Written by Barry Lee Musikant, DMD, and Allan S. Deutsch, DMD Monday, 31 March 2008 19:00
A series of the special 3-D photos discussed in this article are available to view as part of the "Read and Watch" program. In order to view these photos, special blue/red viewing glasses are required. To request a complimentary pair of glasses, visit the Web site essentialseminars.org/3d. When you receive the glasses, visit the Dentistry Today Web site and see how this 3-D technology is adding a new dimension to endodontic education.
Effective endodontic education is based on the systems being taught and the way they are presented. In our 17-hour, 2-day courses we give the dentist 11 hours of hands-on experience. All endodontic procedures are performed on natural teeth, first on teeth with the pulp chambers accessed and then on unopened teeth. Dentists may bring extracted teeth; however, teeth are supplied in the course, and the number of teeth on which any given participant may perform endodontic procedures is open-ended. Many dentists prepare numerous teeth, concentrating the second day on procedures for which he or she feels the most practice is needed.
We gave up using plastic blocks years ago because they simply do not accurately simulate the challenges of a natural tooth. Most rotary Ni-Ti courses tell the participants to bring accessed teeth. While this approach allows them to concentrate on learning the safe usage of rotary Ni-Ti, it does nothing to acquaint the participants with the most important part of endodontic therapy, namely access.
|Figure. This is an example of a photograph using the stereomicroscope. To view a series of 3-D photos using this new technology, visit essentialseminars.org/3d to request a complimentary pair of special viewing glasses. When you receive the glasses, visit the Dentistry Today Web site at dentistrytoday.com to view the photos.|
In our educational approach, after participants familiarize themselves with the basic use of relieved reamers used either manually or in the 30° reciprocating handpiece, we do an extensive presentation of the steps required thoroughly accessing the pulp chambers of a variety of teeth. We also discuss the tools required to uncover many of the tissue inclusions that may be present in various teeth, molars in particular. For many years access was a tough subject to present initially on screen; it has always been a 2-dimensional presentation of a 3-dimensional procedure. This all changed recently with the acquisition of our stereoscopic microscope (StereoImaging Corporation), which allows us to take extremely clear 3-D microphotos of the steps required to gain complete access (Figure).
In our educational program we have included a series of 3-D photos, showing in one case the discovery of MB1, MB2, and MB3 canals. In another case, we presented what first appears to be 2 mesial canals in a molar only to have it open into a single sheath of tissue traversing the entire bucco-lingual width. We can also appreciate the multiplane curvature of many canals when we examine extracted teeth in 3 dimensions. The clarity and depth of these images give the dentist far more information than can be obtained from 2-D images, and dramatically demonstrate the advantages of using the binocular microscope to perform superior endodontics. At this stage of technology we consider that the use of the microscope is mandatory for excellence in endodontics.
These images are viewed in 3-D using red and blue glasses with the blue lens over the right eye. Once one appreciates the view provided under the microscope in accessing complicated or even simple anatomy, when blown up on a large screen, the enthusiasm to try out the binocular microscope is increased immensely, and of course we supply the microscopes so participants can fulfill the expectations we encouraged in them. From there it is a simple addition to show the participants how to use ultrasonics and Munce burs (CJM Engineering) to access more deeply into the pulp chamber safely and efficiently.
Obturation follows the same format. We are never speaking for more than an hour before the class is engaged actively in a workshop covering some aspect of endodontics. First we teach instrumentation, and then immediately after this initial discussion the participants shape preopened molars and bicuspids. We then teach obturation using the bidirectional spiral to place epoxy-resin cement, and more often than not a single, well-coated point. This discussion is followed immediately by the obturation of the canals they just shaped with the relieved reamers. All cases are x-rayed in both the mesio-distal and bucco-lingual plane, allowing dentists to appreciate the 3-D nature of the fill.
We then perform access and repeat the process, except that they are now performing the tasks on unopened teeth. In the course of 2 days, we also cover post placement, diagnosis, pain relief, antibiotics, and a host of other related topics.
The point of this paper is to emphasize the need for innovation in both the tools taught and the way knowledge is disbursed. Nothing beats hands-on experience because it builds up a series of images in the participant’s mind that is his or her road-map for future work and the ongoing process of educating oneself, which is the ultimate goal of the course. We are teaching techniques that have a wide window of success. We do not have to spend time on teaching the limits of rotary Ni-Ti, where the main concern is the impact of the canal anatomy on the integrity of the instruments. Quite simply, separation is not an issue in the techniques we teach, and as a result we can immediately concern ourselves with the challenges presented by difficult anatomy without concern for instrument separation.
By integrating 3-D into the educational process we have further enhanced the images that the dentist can stockpile in his or her mind for future reference. We like to think we have pioneered some useful armamentarium and ways of learning that will help more dentists learn effective, safe ways to produce excellent endodontic results.
Disclosure: Dr. Musikant holds 18 patents for co-inventing endodontic products for Essential Dental Systems, a company he co-founded.
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