electrics on an everyday basis, I couldn’t believe the difference it made.

The control, precision, and torque were phenomenal. My preps took less time, my margins were better, and the fit of my fixed prosthetics was better as well. I truly believe that the only doctors who are opposed to electric handpieces are doctors who have yet to use them clinically. Once you experience the difference, you will be as big a fan as I am.

Computer-Controlled Local Anesthetic Delivery

I’ve never met a dentist who does not give the most painless injections in the industry. When I ask them how they know this, they reply that their patients never talk about the injections being painful. I hate to be the one to deliver the bad news, but your patients are just being kind.

I know this because I was in the same situation—until I began using Milestone Scientific’s STA Single Tooth Anesthesia System®. I was approached by the folks at Milestone Scientific about helping them make some changes to the device a few years ago, so I began using it on a regular basis. I was a psychology major in undergrad, and I was well familiar with the placebo effect. Honestly, I thought that was what the STA was—a tremendous placebo. When I began using it, patients raved about how painless the injections were.

I now use the device on blocks, infiltrations, and periodontal ligament injections. Patients are incredibly appreciative. If you can figure out a way to make patients dread injections less, that is a practice builder.

It turns out that the average width of a fissure is between 40 to 156 μm, whereas the width of the explorer is 68 μm. By the time the caries has progressed to the point it can be detected with an explorer, it is much larger than the diameter of the explorer. In a nutshell, the explorer is too wide to find caries at its earliest point of development, so we let the process progress until the decay is large enough that it is easily detected by the explorer tip. Basically, we are allowing the cavity to grow until we can detect it. To me, that just doesn’t make sense.

Once I began to study the process of dental caries, I lost confidence in the sharp explorer as the gold standard of caries detection. Instead, my team and I utilize digital caries detection.

That is accomplished by using devices that work in a way similar to an intraoral camera. Under certain wavelengths of light, areas of decay fluoresce. This allows you to take a still image of the tooth that shows the area of fluorescence. The light from these devices will go to the bottom of pits and fissures where the tip of an explorer will not.

The fluorescence begins early in the process when the breakdown first starts. These devices allow the team to locate and monitor the breakdown, which can then be removed and restored at the very earliest stages. That allows us to frequently restore before anesthetic is necessary.

My current caries detection device is the CamX Spectra from Air Techniques. It takes the areas of fluorescence that it detects and creates a “radar weather map” over the occlusal surface of the tooth. It makes the caries easier to see for the team and easier to understand for the patient.

More than 80% of doctors are now using magnification. I’d like to point out the advantages of using auxiliary lighting with your magnification.

When you think of the cost of a track light in your operatory, purchasing auxiliary lighting is an easy decision. A decent overhead track light is usually about $3500. An LED light attached to your surgical telescopes can easily save you thousands.

I cannot think of any clinical situation where a track light would be a better option than a light mounted on your scopes. It is rare in dentistry to get better ergonomics and save thousands of dollars by purchasing 1 product instead of another. You can take that savings and invest it in something else.

Most offices are using a type of sterilization monitoring service where spore strips are sent to an outside lab for testing and validation. The problem with that is it takes an extended amount of time to get the results back.

Instead, you can now do testing in your office that checks the efficiency of your autoclave(s) in less than 30 minutes. I know of 2 devices that allow you to do this: Tuttnauer’s MiniBio Incubator and the 3M™ Attest™.

Both are tabletop units that take up very little space. They utilize small vials that are run through a sterilization cycle and then placed into the unit along with a control vial.

The device incubates the vials and uses a spectrometer to monitor the fluid inside for growth of bacteria in the medium. The incubation process takes less than 30 minutes. If growth is detected, the unit notifies you by beeping and flashing LED warning lights.

It keeps the entire process in-house and works very quickly.

I honestly do not think there is 1 thing I continue to do the way I was trained. My training was great for the time I received it, but medical knowledge is doubling about every 18 months. That means we not only should keep learning but also that it’s absolutely necessary.

Add to that just how much more fun I am having now. Sometimes I cannot believe how lucky I am. I cannot believe how blessed I am to be in this profession at this point in time. I sure hope you feel the same way!

As times change and technology evolves, it’s as necessary as ever to keep learning and improving your skills and tools. 

The Times, They Are a-Changin’

like it was yesterday—but it was 15 years ago. I was walking the exhibit floor of the American Dental Association meeting, when I came across a very small booth with a very intriguing device. The company was Cadent, and the device was named iTero.

It was a digital impression system, but unlike the other systems at the time, it didn’t come with a mill. There was finally a company for doctors who wanted digital impressions but didn’t want to use a mill. I did my research, and before long, I owned a device. A few years later, we upgraded by purchasing the iTero Element® system.

After all this time using their products, I was ecstatic when Align Technology—the company that purchased Cadent in 2011—reached out to 

® to have me test-drive their new iTero Element 5D Plus imaging system.

I love watching devices evolve, and the iTero Element line of scanners is no exception. The intraoral scanner has taken the advantages of the original iTero Element scanner and improved upon them. The stand is more stable and more esthetic, the wheelbase has been expanded, and the length of the wheel arms have extended slightly, which greatly increases stability. The scanner has also been given light and dark accents, giving it much more of a space-aged look.

The unit was shipped to us disassembled, and my trusty assistant and ‘fix-it gal’ Nicky had it assembled and ready to roll in less than a lunch break. When she first turned the unit on, we were asked to connect to our secure Wi-Fi and to input our account information. Because we were existing iTero customers, all our previous cases and settings were downloaded from the Cloud, and within moments, we were ready to roll. It was easy and impressive.

We were blown away. The screen resolution is stunning

 the details are easily and clearly identified, the scans are gorgeous, and the processing power is downright impressive. We always position the iTero so the patient can see the monitor while the scan is taking place, and the speed with which the data appears on the screen is phenomenal. When I started with digital impressions in the late 1990s, the operator was taking photos with the device by tapping a foot pedal, and when enough images had been acquired, the system’s software would assemble those images into a 3D digital representation.

Watching the iTero Element 5D Plus imaging system scan the mouth is akin to watching water flow over an object. The system takes thousands of images per second,and combined with the processing power of the device, the scan appears smoothly and precisely. Patients are practically hypnotized by the experience. The color depth allows for easy margin discernment, and the resolution allows the user to enlarge the image on the screen with no loss of detail.

Another clinical feature that bears mentioning is the efficiency and the time savings it brings. In the past, when moving our iTero from operatory to operatory, it was necessary to power the scanner down, wheel it in, plug it in, then go through the boot sequence. Although it wasn’t a tremendous weakness, it did impede clinical progress on many occasions. Being a 3-doctor practice, there are times when the scanner is in use by another clinical team while the second team waits for the unit. The power down and power up steps simply added time to the process, but now that problem is history. The iTero Element 5D Plus imaging system comes with a built-in battery, which means when one team is done, the unit can be unplugged and moved to where it is needed next without fussing with the “power problem.” Now the unit is wheeled in, plugged in, and working on the next case in a matter of seconds. This has saved time and, more importantly, frustration for clinical personnel.

The clinical results have been phenomenal. The cases we have performed with the help of the iTero Element 5D Plus imaging system have been accurate and the prosthetics require minimal chair time to seat. One of the best things about iTero scans is the time they save: the system is fast and accurate on the front end, which leads to incredible accuracy on the back end. In the old days of analog impressions, when a case went to place with no adjustments, it was a high five moment. Now, when adjustments are necessary, we evaluate what happened on the front end to make that happen. Our expectations are now that cases fit with minimal to no adjustments.

It’s also a tremendous advantage of the device that our lab receives the case within minutes. If need be, we can discuss the case with the lab almost as soon as it is done. It also means, for cases that are done model-less, the lab can begin to design the case practically before the patient has left our office.

The scans have also been used to create restorations with our Axsys Versamill 5x400 mill. Having a mill is not a requirement to have the iTero experience in your office, but if you do own a mill or are considering purchasing one, your iTero scanner will provide incredibly accurate data for your design process.

The iTero Element 5D Plus imaging system is a terrific intraoral scanner, but it does much more. In addition to scanning, the system can take beautiful intraoral images. This saves time and boosts efficiency when it comes to documentation. Do you need to have photos of your preparation to send to third-party payers? No need to stop and pick up your operatory intraoral camera—you can take those photos directly with the iTero.

We’ve all had the experience of saying to a patient something along the lines of, “Your teeth are showing signs of excessive wear.” only to be met by the response, “No they aren’t.”

These situations are much easier to deal with due to iTero’s Occlusogram feature. Instead of telling a patient they brux, you can show them. In my office, we scan and discuss what we see before we mention the problem. This makes the acceptance easier. 

Humans are visual creatures. More than 85% of what we discern about our environment comes through our eyes, and the iTero Occlusogram plays to that advantage. It shows the teeth with a colored “weather radar” appearance that clearly identifies the patient’s wear patterns. It is a tremendous educational tool and a great adjunct to our office philosophy o “Focus, Educate, Relationships.”

Have you ever monitored a patient for several years and wished you could show them how the condition of their dentition changed? iTero’s TimeLapse feature puts this magic at your fingertips. If you scan a patient multiple times at different appointments, the iTero Element 5D Plus imaging system can combine those scans and create a video to show the changes that have occurred over time.

This is a powerful tool that can provide years of data in the span of a few seconds, which greatly increases patient understanding. Because the iTero Element 5D Plus scans so quickly and is easy to use, we have incorporated scanning every new patient to the practice. This is helping us to build a baseline of patient data. Our goal is to incorporate a digital scan into our normal 6-month hygiene visits to allow us to monitor every patient easily and efficiently.

Another benefit built into the iTero Element 5D Plus imaging system is the implementation of near infrared imaging (NIRI) to aid in the detection of caries above the gingiva. Infrared is outside of the visual spectrum, and this harmless wavelength penetrates tooth structure, allowing the device to operate as an accurate and powerful transillumination device for identification of caries above the gingiva. After completing the scan, the operator can tap an icon on the screen and see the scan through the eyes of NIRI imaging.

Viewing the dentition through NIRI is another data gathering tool for the doctor to help render a clinical decision. Combining things, such as NIRI, with the data acquired through digital radiographs, can add accuracy to a clinical situation that otherwise might have been difficult to diagnose with a high degree of certainty. NIRI is also nonionizing, meaning that it can be used on pregnant patients and young children without any concern regarding radiation.

Whether used as a diagnostic scan in hygiene or reviewing scans taken for routine prosthetic cases, NIRI is a feature that is accurate, always on, and simple to use. During my test drive, I encountered areas of decay that I otherwise would not have identified.

With the iTero Element 5D Plus imaging system, full mouth scan takes just minutes, and the learning curve is short. Even our study models are now done digitally, and the models are created using our 3D printer. Gone are the days where study models were taken in alginate, then poured immediately to minimize distortion. Cases are stored in the cloud and can be reprinted easily, if needed.

As I mentioned previously, the seating of cases is tremendously easier than before. Single unit cases—which are most of the cases seated in the average general dental practice—are frequently accomplished in 10 minutes. We normally block 30 minutes for a single unit seat, but it is rare if it takes longer than 10 minutes.

Allow me to let you in on a secret: Patients hate impressions. However, they are fascinated and impressed with the iTero Element 5D Plus imaging system, and they talk about it to their friends and relatives. One of the unseen benefits of the system is that the technology markets itself. We get referrals based on digital impressions and our overall use of technology to improve patient outcomes.

I’ve been an iTero client for well over a decade, and for good reasons. However, I’m not just impressed with the iTero Element 5D Plus imaging system simply because of that fact. I’m impressed because the system is capable of so many things! I also feel that, as a long-term client, I have a better appreciation for how much their systems have improved.

Caries detection with NIRI, occlusal analysis, time-lapse videos, intraoral photography, and digital impressions are all wrapped up in a highly esthetic and highly mobile high-tech package. I know a lot of you that have not yet made the jump to digital are weighing your options. The lack of trade shows for over a year hasn’t helped. However, if you are looking to make a purchase in the near future, and you saw an iTero unit a few years ago, you owe it to yourself to take a close look at the iTero Element 5D Plus imaging system.

Suffice it to say if you haven’t seen iTero lately, you haven’t seen iTero.

Oh…one other detail I should tell you. There is a time limit to my test drives and there always comes that point in the process when the product must be sent back to the company that was gracious enough to allow me to have time to evaluate it.

This time was a bit different. I was so impressed with the iTero Element 5D Plus imaging system that I called the company and had them start the paperwork so I could have one of my own. In just a couple of months, the technology had become indispensable to my practice. The iTero Element 5D imaging system is an impressive device. I’m so impressed that I cannot do without it. I think you will feel the same way.

John Flucke, DDS, took this the latest iTero intraoral scanner from Align Technology for a test drive and came away impressed enough that he purchased the scanner for his practice.

Advertorial: An Indispensable Intraoral Scanner That Goes Beyond Digital Impressions 

As someone who loves the practice of dentistry, I have a confession to make: I flat-out love endodontics. Now, don’t get me wrong; I love composites, I love fixed prosthetics, I love treating sleep apnea, and I love improving patients’ smiles. The great thing about being a general dentist is that I get to do all those things, but my favorite procedure is endo.

I’m willing to bet that a lot of you just groaned at that last sentence, but bear with me on this. Quite a few years back, I injured my right elbow—not severely, but enough that the process of performing extractions became painful. So I chose to stop doing them. I began to look for another procedure that I could be as passionate about that would save my patients from a referral.

I always had interest in endodontics, but after I was forced to give up on performing extractions, I decided to devote some time to learn. I consider myself fortunate because I became friends with an endodontist who loved tech as much as I do and who also happened to be a great teacher. 

We would get together frequently and with practice blocks and extracted teeth, he taught me the art and science of endodontics. I basically got a miniature residency from all the work we did together, and I became confident in my endo skills. I owe my friend Jerry a debt of gratitude.

That confidence allowed me to do more cases, and also allowed me to better evaluate products and techniques. As new, superior products and methods were introduced, I extrapolated what I had learned to help me incorporate those products into my cases.

Also, some of my time is spent evaluating products in different phases of development, so I often get a chance to see things well before they hit the market. That sometimes gives me months of experience with a product before it is even released.

Efficiency in endodontics is important. I look upon making the procedure faster while achieving better outcomes as critical. Patients do not want endo to take longer. In all my years of practice, no patient has ever asked me to leave the rubber dam on for 15 or 30 more minutes because they enjoy it so much. The procedure should take as little time as possible while providing the best outcomes we can deliver. These are products currently on the market that can make your endo life easier and less stressful.

Septodont Paroject Intraligamental Syringe

Although not strictly an endo product, this beauty can make a tremendous difference when an infected tooth won’t get numb. Sometimes teeth simply don’t cooperate, and a periodontal ligament injection is a great way to get anesthetic right where you need it.

The device is simple, sleek, and effective. We also routinely use it for restoring a single lower molar instead of delivering a block. You can check it out at 

https://www.septodontusa.com/products/paroject

One of the most important parts of endo is creating the “glide path.” This is the initial part of shaping that prepares the canal for rotary files. Often this is done with hand files, which can be a slow and difficult process. Some current instrumentation techniques allow for reciprocation and rotation with the same type of file. Other systems require the creation of a glide path with the time-tested process of using hand files. Of course, filing by hand is frequently a slow and arduous process.

But what if you could take that hand filing and convert it to engine driven? That is the beauty of the M4 Safety Handpiece. This device is a contra angle that fits on a standard E speed motor attachment (usually the one on your endo motor). The head has a push button chuck that will accept the handle of almost any type of hand file. Once the file has been gripped by the M4, it moves in a 60º “watch-winding” oscillation when you step on the rheostat, turning 30º in each direction. This makes the hand files efficient, allowing the operator to finish with a file in less than 30 seconds.

The M4 has become a vital part of my endo setups. My glide path steps are efficient and predictable. It truly is one of those devices I do not want to work without. Find it by going to 

https://www.kerrdental.com/kerr-endodontics/m4-safety-handpiece-endodontic-contra-angle-shape

If you follow the endodontic literature, you understand that mechanical debridement, even with the very best instruments in the hands of the very best operator, will not completely clean the canal system. There are too many oddities in its shape for a file to reach and adequately clean them. We need to use our irrigation chemistry to reach those areas for us.

Of course, the standard and most popular way of removing pulpal remnants and bacteria is to use sodium hypochlorite. Yet with all those little nooks and crannies in the canal system, how can we ensure that the irrigant is adequately reaching those areas and working its magic? The best way to do this is to agitate the irrigants with ultrasonic energy.

This can be done by using a piezo unit, but those devices are a bit pricey and also occupy a pretty large footprint. Instead, how about a small, light, and cordless unit designed specifically for endo? That is what you get with the EndoUltra from the folks at Vista Apex. The EndoUltra is the only cordless activator unit capable of generating the tip frequency (40,000 Hz) required to create sufficient acoustical streaming and the cavitation necessary to effectively clean, penetrate, and remove vapor lock. It uses titanium tips that can be bent to accommodate easy access to any tooth. It also has a white LED that helps illuminate the field during use.

One other thing that makes it so great is that, in addition to all its benefits, it is also affordable. Check it out by going to 

https://vistaapex.com/product/endoultra-cordless-ultrasonic-activator/

Medidenta Advanced Cordless Endo (ACE) Motor

I owe a great deal to my friend Dr Carlos S. Ramos. He is an endodontist as well as a tremendous endodontic researcher, teacher, and inventor. He has taught me and explained countless endodontic secrets of success. His outside-the-box thinking is inspiring, and one of his latest inventions deserves mention.

Two of the most important changes in endo in the past couple of decades involve the development of the electronic apex locator (EAL) and the electric torque-controlled endo motor. Achieving clinical success without an EAL is difficult, and knowing the location of the apex is critical. Knowing its exact length and then moving your instrument to it exactly is more difficult than it sounds. One must first determine the canal length, then translate the determined distance to a file in a handpiece. After that, getting it to precisely the right spot is challenging.

The solution is to have the EAL built into the electric torque-controlled motor so that the 2 devices work simultaneously. Being able to know the location of the file in the canal at any moment as you are working is powerful and helps ensure clinical success in instrumentation.

One of the more recent improvements in instrumentation is the concept of using a file system that allows for the files to be used in reciprocation as well as rotation. The ACE motor is one of a few motors on the market that will do just that. Dr Ramos has also invented the Endo-Eze™Genius® file system, which uses both reciprocation and rotation in instrumentation. To enable that, he has designed the ACE motor to perform those critical functions well.

However, it’s not simply that this motor (which he designed) works great with the Genius files (which he also designed). The other truly great aspect of this device is that it is designed with fully open architecture. By that I mean the motor is totally programmable by the end user. In a nutshell, that means the doctor can tell the motor precisely how to perform.

The ACE is far and away the most comprehensive and all-encompassing endo motor I have ever seen. The device is so impressive, I could easily have devoted this entire article to it. However, you can learn everything about it by watching an 11-minute video. Head over to YouTube and prepare to be amazed.

https://www.youtube.com/watch?app=desktop&v=Wd-4-8Fo7aQ

Almost every endodontist has a surgical microscope these days. However, although more than 80% of general dentists work with surgical telescopes, only a very small percentage actually work with microscopes. The main reason they have not embraced the concept of microscopes is the cost. Although microscopes aid in endo, most doctors feel that working in 3.0× to 5.0× is perfectly acceptable for quality restorative work.

The expense of a surgical microscope is hard to justify when endo is not the only procedure on your daily schedule. Enter Labomed, with their line of affordable surgical microscopes. The company currently offers 3 models, and they are more affordable than those from other companies in the dental space.

The products offer features such as the ability to connect a DSL camera for taking photos, connections for monitors, and even a splitter that allows the assistant to see what the doctor sees. I have had one of their microscopes in my office for the past few years and have been very happy with its performance. Give them a look at 

https://www.laboamerica.com/category/dental-microscopes/

If you noticed that I failed to mention a file system, I have a good explanation. File systems are a bit like cars. Each system has advantages and disadvantages. It really comes down to what works best in your hands. The products mentioned here will improve your clinical outcomes no matter which file system you use.

The important thing to remember is that endodontics is a constantly changing landscape. Like walking up the down escalator, if you are not pushing to move forward you will be moving backward. This constant push to be our best is one of the things I love most about what I do. I hope you feel the same way. I sincerely hope that this column has given you some nuggets to improve your patient outcomes.

A variety of endodontic products can help make procedures more cost-effective and efficient.