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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.
Exploring the benefits of Ultradent’s Endo-Eze Genius Endodontic System.
As a general dentist, I get to see it all. The biggest reason I didn’t specialize is that I have a very wide range of interests and I was concerned that I might not enjoy doing the same procedure(s) day after day. I’m very much a “variety is the spice of life” kind of guy when it comes to my profession and my hobbies.
Of course, the drawback to that is I need to stay up to date with the changes and advances in multiple dental disciplines. That’s where passion and dedication come into the equation. My patients put a huge amount of trust in me and I owe it to them to provide them the very best, state-of-the-art care that I possibly can. As general dentists, we need to spend a decent amount of time learning and keeping up with the frequent changes that our procedures undergo.
Now as I said, I love variety. Yet I also really, really love endo. Of all the procedures I get to perform, endodontic therapy is by far and away my favorite. At this point, for all of you who are asking “Why?” my answer is: I can’t really say. Some people have a love of surgery; my engine just runs a little faster when I see endo on the schedule.
It may be because I have good success. It may be because a good endodontist friend taught me a ton through one-on-one, hands-on experience (thanks Jerry). Or it may be because the procedure has evolved to incorporate tons of high-tech gear. Suffice it to say that at this point I just don’t know.
However, because I’m so passionate about it, I have invested a substantial amount of time and treasure to become as knowledgeable as my limited brain power will allow. That means that over the years I’ve listened to and studied the techniques of a lot of experts. One of the things I’ve discovered in all of this is that there is no singular system that will work 100 percent of the time. Anyone who says differently is trying to sell you something-and it’s usually their endo system.
So, what do we do when we are looking for a way to perform endo therapy as well as we possibly can, yet no one system can do it all? I propose finding a system you like and becoming incredibly proficient with it while referring cases that are outside the scope of your system.
Answering the call
With that guideline in mind, I’d like to tell you about Ultradent’s newest idea to make endo easier. It’s called the Endo-Eze Genius Endodontic System and it is something I think the profession needs to know more about.
The Genius system is based on science and research, which are two of my favorite things. One of the biggest endo problems for the general practitioner is the use of rotary files. While there are certainly clinical situations where rotary does an excellent job, there are also plenty of areas where it would not make an excellent first choice. Also, there is the absolutely warranted concern over file separation with a file rotating 360 degrees.
The amazing advantage of Genius is that it is a combination system of reciprocating and rotary, in that order. However, unlike other systems, reciprocating is the heart of Genius. This has two serious clinical benefits:
1. Utilizing reciprocating greatly reduces the incidence of file fracture. It is much more difficult (though not impossible) to break a file that is oscillating than to break a file that is rotating.
2. Most root canals are not perfectly round. Because of this, in many canals there are small ribbons or other anatomical differences that perfectly round instrumentation can miss. Utilizing reciprocation and a brushing motion against all sides of the canal can provide for better cleansing while also decreasing the incidence of fracture.
The perfect example of the benefits would be an upper second premolar. It is usually a single canal with a figure-eight or elongated ribbon shape. Instrumentation utilizing rotary with a large taper can create a very round preparation in the middle but leave the buccal and lingual surfaces basically uninstrumented.
Continue to page two for more...
A Genius concept
This system utilizes an S-shaped file with two cutting surfaces (as opposed to the usual three with rotary) and a taper of .04, which is a smaller taper than utilized with most rotary systems. This results in less binding of the files as instrumentation is performed, better cleansing since the files can better reach all the anatomical nooks and crannies, and removal of less tooth structure since an .04 taper is the goal for final instrumentation.
The clinical technique is as follows:
• Preoperative radiograph
• Glide path to ISO size 10-15 (this can be done either via hand or engine driven files)
• Genius Orifice Opener (.08 taper 18 mm length) taken to about halfway down the canal with rotary
• Genius red (25 with .04 taper) to working length with reciprocating
• Final file size to working length with reciprocating (.04 taper, tip size varies with case 30-50)
• Final file size to working length with rotary.
To decrease confusion, you read that right. The clinician goes from 25 .04 to the MAF in one step. For example, if your MAF is 50, there is no need to go from 25-30-35-40 and then finally 50. You can go directly from 25 to 50.
The final step is MAF in rotary and that is done just to ensure debris removal. Rotary mode will bring all debris and dentin shavings out of the canal.
Closing the deal
The Genius system encompasses not only instrumentation, but obturation as well. Now, most systems currently offer some type of obturation that matches their files, but Genius goes beyond all the others by utilizing gutta percha cones that are injection molded. This means that the points fit the canals like a cork in a bottle.
These injection-molded points are combined with Ultra-Res sealer, which is a resin-based, self-etching resin endo sealer that bonds to the root surface to ensure maximum apical seal. Since the injection-molded gutta percha points fit the instrumented canals so well, they act as pistons to drive sealer into any small undulations that might be difficult to get gutta percha into. Studies have also shown the apical 3 mm are only contacted by a single cone so whether the clinician chooses to use a single cone or warm vertical condensation, a resin sealer helps prevent apical leakage into the periapical area.
In addition to the full line of instrumentation, Ultradent also offers all the necessary chemistries to take an endo case from start to finish. The company offers the following irrigants:
1. File-Eze. This is a lubricant that also contains 18% EDTA to start the case.
2. Chorcid and Chlorcid V. These are sodium hypochlorite solutions. The difference is that V stands for “viscous” and is a thicker consistancy.
3. EDTA. The EDTA solution is used after Chlorcid to remove the smear layer and to help the Endo-Rez bond properly.
4. Consepsis. This is a 2% Chlorhexidine solution that is used as a final irrigation. Chlorhexidine has also been shown to have a residual antibacterial affect.
Wrapping it up
Endodontics can be complicated, especially when one factors in how many different systems exist within the profession. However, I salute Ultradent for creating a system that not only helps simplify the entire procedure, but also decreases the incidence of untoward outcomes.
If you are looking for a way to make your endo easier and more predictable, make sure to call your Ultradent representative and take a look at the Ultradent Genius System. After studying endo for years, I feel you will be impressed by what they have developed!