Fine Cut Endo Contra Angle by Special Products, Inc.
So I put my head together with George Mikula, a machinist, and invented the Precision Endo Syringe, my first invention, and founded Special Products to sell it.
"Why should I change?"
Sub rosa, that is the question I always want to answer first.
The short answer is because the Automated Endo technique has been found by thousands of dentists like you, to be a fast, reliable, safe, effective and simple way of doing endo in a general practice.
The long answer requires a little perspective on where we have been and where endo is going.
Modern endo really started in 1958.
Until that time there were no real standards for the manufature of instruments.
And since then we have no shortage of DIFFERENT ways of doing endo with those "standards"
Until 1958 endo was an art.
It was taught by good ol' Dr. Quackenbush at the old dental college by simply saying "Do this because I know it works."
Very little rationale.
Very little understanding of what we were doing and why.
But I'm getting ahead of myself.
Why was 1958 a watershed year?
That was the year that all the endodontic manufacturers got together and decided on standard sizes for endo instruments.
The International Standards Organization decided that all instruments should have a 1 percent Morse taper.
Which in short means that for every 1mm of length, the RADIUS increases one-hundredth of a millimeter thus the one-percent figure.
(Which is actually TWO hundredths of a millimeter in DIAMETER.)
Which today is known as the .02 taper.
And because all the major manufacturers made instruments with about 16mm of blade, that too was defined as a standard.
And since instruments were all made by making a tapered three sided blade by grinding flats on a round piece of wire and then twisting it, standards were defined in terms of twisted wire files.
(Although there were a few companies making files by grinding flutes directly into the round wire. )
These were of course, what we know as Hedstrom or Hedstroem files.
What pretty much everyone agreed on was that the canals should be cleaned and then obliterated with something. That something divided the endo world in to three camps.
Those who filled with silver were newly enamored with the fact that they could now, define a shape for a preparation by the use of standardized instruments, namely by inserting a standard instrument and rotating or twisting it.
And since they could also make metal points to that shape, they devised the silver point technique.
Those who filled with gutta percha also used points that were tapered like the files.
One of the first methods was to make a prep, coat a point with cement and insert it into a pre-prepared canal.
(It was only later that someone figured out that gutta percha could be made to flow with heat.)
And finally there were those who adhered to the cement technique. (often incorrectly called the paste technique. Pastes dry. Cements set. )
Chief among them was Dr. Angelo Sargenti of Switzerland.
In fact his method preceded and straddled the 1958 era. At that time there was a consensus that canals needed not only to be cleaned but to be disinfected as well.
Sargenti understood quite well that prior to standardized instruments, it was nearly impossible to really clean a canal.
So he rationalized that since one could not 'clean' the canal anyway, why try.
By trial and error he put together a cocktail of ingredents that surely would kill bacteria.
It included some arsenic, lead and other rather caustic compounds and for good measure, paraformaldehyde.
When his technique hit America, just as standardized instruments were available, those who had not adopted them yet, saw a lot of good in his method.
But there was a fly in the ointment...if you'll pardon a pun.
A group of endodontic instructors had been fighting for recognition by the American Dental Association as a specialty.
To gain acceptance they had to unify behind ONE tried and true method else they would not get specialty status.
There was a lot at stake.
Specialty status meant that every dental school in the U.S. would have to teach endo...and have an endo department...with Chairmen and faculty.
Prior to 1960 there were only a few that did.
Many lumped endo, perio and pharmacology together under the rubric of 'dental therapeutics' and some didn't teach endo at all.
One school as of 1960 had a dentist come to the clinic one day a week to do one case and the students could watch...if they wanted to.
So it was terribly important that the endo specialists stuck together.
There were a lot of things wrong with Dr. Sargenti's method.
But then too, there were a lot of things wrong with silver points and gutta percha too.
But, because the endodontic profession was just getting started they picked Dr. Sargenti as a whipping boy.
The American Endodontic Society, the Sargenti group, gradually modified the technique to suit the American taste until all that was left was the cement as a sealer-filler containing only one active ingredient, paraformaldehyde.
The preparation now made possible by newer instrumentation was changed too.
Instead of admitting that one couldn't prepare a canal, good preparation was taught, but unfortunately, they had already been tagged with the old "Sargenti method" brush.
What has survived has had a profound effect on endo.
First the preparation methods and secondly the idea that cement works as well as gutta percha for sealing the canals.
I graduated in 1962 from one of the first schools to actively teach endo.
The Coolidge Study Group in the Chicago area was paramount in promoting good endo.
And I learned that if anyone used a rotary instrument in a canal he(and there were no women students in my class) would be promptly bounced out of school.
When I started doing endo full time in the early seventies, the accepted method was hand filing using the push-quarter-turn-pull method, getting at least two negative cultures, and filling with a series of gutta percha points, using lateral condensation.
PERIOD.
That was it.
End of discussion.
The average series of treatments could take three or four hours.
I realized the futility of doing that kind of endo in a busy group practice where I was expected to do the lion's share of the endo.
Many days I would be faced with seven to ten NEW cases.
Fortunately, I had bought a Giromatic handpiece in 1962 (when they were still sold by S.S.White).
I had tried to use them with K-type reamers and found that it didn't work too well and put it away in my dental museum(you know. The drawer where you keep all your mistakes).
Fortunately at that time, hedstrom files became available in the U.S. and I figured I had little to lose and bought some.
They worked pretty good and I was off and running.
In 1963 I was influenced by reading an article by Drs. Alvin Krakow and Harold Burke explaining how a syringe could be used to introduce a cement sealer in to pedodontic teeth.
And bought one of those...which was also in my museum by 1970, and I was using gutta percha again.
Faced with an onslaught of endo, I began filling with cement using the old PCA Pressure Filling Syringe and found that they looked as good as any gutta percha endo I was doing.
The owners of the group practice didn't restrict me to gutta percha but they drew the line at N2 which had a bad reputation in our area( some deservedly and some not so deservedly).
My epiphany occurred one Sunday in July 1972 while waiting for the Super Bowl on TV(this was before cable)
I wiled away the time watching a documentary on oil well drilling.
I watched them using drilling mud(which by the way is barium sulfate) to pump down into the well which flushed out the debris created by the drill bit.
The next day as I was filing with the Giromatic I directed the dental assistant to direct a stream of water into the access cavity while I was cutting.
IT WAS LIKE PUTTING THE GIRO INTO OVERDRIVE!! and I discovered "washed field endo technique."
Since the file was on the end of a handpiece(as opposed to on the end of my fingers) it was actually feasable now.
Combining Girofiles, Giromatic, Circumferential filing, Washed Field and Syringe Endo made it possible for me to keep up and I've never looked back.
We then began scheduling two endo cases, one for preparation and one for filling in each 45 minute segment of time.
Needless to say, the owners of the practice were interested in my productivity. And they invited their friends to watch. So...I figured if they were interested, so would a few other people.
By this time I was leaving my post as Director of Continuing Education at Loyola Dental School and decided to send a few brochures to Wisconsin and take my course on the road.
With support from my loyal wife and a few dental manufacturers I got a grand total of 12 attendees in five courses and I was off an running.
In 1978 we moved to Santa Cruz, California and in 1978 I realized that if I didn't do something drastic, the course was doomed.
I learned a very important lesson.
It is this....Just because *I* can do a technique doesn't mean I can teach it to others.
Dentists were just not willing to put up with the inconvenience of the PCA Pressure Filling Syringe.
It leaked.
It was difficult to load.
It was even worse to clean.
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Fine Cut Endo Contra Angle by Special Products, Inc. So I put my head together with George Mikula, a machinist, and invented the Precision Endo Syringe, my first invention, and founded Special Products to sell it. |
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which allowed much more precise control of the filling process complete with reusable but changeable mini barrels |
Since then many other innovations came about the same way until today, we have...
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the Fine-Cut Endo handpiece which literally does the circumferential filing for you by moving the file up and down in the canal hundreds of times per second and |
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The cartridge syringe which takes the idea of the multi mode one step farther and makes the barrels and needles a single unit that is disposable. |