What Does it Really Take to Perform Efficient, High Quality Root Canal Therapy?

You're listening to The Dr. Phil Klein Dental Podcast Welcome to Dental Talk. I'm Dr. Phil Klein. When it comes to your root canal cases, increasing speed doesn't necessarily mean sacrificing safety or a favorable outcome. Today, we'll be discussing research-based facts and the tools to use to make our root canal procedures faster and easier with predictable clinical outcomes. Our guest is Dr. Aaron Nicholas, who has been practicing dentistry for over 30 years. and was picked as one of Washington's top dentists by Washingtonian Magazine, and has been chosen every year as a top doctor by the Consumer Council of America since 2004. So that's 19 years. That's pretty impressive. Dr. Nicholas, it's a pleasure to have you on the show. Thanks for having me on the show, Phil. Yeah, I've been around a long time. Yeah, so that's good. So you have a lot of experience. So let me start the podcast with the question about what you are currently using. Because we are going to be talking about a specific piece of equipment that we've talked offline about this that you find really irreplaceable, indispensable. It's something that you have to have when you do your root canals. And since you've been doing this for so many years, we certainly want to hear about it. So what method are you currently using to clean and shape your root canal cases? I think it's interesting that we all want to... have the magic bullet, the magic file or the magic handpiece or the magic whatever. And a lot of endo, you've practiced endodontics for quite a while. You know that a lot of it just has to do with going through the process and making sure that you finish each stage before you kind of go to the next one and not trying to jump and skip steps and that sort of thing. When you're doing endodontics, you're probably going to be using something to create an access opening. You're going to be using some sort of a file system. You're going to use some sort of an endodontic handpiece. You're going to be irrigating with something. And so there's not really magic there, but there are... files and there are handpieces that are better than others and that can make your life easier or something that you just have to deal with and work around. So I think I've got it down to the things that make my life easier and allow me to be efficient and allow me to be effective and make my day just smoother and more calm rather than having to always be working around your technology instead of letting your technology work for you. Anything specific you can talk about as far as what you're using? whether it's a file system, the actual handpiece, what is it in your armamentarium that allows you to be so efficient and successful? Besides, of course, the skill set that you have and the experience you have, we're assuming as endodontists, we all have that. As GPs that do a lot of endo, we also have that. So tell us about the armamentarium that actually makes a difference for you as far as efficiency, speed, and predictable clinical outcome. So I've been using the same file system and the same handpiece now for decades, actually. I really like the Merida Triato ZX handpiece. And the place that I started with that was because they actually have the Apex locator built into the handpiece. And that just seemed to make a whole lot of sense to me. I had prior to that had an Apex locator and a handpiece and tried all sorts of ways to hook the Apex locator to the file while I was using it. to try to get it to be able to apex locate while I was filing, but it seemed like invariably it would get wrapped around and it wouldn't be in the right spot or it wouldn't be reading or, you know, I would have some sort of an issue. So it just made more sense to file some and then do the apex location. But then when they came out with this apex locator built into the handpiece, And then it's cordless. So you just have a little clip on the lip and a very thin wire. So it's not like a corded handpiece. Then it makes it so I still have the tactile sensation from the file. And at the same time, I'm getting that feedback about, you know, where are we in the canal? How far are we? What do I kind of lets me know where I need to go next, because I know exactly where I am at this point. Yeah. So that's the tri-auto. ZX handpiece from Jay Morita. Now, Jay Morita has been known for many years to be the expert in apex location through their technology. Even when I practiced years ago, we used Jay Morita equipment to locate the apex. Now, now that it's integrated into the handpiece, was there any compromise at all regarding instrumentation or location of the apex? Yeah, no, I'd say there is literally no compromise at all. The one thing you did have to be careful about is you can't have a pulp chamber full of sodium hypochlorite because it can cross-read, so you need to know how to use your technology. But as far as was it less accurate than the root ZX that was the apex located that used to sit on my tray, no, I'd say it's the same. It's literally the same. I saw no difference whatsoever as far as being able to apex locate while filing versus file a bit and then apex locate. I had the settings exactly the same, and it all worked exactly the same. I didn't miss a beat as far as going from separate apex locator to apex locator built into the handpiece. So when you're instrumenting with this handpiece, you're actually seeing the tip of the instrument digitally through this technology while you're instrumenting the canal? Right. So on the handpiece, there's like a little screen, and there's a little graphic, and it shows you... It shows you moving down the canal. You're not... seem like a file, but like little lights that are moving you further and further towards the end point. And then also there's a little beeping. And so the closer you get to the end, the faster the beeps go. And then eventually it's a solid tone, which is when you're at the apex. For me personally, I'm wearing loops. I'm looking in the tooth. I'm trying to make sure that I'm taking care of everything that's going on there. So I rarely look at the screen, but I do listen to the beep and then I know kind of how far I am. away and you get kind of a feel for that. The handpiece can be used just as an apex locator. And if I'm doing that, then I'll have the screens where I can see it. I set it over on the delivery and I can see it as I'm working with a file and getting that length. But as I'm actually instrumenting and using the apex locator, I'm definitely not looking at the screen. I'm definitely looking at kind of where I am and what I'm doing. And then the beeps let me know. where I am in the tooth, and I know when I need to stop. Do you use x-rays as well to get your length, or do you rely strictly on the TriAuto ZX? To me, the... Using an x-ray to determine what your working length is or what your master cone length is, is kind of really, really old school because we know that at least 20% of the time, the radiographic apex is not the anatomic apex. And so if you end up making your master cone to the radiographic apex, sometimes what you have is gut of purchase sticking out the end of your tooth. And if you think about teeth that you've extracted that have had root canals, and then there's little bits of gutta percha hanging out of them, you can pretty much guarantee that that's what happened was that master cone length was set by looking at a radiograph rather than using the apex locator. So for me, if I can't get the apex locator to give me a good solid reading, I don't fill that day. We're going to come back another day and fill because I just need to let things heal up a little bit. And then usually the next time you come back, the Apex Locator gives you a solid reading and you can fill to that and you can bank on that. So what does it save you as far as chair side time, having this integrated into one piece of technology? I'd say probably we're looking at. Probably 10 minutes pretty easily, you know, having to go back and forth with the apex locator versus being able to work and have that happening at the same time. More on some teeth than others. The more dilacerations and curvatures you have, the more time it's going to save you because obviously you're checking more frequently, whereas if you have a nice straight canal, you know, you drop down to the apex right away. But with something that has more curves in it, you're going to have to go back and forth. before you can actually get that cleaned out to the apex and know where you are. And you could use any file system with this handpiece. Yeah, I mean, it has, what does it have now? The new one has eight settings. The old one had like four, but the new one has like eight settings. It has a reciprocation setting, I assume, to be able to work with the different files that require that. And then they have just the normal clockwise settings. And then at each of those, You can set them for torque and speed. So you can kind of get it to exactly where you want it. The new features are a little bit lost on me because I used the original one. It's what I was used to. And when I got the new one, I played around with the new settings, but I was just real comfortable with my old settings. So I actually call up their tech department. The tech guy helped me set it up exactly like my old one. And so I just keep using it like that. I do have friends that have bought the new one and started playing with it. And they really like some of those new settings. they love it, you know, and they, and they keep that. But for me, I just, mine are just the old settings and that works out fine. Yeah. What are your settings that you're typically using for your cases? I typically use a pro taper file. And so for the, their first two files, they want it to be, I believe it's five Newton centimeters of torque and 300 RPM. And then for the rest of the file, the finishing files, it drops way down to, I think it's 1.5. And then Still 300 RPM. I just set it up so long ago, and we just kind of keep using it over and over. And we set those as M2 and M3. And so, you know, we know M2 for the first two files, M3 for the last files, and we're good to go. In terms of the automatic safety features, there's automatic reverse or stop, those kind of features. Can you talk about them briefly? Sure. So there's a torque setting, whereas if you hit that torque setting, it's going to auto-reverse on you so that you don't break a file. Could you do that manually by yourself? Maybe, but to have basically an instantaneous feedback and have that file automatically reverse is a big advantage. And sometimes it'll all of a sudden auto -reverse on you and you'll realize, oh, I didn't realize I was pushing on the file that hard. And so it kind of saves you from yourself at times. I haven't had that happen in a while, but early on, I definitely had that happen more than once. It also will stop at the apex wherever you set that. So I set it down to as far as I can because for me in the end, I actually want to file out the apex about a half millimeter. So it'll stop me before it will actually not allow you to file through the apex. So it'll stop you at the apex. You can then. uh note what the reading is so now you know how long that uh that tooth is and then for me the way that i uh that i work with that is i then undo the uh the apex locator lead i go ahead and put it on manual and then i'll follow that half millimeter beyond there to make sure i have everything nice and clean but it definitely will at times literally save you from yourself because you're so intent on what you're doing you're not realizing sometimes the ways in which you're uh you're overstressing your files how did you get to know about the tri-auto zx ampi's I've been using that product for so long, like I said, decades. I don't actually remember my thought process in going through there. I knew I had the RootCX Apex Locator, and I think I may have had a handpiece that died, and I just decided to see what was out there. And since this is made by the same people who I trust for the Apex Locator, it seemed like it would be a great fit, and it would save a ton of time if I could actually be able to file. and Apex located at the same time. And it turned out to be kind of a happy coincidence, I guess. Yeah, that's so important too, to have trust in the company. And they are the leaders in endodontic technology in so many ways. They've been around a long time. They have such a good track record and they have a fantastic group of people that work at Jaymarita. You mentioned a tech person. It wasn't difficult to get in touch with them and talk to someone on the phone? Super easy. Just really, really easy. The guy's name was Ron, and I just called him up and go, hey, Ron, I've got this thing going on. What do I do to make this happen? And he's like, let me walk you through it. Do this, do this, do this. And I had a couple of other docs that I had recommended the handpiece to that had decided they wanted some things different. I'm like, call the tech department, talk to Ron. He'll get you squared away. And they all had a great experience as far as the support after the sale. We usually don't do. podcasts on specific equipment or products because we don't want to sound like we're just an infomercial but this is something that brings great efficiency to endodontics we've heard a lot about the triauto zx from various endodontists around the world that use it and uh we thought it was important for our listeners that do endo gps this is kind of great for gp too right Yeah, no, it's really good for a GP, especially if you haven't bought any endo equipment. It's like you can make this one purchase, and you kind of get both ends. You get the handpiece, and you get the apex locator. The other thing that I can say is that I've tried some other cordless units, and sometimes they don't have enough oomph to, like, really get the job done. And as soon as the file starts to engage, you can hear it slow down. And it seems the Merida works really well for having enough oomph in the battery that it will allow you to keep moving. even after the file starts to engage the dentin. Dr. Nicholas, it's been great talking to you this afternoon. We're talking to Dr. Aaron Nicholas, who's an expert in endodontics practicing over 30 years, and he's giving us his input on something that he needs or depends on strongly in his practice to get through his endodontic cases so he could get efficiency and high -quality root canal therapy to his patients. Thank you so much, and we hope to have you on again. to give us an update on any new equipment and stuff that you're using in your office to make everything work so well. Thank you. All right. Thank you, Phil. Good to be here.