AES Wi05 - American Endodontic Society

AMERICAN ENDODONTIC SOCIETY
AES CENTRAL OFFICE: P.O. Box 545, Glen Ellyn, IL 60138 (773) 519-4879
EASTERN OFFICE: 528 Freedom Blvd., Coatesville, PA 19320-1562 (773) 519-4879
AES WEBSITE: www.AESoc.com
Number 129
Winter 2014 ©AES
GLUTARALDEHYDE VS PARAFORMALDEHYDE
Alvin H. Arzt, D.D.S., MAES
Dedicated to
Saving Teeth
It has been 61 years that I have now been a dentist. In my
dental school days, “cavity toilet” was a key word prior to placing
any restoration. A wipe of the finished cavity floor with phenol
prior to placing the restoration was a routine never forgotten.
Even in those days, sealing bacteria under a filling was considered improper. This was independent of all the caries removal.
Much of this needed routine may have been forgotten with the
use of using an acid etch, such as phosphoric acid, to prepare the
Dr. Alvin Arzt
remaining tooth structure to accept the new composite sealer.
AES Treasurer
But the remaining bacteria in the cavity prep would be forever
sealed under the restoration.
Dr. Gordon J. Christensen, the founder and director of the Practical Clinical
Courses, recently stated in his “ask Dr. Christensen columns”, that the technique he
favored was the use of glutaraldehyde solution, prior to placing any liner in a cavity prep,
prior to placing a composite filling. The glutaraldehyde does not alter the bonding effect
or may improve the bond of these agents. This reminds me of the old technique of “cavity toilet” necessary to disinfect that cavity prep prior to placing the restoration.
And that brings us to the relationship of Glutaraldehyde formula CH²(CH²CHO)²,
with Paraformaldehyde HO(CH²O)nH, the solid form of the gas formaldehyde, which
is also an equal disinfectant.
Back in the 1950s Dr. Angelo Sargenti researched the results from Balint Orban,
a noted periodontist of his era. Dr. Orban wrote that a dilute solution of paraformaldehyde (7%), wiped deep into a periodontal pocket, disinfected that pocket and induced
reattachment.
Dr. Sargenti reasoned that if this 7% paraformaldehyde could repair periodontal
pockets, then it would be ideal to disinfect root canal pulpal tissue that has become gangrenous and seal the canal, with a sealant that prevents reinfection. And so, N2 Root
Canal Sealant was born. Dr. Sargenti developed a technique and sealant that would
allow a dentist to cleanse and reshape a canal, remove the debris mechanically (engine
driven), and introduce the sealant to completely disinfect the canal(s) and seal them and
then the sealant would harden so it would not leak out and become the filler. In vital pulp
contamination, Dr. Sargenti worked out a procedure that a portion of the apical pulp
could remain, and with the far reaching action of N2 the portion of vital pulp remaining,
maintained its vitality and health.
Recent published research (2013), by Dr. Robert Teeuwen of Germany, has
proven again that the early teachings of Dr. Sargenti are true. Dr. Teeuwen’s root canal
treatments extend to over 16,000 permanent teeth, and include hundreds of these with
their roots still not fully formed, but with large carious lesions causing the coronal portion of the pulp to become gangrenous. He extirpated the pulp up to the level where
cont. page 2
GLUTARALDEHYDE VS PARAFORMALDEHYDE
cont. from page 1
bleeding was observed and shy of the apical non-formed root area. After a few months,
his x-rays revealed that the roots continued to develop to normal length and a sclerotic
membrane (walled off barrier), separated the N2 from the remaining normal pulp. This
certainly proved that N2 was self-limiting and well tolerated by healthy tissue.
It is no wonder that Dr. Sargenti first lectured in the US in Dallas in the 1960s, and
it was not long before over 35,000 US dentists adapted this technique to their usual root
canal office regime.
With the bad publicity N2 has endured, it seems to have been proven contrived
and not true. In the July 2008, Volume 34, Number 7S, Journal of Endodontics, an article was published that proclaimed:
Reevaluation of earlier research that examined potential health risks associated
with formaldehyde exposure has shown that this research was based on flawed
assumptions, which resulted in erroneous conclusions. The purpose of this review was
to examine more recent research (2008), about formaldehyde metabolism, pharmacokinetics, and carcinogenicity. These results indicated that formaldehyde is probably not a
potent human carcinogen under low exposure conditions. In spite of all this favorable
research toward Formocresol and its much reduced relative, N2 which is 5%
paraformaldehyde without any caustic cresol, the antagonists refuse to retreat.
N2 now contains 5% paraformaldehyde as compared to Buckley’s Formocresol, which
is 19% paraformaldehyde and 35% cresol. Formocresol is probably used today (2013),
as frequently as it was used 50 years ago. When a patient comes into a dental office
with a severe toothache, the dentist who is treating this patient, who is in extreme pain,
into his crowded schedule, the dentist usually anesthetizes the tooth, opens up the
chamber and inserts a cotton pellet with formocresol, into the exposed chamber and
seals the tooth temporarily. Then the patient is rescheduled when the schedule allows
more time, or perhaps the patient is now referred to an endodontist to perform a root
canal. Formocresol is not restricted to pediatric dentistry as dental teachers recommend, but more likely to an adult patient.
What conclusions can we arrive at when Dr. Christensen recommends a disinfecting agent before applying the restorative material. What can we surmise when the
New York University Dental School research admits that conventional root canal treatments have only a 80% success rate. Yet research shows that N2, with 5%
paraformaldehyde reaches a 98% success rate. It is clear that bacteria contamination
can be the criteria between successful treatment and failure.
What dental procedures, including all specialties, involve procedures that can
have the sites with remaining bacteria? Operative, with usual removal of decay, and
restoring with a permanent restoration. This restoration could be a class I cavity, an inlay,
a crown, or even a veneer facing. In a simple prophylaxis, where there is deep scaling,
every stroke of the scaler could transport bacteria to another pocket. Does this mean the
scaler should be disinfected before another area is reached? The usual technique now
is to wipe the scaler clean from blood and debris with a cotton sponge, before the next
tooth is scaled. All this could be considered impractical in actual practice.
In implant insertion, the implant is obviously sterile, but is the bone site sterile where the
implant is to be inserted? Antibiotics are often prescribed in conjunction with the treatment to overcome any contamination.
It should be considered by all dentists, that in their treatment of a patient, that the
tooth or area may need “a cavity toilet” before they consider the job completed.
Dentistry has certainly changed in the 61 years of my practice. This past March 2013, I
finally retired my active dental license. It has certainly been worth it for me and I hope
for my patients.
page 2
(Reprinted with permission from The Profitable Dentist Newsletter - Winter 2013 issue 246)
AES PrESidEnt’S MESSAgE
I hope all of you had a wonderful Holiday season with family and
friends. We all work so hard it is nice to have time with our loved
ones.
Our annual meeting was held September 20th in Philadelphia.
We did not have it in conjunction with the American Dental
Association. Our arrangements were done by Earle Kuhn and they
were excellent. We had our largest attendance in many years. Dr.
Alvin Arzt presented a well-received presentation about Sargenti
Endodontics. During the meeting an Honorary Mastership was preDr. Michael Bowman
sented to our friend and colleague Dr. Pat Wahl, a noted endodonAES President
tic educator and lecturer. This award was presented to Pat for his
paper “Angelo G. Sargenti: Madman or Messiah? An Endodontist
Reveals Myths and Half-Truths Behind the Sargenti Controversy”. This is the best paper
I have read explaining the truth about our material. If you haven’t read it you may find it
on our website at aesoc.com.
At the end of our meeting I had the distinct pleasure of presenting Dr. Alvin Arzt our
founder and mentor with the First American Endodontic Society’s LIFETIME ACHIEVEMENT AWARD. Alvin did not know he was going to receive this award. I know of no one
else who so richly deserves it. Without Alvin’s hard work through the years Dr. Sargenti’s
simplified endodontics would not have helped save the thousands of teeth it has. We all
owe Alvin a great deal of thanks.
I encourage you to mark your calendars for October 17, 2014, in Chicago for our next
AES meeting. Dr. Barry Musikant will be joining our lineup. He is the founder of Essential
Dental Systems. He is an outstanding Clinician and the inventor of the safe-sider system of debriding canals.
If you have not renewed your membership I encourage you to do so. Your Board of
Directors continues to fight every day on your behalf so that you can provide the first in
endodontic treatment to your patients.
Our Director Earle Kuhn is updating our list of pharmacies that compound Sargenti
Sealer. Please send us information about the pharmacies that you use so that we can
add them to our national list.
As a personal note: I am always impressed when I attend our meetings by the Doctors
that I meet who have used Sargenti Sealer with outstanding success for 20-30 or even
40 years. We have truly helped many patients keep their teeth for a lifetime.
Proud to be your President
Michael E. Bowman, DDS, MAES
AMERICAN ENDODONTIC SOCIETY
2014 ANNUAL MEETING
The American Endodontic Society s 2014 Annual Meeting will be
held on Friday, October 17 in Chicago. The meeting will be at the
Hyatt Hotel. The morning session will be a Sargenti Seminar (see
page 7). All AES members are invited to attend the Board meeting
that will be held in the afternoon.
page 3
Dr. Alvin Arzt
Receives Lifetime Achievement Award
Alvin Arzt, DDS, MAES
At the recent Annual Meeting of the American Endodontic Society, AES
founder Dr. Alvin Arzt was presented with a Lifetime Achievement Award in
recognition of his dedication to promoting the use of the Sargenti Method of
Endodontics. Dr. Arzt founded the American Endodontic Society in 1969 as a
non-profit organization to organize and unify dentists with special interest in saving teeth through a simplified method of endodontic treatment.
AES President, Dr. Michael Bowman presented this special award that read:
“In recognition of a lifetime commitment to the education of the dental
profession in the use of the Sargenti Method of Endodontics.”
Dr. Patrick Wahl
Receives Honorary Mastership
Patrick Wahl, DDS
Dr. Patrick Wahl was presented an Honorary Mastership at the recent
AES Annual Meeting. The Award was in recognition of his article Angelo
Sargenti: Madman or Messiah? An Endodontist Reveals Myths and Half-Truths
Behind the Sargenti Controversy.
A copy of this outstanding article is available to AES members. To receive
your copy, send an email with “Dr. Wahl Article” in the subject line to
[email protected].
page 4
BIOMIMETIC ENDO
By Kenneth Armstrong, D.D.S., MAES
In October 2013 I attended the 2nd Annual Conference of the Academy
of Biomimetic Dentistry. There were times when I felt I was back in dental
school again, learning new ideas and techniques in dentistry.
Biomimetic comes from two words: “biology, “ the science of life or living
things, and “mimic,” to copy or imitate. Biomimetic means the treatment of a
tooth that allows it to behave like, or mimic, a natural tooth. Using advanced
ceramics and adhesives, minimal prepping and sealing of the tooth allows
small restorations to be placed rather than large crowns. It is truly “Tooth
Conserving Dentistry”.
Recently I came across a paper, “The New Science of Strong Endo
Teeth”
(1). The paper asked the question if today's endodontic accesses
Dr. Kenneth Armstrong
were as outdated as G.V. Black's cavity preparations? Their conclusion was
AES Secretary
that sadly they were. The authors described the current access prep and
canal shape as “grotesque straight-line access, carving a superhighway to
the apex.” Massive amounts of tooth structure was being obliterated and sacrificed. A literature review
(2) showed that apical shaping size and canal taper had no significant relation to better outcomes. In other
words as Clark et al pointed out, “Big shapes don't create better outcomes. They do however weaken the
tooth badly.”
Biomimetic endo would maintain as much of the natural healthy tooth structure as possible, minimal removal of dentin during access opening, and instrumenting the canals only as much as necessary
to retain as much sound dentin as possible.
A paper by James Gutmann (3) on Minimally Invasive Dentistry (Endodontics) has several ideas
on conservative endo. One is to consider doing a pulpotomy as a definitive procedure. This is an ideal
use for Sargenti sealer. When treating vital teeth, remove the pulp in the pulp chamber and seal off the
canal orifices by entering them a few millimeters and placing sealer in the canals and in the pulp chamber. The goal is to leave healthy pulp in the canals, the best sealer of all and truly biomimetic.
Gutmann states that Minimally Invasive Dentistry is the application of “a systematic respect for the original tissue.” He goes on to say that this statement implies that the dental profession recognizes that an
artifact is of less biological value than the original healthy tissue.
In place of the word “artifact” read “root canal sealer”.
Secondly, Gutmann states that the use of Peeso reamers and Gates Glidden drills deep into the
root canal should be abandoned in favor of minimally tapered rotary instruments, no larger than an .06.
Thirdly, he recommends keeping the apical size small when possible between sizes 20 and 40 to preserve radicular dentin.
The problem is we all want what Clark et al calls “the look”. That is that beautiful X-Ray of a
densely filled canal all the way to the apex. Getting that result can cause a root fracture or so weaken the
tooth cervically it breaks off eventually at the gumline. I am also well aware that finding the canal orifices
and checking for possible other canals can lead to wider access openings that we'd have wanted. There
are also cases where the tooth is so badly broken down that saving any healthy tooth structure is a real
challenge.
In summary I would say the Principles of Biomimetic Endo are as follows:
1. Try to make a minimal access opening to the pulp chamber and as the paper on the New Science of
Strong Endo Teeth points out leaving a little bit of pulp chamber roof leads to less gouging of the
walls and a stronger tooth.
2.Do not excessively widen the canals. Removing a lot of dentin in the cervical area can lead to cervical
fracture of the tooth. We want to leave a good ring of dentin around the tooth.
3. Leaving healthy pulp sealed over with Sargenti Sealer is good conservative dentistry. There is no better sealer than the tooth's own pulp. Just as we try to leave healthy tooth structure and only
remove decay in our restorations, trying to widen and shape deep in a canal to remove healthy
pulp is not in the best interest of the tooth.
References:
1.Clark D, Khademi J, Herbranson E. The New Science of Strong Endo Teeth.(116-7) Dentistry
Today. April 2013;32:112.114
2. Ng, Mann, Rahbaran,et al Int Endod J.2008;41:6-31
3. Gutmann J, Journal of Conservative Dentistry 2013,16(4) 282-283
Editor's Note:
Minimally removing tooth structure in a root canal preparation will only be successful if an antibacterial root canal sealer is included in the obturation of the canal. N2 root canal sealer is the only root
canal sealer in use today, that has a far reaching action in destroying any bacteria left in a canal, and at
the same time allowing healthy pulpal tissue to remain vital in the canal.
page 5
AES member and N2 researcher Dr. Heinz-Friedrich Overdiek
of Heidelberg, Germany passed away at the age of 93. He
finished his study of medicine in 1945 and his study of dentistry in 1948. A friend of Angelo Sargenti, he practiced and
taught dentistry until 1965 at the University of Bonn. After
Bonn, he was professor/chairman at the University of
Heidelberg. His students were required to use the N2 method,
and performed about 40,000 N2 root canals under his guidance.
AES Members are Achievers!
Congratulations to Dr. Joe Steven and Dr. Mark Troilo who
were recognized in the December 2013 Dentistry Today as top
100 Leaders in continuing education.
NEW CENTRAL OFFICE ADDRESS
The address to the American Endodontic Society’s Central Office has changed.
The new address is:
American Endodontic Society
PO Box 545
Glen Ellyn, Illinois 60138-0545
Please update your records.
page 6
Many of your peers are using Simplified Endodontics!
Recruit a new member for AES!
mEmBErSHip ApplicAtiON
(please type or print)
NAmE
ADDrESS
city, StAtE, Zip
OFFicE pHONE
FAX
EmAil
prOFESSiONAl DEGrEE(S)
ScHOOl yEAr
typE OF prActicE
WHAt prOmptED yOU tO jOiN tHE AES? (cOllEAGUE, ADvErtiSiNG, Etc.)
Dentist/Active . . . $245 Dentist/retired . . . $50 Auxiliary/Student . . . $50 Allied . . . $50
n payment Enclosed
card Number
please charge my: n mc n visa
ccv No.
Exp. Date
Signature
payment by check should be made payable to: the American Endodontic Society
mail to: the American Endodontic Society p.O. Box 545, Glen Ellyn, il 60138
or fax to (630) 858-0525
page 7
AmEricAN ENDODONtic SOciEty
PAF Donations
Thanks to all our Professional Action Fund contributors.
let’s all pledge
to make a
contribution.
PlATiNuM
SilvER
BRoNzE
(Donations $1,000.00 and Higher)
(Donations $100.00 to $499.99)
(Donations under $100.00)
Dr. Alvin H. Arzt
Dr. Jason Bowman
Dr. Michael E. Bowman
Dr. Juan Delgado
Dr. Martin A. Drozdowicz
Dr. E. Roy Finley
Dr. Robin Gallagher
Dr. John D. Ryan
Dr. Joe Steven, Jr.
Dr. Mark P. Troilo
GolD
(Donations $500.00 to $999.99)
Dr. John D. Harker
Dr. Kimberly C. Norman
Dr. William E. Stein
Dr. Kenneth J. Armstrong
Dr. A. John Bahr
Dr. Joseph M. Bolil
Dr. Danny Chacko
Dr. Patrick Del Grande
Dr. Anthony R. DiBiagio
Dr. Joseph F. Eckman
Dr. Werner l. Flier
Dr. Thomas E. Hartnett
Dr. lewis Holtzman
Dr. Walter Johnson
Dr. Douglas E. Kaylor
Dr. Jeffrey Martin
Dr. Robert H. McCoy
Dr. Karen Kile McGlothlin
Dr. Anthony A. Nigro
Dr. Peter P. Perimenis
Dr. Thomas R. Watkins
Dr. Robert C. Brooks
Dr. John E. Dreslin
Dr. Joseph T. Discepola
Dr. Alexandria Hammond
Dr. G. Douglas Hoover
Dr. Sheldon Korman
Dr. John D. McMahon
Dr. Donald l. Robbins
Dear AES Members,
As clinical practicing dentist who uses N2 you know its effectiveness as a endodontic sealer. The
benefits to patients as a cost effective, predictable and comfortable procedure to save natural
teeth are enormous. Please consider a donation to the Professional Action Fund to preserve the
choice to use N2 . If you have given in the past, thank you! But, we still need your ongoing support.
If you have never made a donation; please join us in this effort.
Kim Norman DDS
PAF Chairman
Your financial support is needed immediately. PlEASE SEND YouR TAx DEDuCTiBlE
CoNTRiBuTioN ToDAY to Help us Continue our Program of Action!
Here is my check payable to the AES Professional Action Fund.
PlEASE PRiNT
Name ____________________________________________________________________________________________
Address __________________________________________________________________________________________
City______________________________________ State _______________________ zip ___________
Credit Card No. _______________________________________
CCv No. __________
Signature ________________________________________________________
page 8
Mail to: AMERiCAN ENDoDoNTiC SoCiETY, P.o. Box 545, Glen Ellyn, il 60138
Exp. Date ________________