Dental News - Interview: The collaboration between endo and restorative

Fred Michmershuizen / DTA

Thu. 17 May 2012

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In an interview conducted at the recent American Association of Endodontists Annual Session in Boston, Tom Gallop, CEO of SS White, discussed the collaboration between endodontists and restorative dentists to preserve dentin and therefore improve outcomes for patients.

Your company is making a big splash here at AAE with a new, expanded booth and presence. What are you trying to accomplish?
To me, with a “me-too” idea, you need to play it low-key to be authentic, but with an ability to execute on a big idea, having a major presence is more appropriate.

So, what’s the big idea?
Doctors tell us that what we do is help them to preserve the maximum amount of healthy tissue, in a very efficient manner that increases the life of the restoration and allows for more endodontic treatments. Increasing the collaborative effort between the restorative dentist and the endodontist is one key byproduct we have seen as a result.

In some ways we have had the endodontist looking at the lower apical third and the keys to achieving great clinical outcomes there, and the restorative dentist has been looking at the pericervical dentin and how can they create a long-life crown. We worked with each group to look at both facets. That is the big idea.

What’s new and exciting for endodontists?
SS White has always been known within the endodontic community for very specific products, like Great White Burs for faster endodontic access through metal, Great White Z Diamonds for access through zirconia and recently EndoGuide Burs for more precise endodontic access.

This year we are introducing a full line of endodontic products driven around our passion toward conservation and efficiency. Those products include the redevelopment of the very popular V-Taper File System, V-Glide Path File, V-Fill Obturation system and other unique endodontic instruments that are all designed to create more conservative and more efficient endodontic procedures.

What sets the V-Taper file apart from other, similar files?
V-Taper is unique because of the variable taper design, which allows for the preservation of cervical dentin to a higher degree than any other file system on the market. It also allows less instrumentation than most systems and more efficiency

Most endodontists want an 06 taper down at the apex to allow them to get better irrigation, better obturation, better three-dimensional fill. But when they have to negotiate around tight curves, often times they have to compromise and use an 04 tapered file. So they are either compromising by not getting the shape they want at the apex, or they are compromising by having to remove too much structure to get the 06 taper down to the apex. With the unique design of the V-Taper system, it allows for the endodontist to have the best of both worlds: get that 06 taper but with much more ease in negotiating those tight curved canals, so they can get the best results.

SS White has traditionally been known as a restorative dental company. How does that enhance your ability to add endodontic instruments to your offerings?

SS White is in a unique position in that we are looking at the tooth as a whole. I think that perspective is different from most other endodontic companies, who mainly focus on the endodontic side of the procedure and do not take into account the needs of the restorative dentist.

What about access techniques to preserve more of the dentin?
SS White originally developed the standard round carbide bur, which unfortunately has not been the ideal instrument for use during endodontic access procedures. When we developed the round bur, it was intended for use in cutting cavity preparations. To effectively cut a cavity preparation, you need a bur that cuts both laterally and vertically. Up until the launch of the EndoGuide Burs, no other manufacturer listened to the endodontist and general dentist on their need to design an access-specific bur that would allow for greater precision in gaining access to the root canal. Rather, the manufacturer said this is what we have on the shelf already available for you to use for your access preparations.

At SS White, we asked clinicians: How can we design a product specific to procedure challenges and anatomy? We focused on the conical shape and small tip diameter as two of the defining features that create more precise access and control. Doctors tell us EndoGuide Burs are better than existing products when they are contending with calcified canals or troughing. They also indicate that the product helps them reduce perforations and conserve vital pericervical dentin. EndoGuide Burs were developed with our team of endodontic and restorative specialists, which include Dr. David Clark, Dr. John Khademi and Dr. Eric Herbranson.

EndoGuide is the first truly endodontic-access-specific-designed product that has been developed with collaboration and input from the manufacturer, endodontist and restorative dentist, allowing for a more precise, efficient and conservative pathway for gaining proper endodontic access.

The dental market worldwide has given EndoGuide Burs a very warm welcome. Key opinion leaders and leading universities in such diverse markets as Mexico, the Netherlands, Italy, Germany, Russia and India, to name a few, have implemented the use of EndoGuide in their teaching, training and other forms of education. The drive and passion that has been put forth worldwide in creating more conservative endodontic access has truly been astonishing.

What came next?
The next challenge SS White undertook after the launch of EndoGuide Burs was that of creating more refined and conservative root canal shaping procedures. The shaping of the root canal procedure has significant value to the quality of the final restoration. Research has shown that preserving dentin has a direct correlation to creating longer lasting restorations. Our challenge was to develop a system that will shape the root canal without eliminating key segments of dentin at the same time, such as the dentin triangle, which is vital to the strength of the tooth. One school of thought is that the dentin triangle should be removed to create proper visibility and to effectively irrigate and obturate the canal. Following this philosophy causes the removal of dentin that could strengthen the tooth if left intact. The system that had the most appeal to us to accomplish our goal of effective shaping, while preserving dentin when possible, was the V-Taper 2 NiTi File System, which has been redeveloped and relaunched here at the AAE meeting in Boston.

Can you talk more about how endodontists and GPs can collaborate to preserve tissue?
The industry has done a remarkable job in the development of more efficient file systems that allow for greater numbers of patients to gain treatment. This has been a step in the right direction. Advances in diagnostics have also taken a major step forward over the past 10 years as well. We have seen a rapid adoption of microscopes, cone-beam and digital X-ray. The combination of increased visibility, better diagnostics and the preservation of dentin is now in place, with the goal of creating better patient outcomes. As a result, the patient benefits from the developmental and collaborative effort with longer life and stronger teeth.

In closing, what would you like to say to both endodontists and restorative dentists?
Thank you for bringing your thoughts and ideas to us. We will continue to listen and develop more effective instrumentation. With what we have done already, we are confident that both the restorative doctor and the endodontist can achieve faster, stronger and longer-life restorations. When this happens, we have seen the relationship and collaborative effort between GPs and endodontists continue to grow.