During a trip to the Aspen Dental Summit in Miami Dr. Nasseh shares a portion of his lecture on ultraonic cleaning and debridement of the canal from his hotel room.
Thanks Ali for the great lecture as always. Your early videos were pivotal for me when I was a new grad and I now firmly believe that single cone hydraulic condensation with a flowable bioceramic sealer is the only way to obturate. My question is what do you think about standard sonic activators (Endo Activator) for activating your irrigant? This is what I personally use out of habit. Is an ultrasonic activator a necessary upgrade? Thanks again. -Tanner
Thanks. I think anything you do it better, Sonic or Ultrasonic. Its just that the sonic requires one more tool on your shelf. If I can multi-use my ultrasonic for that I'd prefer to get more out of less than add one more tool. But if you have it and it works in your hands use it. Cheers!
@@AANasseh Great point, I'm all about simplifying the armamentarium. I'll have to pick up some of those ultrasonic file tips for activation. Thanks again as always. 👍
@@behindtheloupes Be sure to use it at the lowest power setting and they should we free in teh canal. No contact at the tip and the sides. I'm designing non cutting tips soon.
Sonic is better than nothing; but ultrasonic, at least based on the research, seems to be better. Either way, both are better than nothing. Flexible tips don't work on ultrasonic as they absorb the ultrasonic energy. They must be rigid. That's how it works. That's why those tips are stainless steel and solid. Cheers!
When do you use the ultrasonic? Is this irrigation your last one after your last file? I have 4 of these for my 4 units and 2 extra ones Judi in case one broke.
I use the ultrasonic all the time. In a previous video where I'm in Pensacola Florida I explain my sequence. You can use the ultrasonic with water to flush and then replace the water with NaClO for the most safety in flushing. Your thin ultrasonic tips should be used at their lowest setting. Just dump them after about 20 uses. Don't take a chance. Cheers!
Does Endo Ultra by Vistal Dental have a similar effect? Or do we need to get a piezo/magnetostrictive type of ultrasonic unit to have adequate energy for activation of the irrigant to clean well?
Theirs can only to Passive Ultrasonic Irrigation (PUI). It's a good unit and works; but only does one thing. A regular ultrasonic can do the same plus more. But it's up to you if you find that to be more convenient. : )
As the product developer that you are, I have a question. I saw that NSK has a Varios perio tip for pocket irrigation and cleaning, called P40 and P41. My question is, how difficult would it be to develop an endo irrigation tip that will irrigate root canals, similar to the Pro Ultra Piezo Flow? According to Dr. Happasalo, piezo flow is the quickest way to debride a canal, apart from Gentlewave. The Varios 970 and Combi Pro have independent bottled water source; how hard would it be to use NaOcl with that unit?
Michael, there are a lot of options in this area and yes, I've been planning on redesigning the E-12 tip now for about 10 years!!! I must say I've been lazy and too many projects have come up that have taken priority... but maybe I should do this sooner than later. But either way, I think the addition of some ultrasonic energy is really what's the important factor in catalyzing the rate of reaction when it comes to cleaning. As you know from my other video, I've been focusing more on flushing with water and then replacing the water with Triton as a safer and more efficient (and less expensive) means of irrigation. I hope this makes sense. Cheers! :)
@@AANasseh Hey Dr. Ali, yes it makes sense. I was just inspired by a video DELabs (Dr. Buchanan youtube page) uploaded not long ago, in which he demostrated the efficacy of Gentlewave in 3D printed blocks with a piece of ham between two shaped canals, imitating a long, voluminous istmus (similar to what one might find in a c-shaped molar). When GW went through its NaOcl cycle, tissue dissolution was clearly evident, but when it went through its EDTA and distilled water cycles, no tissue dissolution occured. Although an in-vitro demostration, and ham is not pulp tissue, I became convinced that activating NaOcl is required in order to debride vital tissue in lateral anatomy like lateral canals and istmi, regardless of which tool you use for activation. As a side note, he also demonstrated how little sonic activation contributes to said tissue dissolution and how much negative pressure irrigation does; I became an avid Endovac user ever since. Having said this, I can totally see how activation of water would be beneficial for flushing the main canal space and how it contributes to desinfection of lateral anatomy in necrotic cases, which is why I've adopted your approach of US flushing with the E4D tip between files. I'd also say that I refuse to associate you with the word "lazy"! You're one of the most prolific endos I can think of! I can't wait to see how that updated E12 looks like!
@@michaellupu2080 I agree Michael. Activating the solution makes a lot of sense. And yes, that video is using Prosciutto, which is not pulpally relevant; however, it does demonstrate the importance of volume and activation; something we've known from a large body of research. I'm glad you're using EndoVac. It's a great product. I've developed a product called TotalVac that will soon be launched (Greater NY Dental Meeting!). You'll see that video soon. However, spending $80K may not be necessary to get the results we want as it's clear from the outcome studies done prior to GW. So, let's not lose sight of the big picture. Cheers! : )
@@AANasseh Thank you for your words of encouragment. Gentlewave looks amazing, but it'll have to wait in my case, for sure. You know what I wonder? What would be the effects of placing a microcanula in one canal and activating NaOcl in the other in roots with interconnecting canals (via istmi), like in lower molars and 2 canal premolars. It would be a clumsy set up, requiring 3 hands (one to administer fresh solution, ideally with the endovac master delivery tip, combining both irrigation and aspiration), another to hold the irrigating handpiece (I'd fear US activating, as it might damage the microcanula) and the third hand holds the mouth mirror. It's like piezoflow combined with NPI, which will obviously increase the amount of wall shear stress at the apex. Might it increase the rate of tissue dissolution? I can't wait to see your contribution to the NPI world!
@@michaellupu2080 don’t over complicate it Michael. Simply Adding NaClO while agitating with US should suffice. That’s what TotalVac is designed to do, but at a fraction of the cost as it will be manual and won’t have any bells and whistles.
Those types of sonic based movement are not as effective as piezo motion. There are also single trick ponies. Ultrasonics can o all that plus many other functions. So, why not use multitasker than a single function tool (studies show it doesn't do a better job than ultrasonics by the way). Cheers.
@@AmarjotSingh007 No need to go beyond the curve. Hold above the curve and refresh the solution often. I probably have to make a video about that to show it.
I'm so sad to hear you working with Aspen Dental. Did you research them at all? So many people are getting together in class action lawsuits against them. They are about money and nothing else! They are the used car dealership of dentistry. All the dentists are employees only and cannot have any say in the practice itself, and have to meet certain numbers every month. Ex- employees have all said how predatory and terrible these offices are.
There are many dental corps out there now. I don't work in their offices but whether Aspen Dental or another DSO, my job is to educate all dentists who are interested in improving their patient care the same way. I don't make any value judgements and say the same things whether I'm lecturing to dentists at Aspen Dental or to those at Spear Education. It's up to the individuals to hear the right messages and act on them. I'm not familiar with the lawsuit you're talking about but It's important that we don't make umbrella judgements about individual doctors working at any large group. After all, if McDonald is sued for any specific reason we won't begin to judge the people who make their fries. We need a nuanced view before judging large groups of people. Cheers.
Great lecture
Thanks Ali for the great lecture as always. Your early videos were pivotal for me when I was a new grad and I now firmly believe that single cone hydraulic condensation with a flowable bioceramic sealer is the only way to obturate. My question is what do you think about standard sonic activators (Endo Activator) for activating your irrigant? This is what I personally use out of habit. Is an ultrasonic activator a necessary upgrade? Thanks again. -Tanner
Thanks. I think anything you do it better, Sonic or Ultrasonic. Its just that the sonic requires one more tool on your shelf. If I can multi-use my ultrasonic for that I'd prefer to get more out of less than add one more tool. But if you have it and it works in your hands use it. Cheers!
@@AANasseh Great point, I'm all about simplifying the armamentarium. I'll have to pick up some of those ultrasonic file tips for activation. Thanks again as always. 👍
@@behindtheloupes Be sure to use it at the lowest power setting and they should we free in teh canal. No contact at the tip and the sides. I'm designing non cutting tips soon.
@@AANasseh Thank you! 🙏
Thanks for sharing!
Thanks for the information
Sir,What about air sonic
Or adding polymer (flexible) tip to ultrasonic!!
Sonic is better than nothing; but ultrasonic, at least based on the research, seems to be better. Either way, both are better than nothing. Flexible tips don't work on ultrasonic as they absorb the ultrasonic energy. They must be rigid. That's how it works. That's why those tips are stainless steel and solid. Cheers!
When do you use the ultrasonic? Is this irrigation your last one after your last file? I have 4 of these for my 4 units and 2 extra ones Judi in case one broke.
I use the ultrasonic all the time. In a previous video where I'm in Pensacola Florida I explain my sequence. You can use the ultrasonic with water to flush and then replace the water with NaClO for the most safety in flushing. Your thin ultrasonic tips should be used at their lowest setting. Just dump them after about 20 uses. Don't take a chance. Cheers!
Does Endo Ultra by Vistal Dental have a similar effect? Or do we need to get a piezo/magnetostrictive type of ultrasonic unit to have adequate energy for activation of the irrigant to clean well?
Theirs can only to Passive Ultrasonic Irrigation (PUI). It's a good unit and works; but only does one thing. A regular ultrasonic can do the same plus more. But it's up to you if you find that to be more convenient. : )
What about the Endoactivator?
EA is a sonic method of agitating the solution. It’s better than nothing but ultrasonics are better overall.
EA is a good option against doing nothing but it’s overall not as good as ultrasonics that are multifunctional.
@@AANasseh thanks for your advice 👍
As the product developer that you are, I have a question. I saw that NSK has a Varios perio tip for pocket irrigation and cleaning, called P40 and P41. My question is, how difficult would it be to develop an endo irrigation tip that will irrigate root canals, similar to the Pro Ultra Piezo Flow? According to Dr. Happasalo, piezo flow is the quickest way to debride a canal, apart from Gentlewave. The Varios 970 and Combi Pro have independent bottled water source; how hard would it be to use NaOcl with that unit?
Michael, there are a lot of options in this area and yes, I've been planning on redesigning the E-12 tip now for about 10 years!!! I must say I've been lazy and too many projects have come up that have taken priority... but maybe I should do this sooner than later. But either way, I think the addition of some ultrasonic energy is really what's the important factor in catalyzing the rate of reaction when it comes to cleaning. As you know from my other video, I've been focusing more on flushing with water and then replacing the water with Triton as a safer and more efficient (and less expensive) means of irrigation. I hope this makes sense. Cheers! :)
@@AANasseh Hey Dr. Ali, yes it makes sense. I was just inspired by a video DELabs (Dr. Buchanan youtube page) uploaded not long ago, in which he demostrated the efficacy of Gentlewave in 3D printed blocks with a piece of ham between two shaped canals, imitating a long, voluminous istmus (similar to what one might find in a c-shaped molar). When GW went through its NaOcl cycle, tissue dissolution was clearly evident, but when it went through its EDTA and distilled water cycles, no tissue dissolution occured. Although an in-vitro demostration, and ham is not pulp tissue, I became convinced that activating NaOcl is required in order to debride vital tissue in lateral anatomy like lateral canals and istmi, regardless of which tool you use for activation.
As a side note, he also demonstrated how little sonic activation contributes to said tissue dissolution and how much negative pressure irrigation does; I became an avid Endovac user ever since.
Having said this, I can totally see how activation of water would be beneficial for flushing the main canal space and how it contributes to desinfection of lateral anatomy in necrotic cases, which is why I've adopted your approach of US flushing with the E4D tip between files.
I'd also say that I refuse to associate you with the word "lazy"! You're one of the most prolific endos I can think of!
I can't wait to see how that updated E12 looks like!
@@michaellupu2080 I agree Michael. Activating the solution makes a lot of sense. And yes, that video is using Prosciutto, which is not pulpally relevant; however, it does demonstrate the importance of volume and activation; something we've known from a large body of research. I'm glad you're using EndoVac. It's a great product. I've developed a product called TotalVac that will soon be launched (Greater NY Dental Meeting!). You'll see that video soon. However, spending $80K may not be necessary to get the results we want as it's clear from the outcome studies done prior to GW. So, let's not lose sight of the big picture. Cheers! : )
@@AANasseh Thank you for your words of encouragment.
Gentlewave looks amazing, but it'll have to wait in my case, for sure.
You know what I wonder? What would be the effects of placing a microcanula in one canal and activating NaOcl in the other in roots with interconnecting canals (via istmi), like in lower molars and 2 canal premolars.
It would be a clumsy set up, requiring 3 hands (one to administer fresh solution, ideally with the endovac master delivery tip, combining both irrigation and aspiration), another to hold the irrigating handpiece (I'd fear US activating, as it might damage the microcanula) and the third hand holds the mouth mirror. It's like piezoflow combined with NPI, which will obviously increase the amount of wall shear stress at the apex. Might it increase the rate of tissue dissolution?
I can't wait to see your contribution to the NPI world!
@@michaellupu2080 don’t over complicate it Michael. Simply Adding NaClO while agitating with US should suffice. That’s what TotalVac is designed to do, but at a fraction of the cost as it will be manual and won’t have any bells and whistles.
Can you design something like EDDY for brasseler system
Those types of sonic based movement are not as effective as piezo motion. There are also single trick ponies. Ultrasonics can o all that plus many other functions. So, why not use multitasker than a single function tool (studies show it doesn't do a better job than ultrasonics by the way). Cheers.
Thank you ! How do you deal curved canals with PUI. I am just afraid of cutting more dentin in apical third with U12
@@AmarjotSingh007 No need to go beyond the curve. Hold above the curve and refresh the solution often. I probably have to make a video about that to show it.
@@AANasseh yes please thank you so much!
Endonomics !
I'm so sad to hear you working with Aspen Dental. Did you research them at all? So many people are getting together in class action lawsuits against them. They are about money and nothing else! They are the used car dealership of dentistry. All the dentists are employees only and cannot have any say in the practice itself, and have to meet certain numbers every month. Ex- employees have all said how predatory and terrible these offices are.
There are many dental corps out there now. I don't work in their offices but whether Aspen Dental or another DSO, my job is to educate all dentists who are interested in improving their patient care the same way. I don't make any value judgements and say the same things whether I'm lecturing to dentists at Aspen Dental or to those at Spear Education. It's up to the individuals to hear the right messages and act on them. I'm not familiar with the lawsuit you're talking about but It's important that we don't make umbrella judgements about individual doctors working at any large group. After all, if McDonald is sued for any specific reason we won't begin to judge the people who make their fries. We need a nuanced view before judging large groups of people. Cheers.