1/24 F DENTAL T RIB O S R A E Y 0 2 & E DIA issn 2193-4673 • Vol. 20 • Issue 1/2024 roots UN E I N T . • 3 0 Y E A R international magazine of endodontics S OF OE M U S M including special news Piezoceramic stack actuator speeds up root canal treatment case report Practical tips for reliable endodontic treatment industry news High-quality instruments for forward-thinking dentists

editorial | Steve Jones Co-chairman ROOTS SUMMIT ROOTS SUMMIT 2024 Welcome to the first 2024 issue of roots magazine. Under the direction of Dr David E. Jaramillo, ROOTS SUMMIT has long prided itself on being able to provide the highest ethical level of practical science which can immediately be applied to clinical practice. This year is no different. In addition to this, ROOTS events for the past 25 years have been a proving ground of sorts for many clinicians who began their endodontic careers by speaking during the case presentation portion of our programme or by presenting a poster. The list of names is too lengthy to include everyone, and I would feel terrible if I missed any on the list, so I will focus only on those featured in this issue. Let’s begin with our headline speaker and native of Athens in Greece, Dr Antonis Chaniotis, whom I had the pleasure of first meeting in 2012 at ROOTS SUMMIT in Foz do Iguaçu in Brazil. Known for his expertise in canal blockage negotiation, he shares insights in the interview titled “The concept of the root canal blockage course was born out of the desire to teach and practise different techniques”. In this interview, he also shares his journey with ROOTS SUMMIT. Additionally, Dr Rajiv Patel, a long- time ROOTS member and speaker, shares the benefits of being part of ROOTS and its impact on his practice in another interview. Dr Bartłomiej Karaś from Poland, one of our case presentation winners during ROOTS SUMMIT 2022, held in Prague in the Czech Republic, writes about a single-session endodontic and surgical treatment of internal root resorption. My friend Dr Johnny Onori from Spain, a consistent contributor to both ROOTS and our Spanish language Facebook group EndoLatinos, writes about how digital planning can increase the success of autotransplantation of third molars and the use of a 3D-printed bio-replica of the tooth to be transplanted. Completing this issue are contributions such as “Practical tips for reliable endodontic treatment” by Dr Friederike Listander and “A second chance”— well-described retreatment case reports by Dr Philippe Sleiman. I hope you enjoy the above-mentioned articles and inter- views featured in this issue. In Athens, ROOTS SUMMIT, like always, will be a very special event, and for those able to attend, we are thrilled to have you with us. Steve Jones Co-chairman of ROOTS SUMMIT roots 1 2024 03

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news | heat loss. These actuators are composed of multiple layered segments that collectively enhance displacement, allowing for a design that is sufficiently small to navigate the tightest spaces in a patient’s mouth. Additionally, the research team constructed the stack actuator from lead-free materials, adhering to the future requirements of the European directive on the restriction of hazardous substances in electrical and electronic equipment. Dentists at Rostock University Medical Center conducted trials of the new technology on artificial teeth and obtained positive results. Additional medical engineering applications The newly developed technology holds promise for a range of medical applications beyond dentistry, including applications in diagnostic imaging and cancer treatment. Researchers are exploring its use in low-frequency ultrasonic transducers, which offer high penetration depth for tomography. Advances in piezoceramic transducers have led to their miniaturisation, allowing as many as 2,000 units to be incorporated into a standard-sized tomography system. This facilitates the high-resolution 3D imaging crucial for medical diagnostics. In addition, high-frequency ultrasound transducers are becoming increasingly valuable in fields like dermatology for their ability to provide precise images at shallow depths. Further potential lies in high-performance ultrasonic transducers designed to target and destroy specific tissue areas with focused sonic waves, a technique particularly relevant in cancer therapy. “Piezoceramic components can be used in a wide array of applications and, thanks to their compactness and performance, are ideal for medical engineering. We are able to develop custom solutions to suit the needs of individual clients,” emphasised Dr Neubert. Dental file with integrated piezoceramic stack actuator. (Image: © Fraunhofer IKTS) roots 1 2024 07 “The newly developed technology holds promise for a range of medical applications beyond dentistry, including applications in diagnostic imaging and cancer treatment.” work in the root canal. The risk of the file breaking is also reduced.” He added: “The core idea of combining the two motions of the dental file came from the specialists at the Department of Dentistry at the Rostock University Medical Center. We used piezoceramic stack actuators as the drive element because they are most able to meet the special requirements for vibration amplitude and frequency, size as well as supply voltage.” Piezoceramic-based actuators bring numerous benefits. Their compact size and rapid, precise operation make them highly efficient and offer ease of control and minimal © TimeLineArtist/Shutterstock.com

Adaptive Just ONE shaping file for multiple canal morphologies. www.fkg.ch/xp-endo-rise

ROOTS SUMMIT special | and tackle challenging cases. All participants work under magnification and light provided by dental operating microscopes, and they use top-notch equipment. All this equipment is constantly updated. Attendees will be able to practise the bypassing of ledges, the removal of cast and fibre posts, the negotiation of calcified canals and the management of broken files. These characteristics make it of unique interest to every lover of endodontics! What instruments will be used during the course, and what techniques will be taught? Microscopes, ultrasonic instrumentation, engine-driven files, digital sensors and phosphor plates will be available for use in simulated conditions. Each participant will have his or her own equipment to use in working on custom-made phantom heads and special teeth. Instru- ments and materials from the best manufacturers in end- odontics will be provided. Traditional and out-of-the-box techniques will be demonstrated and practised. Some new techniques were inspired by this course and spe- cially developed for it. So, attendees should be prepared for a unique experience. In a recent study, you spoke about future develop- ments in managing root canal blockage. Could you tell us something about these developments and how you handle them in your courses? Machine-assisted 3D irrigation devices, lasers, digital workflows, advanced planning software programs, guided endodontic techniques and artificial intelligence will shape the future of endodontics. We always try to highlight and reflect on these future developments in our canal blockage courses. “The ultimate evaluation of the dimensions, content and negotiability of the blockage is always done clinically.” Why did you decide to present at next year’s ROOTS SUMMIT, and what are you personally look- ing forward to? Accepting the invitation to present at ROOTS SUMMIT 2024 was an instant decision. No one can resist the temptation of being a part of it. Having the event take place in Greece for 2024 will be an amazing experience. ROOTS SUMMIT is all about gathering endodontic en- thusiasts from around the globe. It’s not only a scientific event but also a cultural blending of endodontists of different origins, cultures and perspectives. I would like to invite you all to visit my home country and to keep the spirit of ROOTS SUMMIT alive. Editorial note: Dr Antonis Chaniotis will be giving a workshop covering root canal blockage on 8 May 2024. More information on the workshop can be found online. He will also be giving a lecture titled “Ledges, bricks and broken tips— root canal blockage management” on 12 May 2024 from 13:30 to 15:30. More information on the programme and registration can be found at www.roots-summit.com. roots 1 2024 11 © Saga Photo and Video/Shutterstock.com

ROOTS SUMMIT special | Dental trauma management is not a one-size-fits-all process, and complex cases often demand the collabo- ration of various specialists to provide the best possible care. An interdisciplinary approach ensures that all aspects of the injury are addressed comprehensively, leading to improved outcomes and a higher quality of care for the patient. Endodontists, with their expertise in diagnosing and treating issues related to the dental pulp and adjacent structures, play a critical role in determining whether endodontic treatment, such as root canal therapy or more conservative vital pulp therapy, is necessary. Could you describe a particularly challenging case of dental trauma you have managed and the lessons learned from it? In the careers of most practitioners, some cases stand out owing to their complexity and the emotions asso- ciated with them. For me, one such case involved an 8-year-old girl with an avulsed central incisor secondary to a bicycle accident. This provided a variety of chal- lenges and lessons to be learned. Key takeaways in- cluded the critical importance of timely and coordinated care, the necessity of urging patients to seek immediate treatment, and the advantages of interdisciplinary com- munication and collaboration. Utilising advanced tech- nology for precise diagnostics was crucial for guiding my treatment decisions. I learned the importance of strategically planning treatment sequences for optimal outcomes, considering long-term care and focusing on patient education about prevention. Additionally, providing psychological support and counselling was instrumental in ensuring the best possible results and patient satisfaction. Are there any emerging techniques or materials in endodontics that you find promising for the treat- ment of dental trauma? A few existing and emerging technologies which continue to be developed are regenerative endodontics, minimally invasive techniques, biocompatible and bioceramic materials, and CBCT. The potential for the utilisation of artificial intelligence in diagnosis, radiographic assessment and treatment planning in dental trauma management appears to be exciting. What do you enjoy about ROOTS SUMMIT, and what are you looking forward to at the upcoming event? I have attended other editions of ROOTS SUMMIT in the past. They are very well-organised meetings offering many practical take-home messages. For me, the journey in endodontics started with ROOTS, and I am excited to share the podium with many of my personal heroes in the field of endodontics. I am looking forward to learning and networking with my friends and meeting new col- leagues from all over the world. I am hoping to see you at the next ROOTS SUMMIT in Greece. Editorial note: The lecture by Dr Rajiv Patel, titled “Dental trauma—stretching the limits” will be held on 10 May 2024 from 13:30 to 15:00. More information on the programme and registration can be found at www.roots-summit.com. roots 1 2024 13 © Viacheslav Lopatin/Shutterstock.com

EDM NiTi FILE SYSTEM HyFlex EDM – OGSF Sequence Take control in your hands p Predictable outcomes with OGSF p Enhanced patient safety through fracture standard protocol resistance and OGSF protocol p Efficient daily case preparation via optimized tip and taper match p Strong cutting performance and centered preparation thanks HyFlex EDM technology 4 2 4 0 . 0 8 4 8 0 0

ROOTS SUMMIT special | achieving the positions of associate professor in 2007 and full professor in 2019. In 2007, she initiated a post- graduate course in aesthetic dentistry, alongside the inception of a master’s programme in aesthetic restor- ative dentistry and endodontics in 2009. Recently, she established the IDIBO research group focused on development and research in dental biomaterials, officially recognised by Rey Juan Carlos University. He currently holds active membership in the Hellenic Association of Endodontists, serves as a country rep- resentative for the European Society of Endodontology and is a member of the Hellenic Society of Endodontics, a certified member of the European Society of Endodontology, an international member of the Ameri- can Association of Endodontists and a member of the European Academy of Digital Dentistry. Her research endeavours have centred on adhesive dentistry, encompassing both laboratory and clinical investigations. Details of her publications can be accessed at orcid.org/0000-0002-6024-9559. Many of these publications are linked to doctoral theses she supervised and have been prominently presented at the International Association for Dental, Oral, and Craniofacial Research (IADR) and ConsEuro meetings, as well as those organised by the Spanish Society of Conservative and Aesthetic Dentistry (SEOC). Prof. Ceballos has held various leadership roles within SEOC, including vice president and president. Additionally, she represents SEOC on the executive committee of the European Federation of Conservative Dentistry. She has been involved in organising congresses, most recently the joint meeting of the Continental European and Scandinavian divisions of the IADR held in Madrid in 2019, and has been a member of the IADR’s conti- nental European division since 2001. Finally, Prof. Ceballos strives to balance her professional commitments with her role as a proud mother of four. Dr Antonis Chaniotis (Greece) Dr Antonis Chaniotis graduated from the National and Kapodistrian University of Athens in Greece in 1998 and completed a three-year postgraduate programme there in 2003. Since 2003, he has operated a private practice specialising in micro- scopic endodontics in Athens. For a decade, he served as a clinical instructor in both undergraduate and post- graduate programmes in the endodontics department at the same university. In 2012, he was appointed clinical teaching fellow at the University of Warwick in the UK. Dr Chaniotis delivers lectures nationally and internationally and has authored more than 20 articles in peer-reviewed international journals. His cases have been featured in peer-reviewed journals and endodontic textbooks. Dr Spyros Floratos (Greece) Dr Spyros Floratos obtained his DMD from the Aristotle University of Thessa- loniki in Greece and a certificate in end- odontics and microsur- gery from the University of Pennsylvania in Philadelphia in the US. Early in his career, he completed an internship at the Athens naval and veterans hospital in Greece. He then pursued a two-year residency in the endodontics department at the University of Pennsylvania School of Dentistry, followed by a six-month continuing education pro- gramme at the National and Kapodistrian University of Athens. Dr Floratos is an active member of multiple profes- sional and scientific societies and currently serves as co-editor-in-chief of the Journal of Endodontic Micro- surgery. He has conducted numerous workshops and practical courses internationally and has authored multiple articles published in peer-reviewed journals. Dr Juan Mesquida (Spain) Dr Juan Mesquida has been immersed in implant dentistry since graduating with a DDS in 2005. He earned a master’s de- gree in implant dentistry from ESIRO Barcelona in Spain in 2007 and graduated from the graduate pro- gramme in implant dentistry at Loma Linda Univer- sity in California in the US in 2011. During his implant specialty residency there, he received first prize for best research presentation at the 2010 annual meet- ing of the American Academy of Implant Dentistry. Additionally, he was honoured with first prize in the table clinics category in 2011, a feat unprecedented in the academy’s 30-year history. Upon completing roots 1 2024 17 © neirfy – stock.adobe.comPlease visit www.roots-summit.com for the ROOTS SUMMIT 2024 programme.

ROOTS SUMMIT special | Dr Mitsuhiro Tsukiboshi (Japan) Dr Mitsuhiro Tsukiboshi has dedicated his career to the fields of dental traumatology and autotransplantation, demonstrating ex tensive clinical involvement, delivering course presentations and contributing to publications. He is recognised as a leading authority in these areas. Dr Tsukiboshi is well known for his lectures on dental trauma and autotransplantation, sharing his exper- tise through educational events worldwide. He has authored numerous articles and two textbooks, one focusing on dental trauma and the other on autotransplantation. These publications have been translated into multiple languages, including English, reaching a global audience. In addition to his academic contributions, Dr Tsukiboshi has held prestigious leadership positions within the dental community, including serving as the president of the International Association of Dental Traumatology in 2009 and 2010 in demonstration of his commitment to advancing the field. In recognition of his significant contributions, Dr Tsukiboshi was honoured by the asso- ciation with the Jens Ove Andreasen Lifetime Achievement Award in Dental Traumatology in 2018, further solidifying his reputation as a pioneer in the field. Dr Ali Vahdati (US) Dr Ali Vahdati earned his first DDS from the Islamic Azad Univer- sity in Tehran in Iran. He furthered his edu- cation by obtaining a second DDS from the Uni- versity of California, Los Angeles in the US, followed by an MSD in endodontics from Loma Linda University in California in the US. Beyond his professional endeavours, Dr Vahdati maintains a diverse range of interests, including music, photography, filmmaking, hiking, cycling and partic- ipating in triathlons. Dr Vahdati’s dedication to both his professional and personal pursuits exemplifies his multifaceted approach to life and learning. Prof. Matthias Zehnder (Switzerland) Prof. Matthias Zehnder is a distinguished figure in the field of den- tistry. He graduated with a doctoral degree in dentistry (Dr med. dent.) from the University of Bern in Switzerland in 1996. After his graduation, Prof. Zehnder embarked on a multifaceted career path, initially working in private practice while serving as a postdoctoral research fellow at the university’s department of oral cell biology. From 1998 to 1999, he furthered his expertise at the Department of Oral Biology and Periodontology of the Boston University Henry M. Goldman School of Dental Medicine in the US. Prof. Zehnder’s dedication to advancing his knowledge led him to pursue spe- cialist training in endodontics at Columbia University in New York in the US, from which he graduated in 2001. He subsequently completed a PhD at the University of Turku in Finland in 2005 and was awarded the “Dozent” title from the University of Zurich in Switzerland in 2007, indicating a high level of academic qualification, allowing him to teach and supervise students independently at the university. Currently, Prof. Zehnder holds the position of tenured head of the Division of Endodontology at the Clinic of Conservative and Preventive Dentistry of the University of Zurich. His primary research interests encompass the development of dental biomaterials, the diagnosis of pulpal disease using molecular markers and the enhancement of approaches to disinfection of dental hard tissue. Dr Vahdati’s commitment to excellence is reflected in his pursuit of advanced studies and residencies across multiple specialties, including periodontics, oral and maxillofacial surgery, and implantology. He shares his expertise as a guest lecturer in end- odontics at Loma Linda University while managing a private practice in Newport Beach in California. Prof. Zehnder’s contributions to the field extend beyond his research endeavours. He has served as an associate editor of the International Endodontic Journal and currently holds the position of editor- in-chief of the Swiss Dental Journal. Additionally, he sits on the editorial board of several other scientific journals. roots 1 2024 19 © neirfy – stock.adobe.comPlease visit www.roots-summit.com for the ROOTS SUMMIT 2024 programme.

ROOTS SUMMIT special | frustrating issue for both the clinician and the patient alike. In recent years, this complication of root canal treatment has seen advances in diagnosis and in preservation of these teeth. tives for endodontic therapy in irradiated patients. Additionally, the ideal time frame in which to perform endodontic treatment in order to obtain a more effective treatment with a greater chance of success will be discussed. The diagnosis of a vertical root fracture has to be done accurately and in a timely manner owing to destruction to the supporting bone if not achieved in time. The use of CBCT as an additional diagnostic tool enhances the possibility of achieving accurate diagnosis of a vertical root fracture, although some drawbacks in this imaging modality still exist. When considering saving a tooth with a vertical root fracture, it is important to take into account endodontic, periodontal and prosthetic considerations. Treatment options for a tooth with a vertical root fracture vary from simple root amputation in a multi- rooted tooth to more complex surgical management in order to retain the fractured tooth. Day 2: Saturday, 11 May 2024 9:00–10:30 Restoration of endodontically treated teeth: Increasing predictability and reducing limits Prof. Laura Ceballos This presentation will explore the objectives of re- storative treatment for endodontically treated teeth, focusing on the essential goals such treatments should achieve. Criteria used to select the most suit- able restorative treatment based on various clinical scenarios will be discussed. Additionally, the lecture will provide a detailed overview of different restor- ative alternatives for compromised endodontically treated teeth, along with their respective advantages and limitations. 11:00–12:30 Effect of radiotherapy on dental structures: Current clinical and future treatment perspectives Dr Josiane Almeida This presentation will show the effects of radiation therapy on dental structures and its implications for endodontic treatment and will provide new perspec- 13:30–15:00 Aesthetic outcome of single-tooth replacement in the aesthetic zone: Preservation vs reconstruction Dr Juan Mesquida The replacement of a failing anterior tooth by means of a dental implant is one of the most challenging treatments clinicians face nowadays, particularly because the aesthetic expectations of patients are increasing. Fortunately, the timing of extraction of a failing anterior tooth in relation to the placement of a dental implant and its impact on aesthetic outcomes have been extensively evaluated. The aim of this lecture is to present an evidence-based analysis, illustrated with clinical cases, of the aesthetic out- comes that can be expected depending on the al- veolar architecture present at the time of extraction, the need for regenerative therapy and the timing of implant placement. 15:30–17:00 Autotransplantation of teeth Dr Mitsuhiro Tsukiboshi In complex implant treatment plans, the option of autotransplantation of teeth is often overlooked. When recipient sites present challenges for implant placement, necessitating additional time, costs and specialised techniques, autotransplantation can emerge as a more suitable alternative if there is a viable donor tooth available within the same mouth. For instances requiring sinus lift or ridge augmen- tation, autotransplantation can be a preferable and advantageous choice. Particularly for patients under 20 years of age, implants may not be indicated. This presentation will explore the indications for and benefits of autotransplantation of teeth as well as the techniques essential for success and will be enriched with numerous clinical case studies, including those involving intentional replantation. roots 1 2024 21 © neirfy – stock.adobe.comPlease visit www.roots-summit.com for the ROOTS SUMMIT 2024 programme.

9 TO 12 MAY 2024 OMS3200 R2 AUTO-FOCUS WIRELESS FOOT CONTROL ZUMAX MEDICAL

case report | 3 Fig. 3: Ultrasonically activated irrigation. Fig. 4: Easy-to-remember HyFlex EDM file sequence: Opener, Glider, Shaper and Finisher. EDTA, sodium chloride and chlorhexidine in 0.2% con- centration to disinfect the canals supported the effective removal of tissue residue and debris. Medical calcium hydroxide was placed into the cleaned canals for tempo- rary sealing and ultimately fixed with PTFE tape before sealing the tooth provisionally with DuoTEMP (COLTENE). Before polishing the temporary filling, the occlusion was checked, and the patient was then discharged symptom- free until the subsequent treatment session. Efficient instrumentation with an easy-to-remember NiTi sequence The actual preparation and final obturation of the root canals were performed during the second appointment. The patient was pain-free when she presented to our practice again. The dental dam placed for this treatment was again sealed with liquid dental dam after local anaes- thesia to provide better protection for the patient. 4 roots 1 2024 25

case report | compact OGSF sequence up to size 30/.04 with the finishing file. The motion patterns programmed in the motor make handling the files extremely easy and enable the working length to be reached in just a single pass. Clamped in the cordless handpiece, the files also give one a good feel for the anatomical contour of the canal (Fig. 5). The well-organised set of four coordinated special files with matching gutta-percha points offered the great ad- vantage that no individual files had to be preselected ahead of treatment. The prebent files moved safely in the centre of the canal, making handling extremely smooth. Furthermore, the files are highly resistant to breakage, and this ultimately benefits both the patient and the practitioner. Sustainable drying with fewer paper points The sequence of electrochemical irrigation followed the same protocol as in the first treatment session. After the last irrigation sequence, the canals could be dried well with a particularly narrow endodontic suction cannula, therefore requiring fewer paper points. In addition, the paper points can be tested easily on a firm surface after they have been in the canal to see whether there is any remaining liquid in the canal. A master point fitting with 30/.04 HyFlex EDM gutta-percha points was selected to match the file system (Figs. 6a-c). Here, the palatal canal length was shortened by 0.5 mm. HyFlex EDM master points of the same length were used for thermoplastic filling of the three root canals, and the canals were filled three-dimensionally with liquid gutta- percha. The AH Plus bioceramic sealer (Dentsply Sirona) provided the required sealing. Here, it is perfectly sufficient to coat only the lower part of the gutta-percha points with sealer. Furthermore, the canal entrances were covered with a flowable composite in Shade A1 in combination with a matching acid etching gel, primer and bonding agent. BRILLIANT EverGlow Flow high- performance composite (COLTENE) in the opaque version in Shade A3 was used for the final restoration. The final radiograph confirmed the reliable sealing of the three canals in tooth #27 (Fig. 7). Conclusion Using a standardised NiTi file sequence such as HyFlex EDM OGSF, the majority of classic root canal treatments can be prepared quickly and reliably. Owing to the structured sequence of Opener, Glider, Shaper and Finisher files, practice teams and patients benefit from efficient and safe root canal treatment. With a few simple steps, one can save both time and material in order to achieve all-round sustainable treatment. 7 Fig. 7: Post-op radiograph of tooth #27. “A standardised treatment protocol minimises potential sources of error on the one hand and facilitates an effective procedure on the other hand […].” about Dr Friederike Listander studied dentistry at Ulm University in Germany from 2004 to 2009. She then worked from 2009 to 2012 as a dentist and research assistant at Ulm University’s dental clinic. In 2013, she specialised in endodontics and established her own practice in 2014. Since then, she has attended numerous training courses to continue to expand her expertise in endodontics, aesthetic dentistry, periodontics, implant dentistry and microsurgery. Dr Listander is also active as a speaker in Germany and abroad. contact Dr Friederike Listander Kirchgasse 5 89179 Beimerstetten Germany f.listander@zahnartzpraxis-listander.de roots 1 2024 27

case report | activation by Er:YAG laser. Laser-assisted irrigation was performed with a LightWalker AT S (Fotona) and an Er:YAG H14 handpiece with a flat SWEEPS 400/9 fibre tip posi- tioned safely at the entrance to the pulp orifice (Table 1). For the shaping of the root canal system, the ProTaper Gold rotary file system (Dentsply Sirona) was used. Minimally invasive root canal preparation began with the 19/0.04 SX file to relocate the coronal aspect of the canals. Cleaning and shaping of the canals were subsequently performed with the 18/.02 S1 file and 20/.07 F1 file to the working length. The R-SWEEPS final irrigation protocol was performed at the end of instrumentation and con- sisted of two cycles of 17% EDTA activated by R-SWEEPS for 30 seconds for each activation period with 30 seconds of resting time in between, rinsing with distilled water acti- vated by R-SWEEPS for 30 seconds, and then three cycles of 5% NaClO activated by R-SWEEPS for 30 sec- onds for each activation period and a resting time of at least 30 seconds in between. After drying the canals (Fig. 3), Table 1: Laser parameters used for root canal irrigation with R-SWEEPS activation. Parameter Energy (mJ) Power (W) Frequency (Hz) Water Air Conclusion Value 10 0.3 15 0 0 R-SWEEPS laser-assisted irrigation supports minimally invasive endodontics and superior decontamination, enabling a paradigm shift in the practice of endodontics. R-SWEEPS may be utilised to increase the efficacy of laser-assisted root canal therapy. 4 5 6 Fig. 4: Post-op radiograph showing the temporary filling. Fig. 5: Three-month follow-up radiograph showing no inflammation in the area of tooth #46. Fig. 6: Final restoration in situ. Odontopaste (Australian Dental Manufacturing), a zinc oxide-based root canal paste with 5% clindamycin hydrochloride and 1% triamcinolone acetonide, was placed, followed by a temporary filling (Fig. 4). about There was no pain or discomfort during or after the clinical treatment, and thus the patient did not need to take any medication to relieve the pain. Two weeks later at the second appointment, the Odontopaste was washed out with one 30-second EDTA cycle, followed by rinsing the canal with distilled water and three cycles of 30-second R-SWEEPS irrigation with 5% NaClO. The final obturation was done with iRoot SP bioceramic sealant (Innovative BioCeramix) and thermoplastic gutta-percha Thermafil (Dentsply Sirona). The three-month follow-up showed healthy periapical bone structure and no clinical symptoms (Fig. 5). The tooth had been restored using a complete monolithic zirconia crown (Fig. 6). The gingiva was completely healthy and had a normal pocket probing depth. Dr Hui Jing Phang graduated as valedictorian from the National University of Singapore, won the University Silver Medal, Terrell Medal, Tratman Medal and Singapore Dental Association Book Prize and was placed on the dean’s list. She started her career as a dental surgeon in a public hospital, treating patients requiring complex, multidisciplinary medical and dental care. After hospital practice, Dr Phang joined a leading family dental care practice with a strong emphasis on advanced dental technology and aesthetic dentistry. She is the founder and clinical director of the Toothbar Dental in Singapore. Dr Phang has a keen interest in cosmetic and restorative dentistry involving dental lasers, tooth whitening, CAD/CAM ceramic dental restorations, clear aligners, dental implants, root canal treatment and dental splints for managing temporomandibular joint pain from bruxism. roots 1 2024 29

Case 1 A 40-year-old female patient was referred to the end- odontic office because of an incidental finding of IRR in the maxillary left lateral incisor on a panoramic radio­ graph. A CBCT scan was taken to assess the extent of the resorption, devise a treatment plan and determine the prognosis (Figs. 1a–c). The resorption cavity was located in the middle of the root and had perforated the mesial wall of the root. The rather round and regular shape of the resorption indicated the inflammatory type. The osteo­ lytic focus suggested a lesion was present next to the perforation area (Fig. 2). Owing to the size of the wall perforation and the presence of the lesion, the treatment plan involved a single­session root canal treatment as well as a surgical approach. After performing local anaesthesia, the access cavity was created. The pulp chamber was reshaped with an ultrasonic diamond­coated tip. The pulp chamber was cleaned with sodium hypochlorite, and the pulp tissue was partially removed from the root canal. An incision was made from the frenulum, through the gingival sulcus from the maxillary first incisor to the maxillary canine. After raising a flap, the granulation tissue was removed from the resorption cavity with a small excavator. The root canal shaping protocol was performed with conventional chemomechanical preparation. The shap­ ing sequence was guided by initial negotiation using passive hand files, followed by preparation with rotary files and irrigation using sodium hypochlorite, activated with manual needle agitation. After the root canal shaping procedure, the following irrigation protocol was per­ formed: three minutes of alternating irrigation and ultrasonic agitation of 5.25% sodium hypochlorite, smear layer removal with double alternating irrigation with EDTA 17% and sodium hypochlorite, and five minutes of alternating irrigation and ultrasonic agitation of sodium hypo­ chlorite. During all the instrumentation and irrigation procedures, the suction was placed next to the resorption cavity to avoid irritation of the bone and surrounding tissue. The obturation of choice was warm vertical compaction of gutta­percha and sealing with the bioceramic sealer CeraSeal (Meta Biomed; Fig. 3). The resorption cavity was filled with Biodentine (Septodont; Figs. 4a & b), and the coronal part of the root canal was filled with warm gutta­percha. The flap was repositioned and sutured, and the tooth was restored with composite resin. Recall appointments were performed after five and six months (Fig. 5). The bone healing was complete after five months (Figs. 6a–c), and after 30 months, there were no signs of the bone defect, fracture or any other abnormalities (Figs. 7a & b). case report | 4b 4a 5 Figs. 4a & b: Biodentine filling the resorption cavity. Clinical (a) and radiographic view (b). Fig. 5: Clinical situation after five months. No visible signs of inflammation. “The most important part of treatment is the elimination of the vital apical pulp tissue sustaining the IRR.” 6b 6c 7b 6a 7a Figs. 6a–c: CBCT scan taken five months after the treatment, showing the healed lesion. Figs. 7a & b: CBCT scan taken 30 months after the treatment, showing the healed lesion. roots 1 2024 31

case report | Table 1: Treatment planning approach. Treatment Obturation No perforation Perforation Perforation + lesion Endodontic Endodontic Endodontic + surgical Gutta-percha Gutta-percha + bioceramic (resorption cavity) Gutta-percha + bioceramic (resorption cavity) cavity with a small excavator (Figs. 9–11). The root canal shaping protocol was performed with conventional chemomechanical preparation. The shaping sequence began with negotiation with passive hand files, followed by preparation with rotary files and irrigation using sodium hypochlorite with manual needle agitation. The irrigation protocol was performed as described in Case 1. The obturation of choice was warm vertical compaction of gutta­percha and sealing with the AH Plus sealer (Dentsply Sirona). The resorption cavity was filled with a fast­setting mineral trioxide aggregate (Harvard Dental), the coronal part of the root canal was filled with warm gutta­percha and collagen sponge was placed (Figs. 12a & b; Figs. 13a & b). The flap was reposi­ tioned and sutured, and the tooth was restored with the GRADIA composite resin (GC; Figs. 14a & b, Fig. 15). Recall appointments were performed after two (Figs. 16a & b) and four years (Figs. 17a & b). The radiographic examination showed the presence of bundle bone. The periodontal status was stable, and the tooth remained asymptomatic. Discussion Although the aetiology of IRR remains unclear, studies agree that removing the vital pulp from the apical area is crucial to halt­ ing the resorption. Studies also concur that once the internal resorption has been stopped, there is little likelihood that the process will revive. Thus, one of the most important prognostic factors is the restorability of the tooth. In the cases presented, the biomechanic integrity of the teeth was compromised, but the patients’ age and determination were the most important factors for treatment planning. The two types of IRR, inflammatory and replacement, have slightly different mechanisms of progression, but both involve the activity of osteoclasts. However, from the clinical point of view, the distinction between the two types is not critical. 16a 16b 17a 17b Figs. 16a & b: CBCT scan taken two years after the treatment. Figs. 17a & b: CBCT scan taken four years after the treatment. about Dr Bartłomiej Karaś graduated in dentistry from Wrocław Medical University in Poland in 2009. He is an educator and the author of numerous publications focusing on minimally invasive endodontics. He is a vice president of the endodontics section of the Polish Dental Association and a fellow of the European Society of Endodontology and of the World Federation for Laser Dentistry. Dr Karaś runs a private dental practice limited to endodontics in Wrocław. In order to diagnose IRR, it is recommended to take a CBCT scan. 3D diagnostics is crucial for creating the treatment plan. The shape of the area of resorption and perforation of the root wall are the most important factors for determining the treat­ ment planning approach (Table 1). The cases presented have demonstrated that a combined endodontic and surgical approach is the most suitable option for cases of IRR that has perforated the root wall and is associated with a lesion or destruction of the surrounding bone. contact Dr Bartłomiej Karaś MAXDENT Ul. Hallera 53/2 53-325 Wrocław, Poland karasdentysta@gmail.com www.bkaras.com roots 1 2024 33

case report | 4 5 6 Case 2—Fig. 4: Initial periapical radiograph. Fig. 5: Immediate post-op periapical radiograph. Fig. 6: One-year follow-up periapical radiograph. treatment, the materials used for obturation, the pres- ence of ledges or separated instruments, intricate root canal anatomy, and the use of fibre-reinforced or metal posts. When approaching retreatment, it is helpful to divide the process into stages, addressing each challenge systematically from the coronal portion towards the apex. By tackling obstacles individually, we can effectively manage the procedure, ensuring all aspects are ad- dressed and our ultimate goal is achieved. If a metal or fibre-reinforced post is present, careful consideration must be given to the remaining thickness of the dentinal walls. Ultrasonic instruments are invaluable for removing hard materials, and in high-risk scenarios, microsurgery may be warranted. In this article, I will focus on a simplified technique for removing gutta-percha, utilising nickel–titanium rotary files and demonstrate by way of clinical cases. Addition- ally, I will discuss the limitations of this approach and when it is necessary to employ alternative techniques based on specific obstacles encountered during re- treatment. For retreatment, I utilise the Traverse and ZenFlex files (Kerr Dental). Specifically, I employ the 25/.08 Traverse orifice opener of 17 mm in length, alongside the 35/.06, 30/.06 and 25/.06 ZenFlex files (Fig. 1). These files boast a unique variable heat treatment, sharp cutting edges and a design of the flutes, making them ideal for both initial endodontic procedures and retreatment. In a step-by-step approach, this sequence is designed for the removal of previous gutta-percha from within the root canal. Firstly, using the 25/.08 Traverse file at a speed of 800 rpm, a small pecking motion is applied. Typically, two or three motions are sufficient to establish an entry point and remove the coronal portion of the gutta- percha. The file is allowed to reach its maximum depth without additional pressure. Subsequently, the 35/.06 ZenFlex file is employed, following the same gentle picking motion. Each movement extends 2–3 mm, lasts only a couple of seconds and is repeated around three times. “When approaching retreatment, it is helpful to divide the process into stages, addressing each challenge systematically [...].” The 35/.06 file is succeeded by the 30/.06 file and, if necessary, the 25/.06 file to ensure complete removal of gutta-percha from the canal. Should an obstacle be encountered, particularly in mesial canals with severe curvatures, switching to the 4% taper ZenFlex files is advised. The same crown-down technique and file sizes are maintained throughout the procedure. I employ a comprehensive sequence of irrigation, which has been previously published.1 7 Case 3—Fig. 7: Initial periapical radiograph. roots 1 2024 35

case report | an apical enlargement file. 3D obturation was done using the elements IC (Kerr Dental) for both teeth. A year later, I recalled the patient for follow-up (Fig. 3). I observed that the healing of both teeth was almost complete, showing beautiful root canal system obturation and multiple exits. The crown on the molar had been replaced, but unfortunately the crown on the premolar had not and exhibited some kind of internal build-up. I advised the patient that this might risk the success of the treatment for the premolar. Case 2 The patient was referred for retreatment of a first man- dibular molar. The initial radiograph showed a cast metal post in the distal canal, a separated instrument in one of the mesial canals and a radiolucency at the apex (Fig. 4). The patient was informed that in order to retreat his molar, I would need to remove his old crown and the metal post to give me access to the root canals to retreat them and that the alternative would be microsurgery on the mesial root, but this would require that I cut a long section of the root in order to achieve a hermetic seal inside the canal because of the separated file and the part of the canal that had not been treated. The patient opted for the first choice. The first steps were cutting the crown and removing it and then proceeding with a delicate cutting of the metal post piece by piece and vibration with ultrasonics for safe removal. This gave me access to the gutta-percha under it. I used the same sequence of Traverse and ZenFlex files, and in the distal root and mesiobuccal root, I managed to go all the way to the working length, but in the mesiolingual canal, I stopped where the separated file was located. Here I used #6, 8, 10 and 15 K-files in order to bypass the file and was fortunate to be able to retrieve it from inside the curvature. Full cleaning and shaping were performed, followed by 3D obturation with the elements IC (Fig. 5). The one-year follow-up showed great healing (Fig. 6). Case 3 The last case I would like to discuss in this article has been one of my most challenging retreatments. The patient was referred from abroad for retreatment of a maxillary molar, as she insisted on saving her tooth. From the radiograph, I could clearly see a separated instrument in the mesial root, but the anatomy was very suspicious (Fig. 7). Looking at the CBCT scan given to me by the patient—for which I would have preferred a higher resolution—I observed three different exits for the mesial root and a very unusual anatomy (Fig. 8). Studying the whole case, I also saw a ramification on the palatal root in the apical area. I explained to the patient that I would do my best to save her tooth. 11 Fig. 11: Eighteen-month follow-up periapical radiograph. I used the same sequence of Traverse and ZenFlex files in the distal and palatal canals up to the full working length, and for the mesial root, I reached the separated file and began the very delicate task of bypassing the separated file and negotiating the very complex root canal system. The immediate postoperative radiograph showing the 3D obturation of the mesial complex and the palatal ramification was most satisfying (Fig. 9). Radiographs taken at the one-year (Fig. 10) and 18-month follow- ups (Fig. 11) showed good healing. Radiographs taken at different angulations showed the complexity of the mesial root. Conclusion In conclusion, opting for a second chance in treatment is always preferable. Understanding the potential and limitations of our tools and abilities is crucial for achieving success. References 1. Wang HH, Sanabria-Liviac D, Sleiman P, Dorn SO, Jaramillo DE. Smear layer and de- bris removal from dentinal tubules using different irrigation protocols: scanning electron microscopic evaluation, an in vitro study. Evidence-Based Endodontics 2017; 2:5. about Dr Philippe Sleiman is an assistant professor at the Faculty of Dental Medicine of the Lebanese University in Beirut in Lebanon and an adjunct professor at the University of North Carolina at Chapel Hill Adams School of Dentistry in the US. He can be contacted at profsleiman@gmail.com. roots 1 2024 37

case report | 3a 3b 4 Figs. 3a & b: Intra-oral scans. Teeth in occlusion (a). Mandibular arch (b). Fig. 4: 3D-printed bio-replica of the tooth. When considering autotransplantation, several conditions must be met to ensure its success. With digital planning, we can create a bio-replica of the tooth intended for transplantation. This allows us to prepare the recipient socket by slightly enlarging it, reducing pressure and minimising mechanical damage to the future donor tooth. It is crucial to avoid injuring the periodontal ligament during this process, as it plays a vital role in the integration of the transplanted tooth into the socket.3 Extra-oral time should not exceed 15 minutes, in order to pre- vent hypoxia-induced cell damage, which can lead to inflam- matory root resorption. Additionally, the transplanted tooth should be kept out of occlusal contact to prevent interfer- ence with periodontal healing. The success of donor tooth reattachment relies on preventing bacterial invasion of the clot between the root and socket. In some cases, flap refine- ment and suturing may be necessary before tooth insertion. Using a semi-flexible splint can stabilise the donor tooth and allow for physiological movement under occlusal loading.4–6 Equally important is root canal treatment. Utilising advanced technology and biologically compatible mate- rials, such as the new generation of bioceramics like CeraSeal sealer and CeraPutty (both Meta Biomed), ensures optimal outcomes. These materials not only seal the apex of the tooth, but also prevent infection spreading from the periapical area, reducing the risk of inflamma- tory root resorption and treatment failure.7 Root canal treatment is a critical factor in achieving long-term suc- cess, underscoring the importance of prudent material selection. The success of dental autotransplantation hinges on meticulous case and patient selection. This case report aims to elucidate how digital planning, employing CBCT and intra-oral scanning, can enhance the success of autotransplantation and how utilising a 3D-printed bio- replica aids in recipient bed preparation, reducing the risk of periodontal ligament injury, thereby boosting success and minimising extra-oral time. 5a 5b 5c 5d 5e Figs. 5a–e: Surgical procedure step-by-step. roots 1 2024 39

case report | 9 11 10 12 Fig. 9: Sagittal section of the CBCT scan seven months after treatment. Fig. 10: Periapical radiograph at seven months showing almost complete healing and no signs of inflammation. Fig. 11: Panoramic radiograph taken two years after treatment. Fig. 12: Periapical radiograph taken two years after treatment. Fig. 13: 3D reconstruction of the STL file two years after treatment. Conclusion Autotransplantation of third molars offers a reliable treat- ment option for replacing lost teeth. It stimulates bone formation at the transplanted site, maintaining mastica- tory function and reducing financial costs for patients by avoiding the need for implants. It is crucial to recognise that the integrity of the periodontal ligament stem cells is a significant prognostic factor in this treatment. Gentle and atraumatic extraction of the donor tooth enhances success. 13 about After preparing the recipient socket to approximate size, the fit of the donor tooth replica is confirmed using radio- graphic imaging. Success is also influenced by factors such as root canal treatment, semi-flexible splint place- ment and occlusal restoration. The synergy of these components is vital for the success of the autotrans- planted tooth. Editorial note: Please scan this QR code for the list of references. Dr Johnny Onori graduated from the Universidad Central de Venezuela in Caracas in Venezuela. He undertook studies in endodontics at the International University of Catalonia in Barcelona in Spain and, more recently, completed the international endodontic programme at the University at Buffalo in New York in the US. He is an endodontist with the Red Cross of Venezuela. Dr Onori is a member of the American Association of Endodontists, European Society of Endodontology and Asociación Española de Endodoncia (Spanish endodontic society). roots 1 2024 41

interview | 1a 1b 1c Figs. 1a–c: Mandibular left second molar presented with unsuccessful primary treatment and symptomatic periapical periodontitis (a). Non-surgical treatment involved an apical plug in the distal root (b). One-year follow-up showed complete healing of the periradicular lesion (c). yet dynamic approach is required. This is because there are various types of root filling materials, including the older silver points, the widely used gutta-percha and calcium silicate materials, each requiring a distinct method of removal to regain full access to the root canal system. Inadequate removal of these materials during retreatments can compromise the treatment outcome. Remnants may limit the accessibility of disinfectants and instruments to micro-anatomies or may result in an inadequate seal. Given the additional challenges, what are the key factors to consider when developing a strategy for a successful retreatment outcome? Key factors for developing an effective retreatment strategy include a thorough pretreatment evaluation by the clinician. This evaluation is crucial for determining the case prog- nosis and formulating the treatment plan. The next step involves decision-making, where the clinician decides on the retreatment approach—whether non-surgical, surgical or a combination of both. In this context, the clinician also has to decide whether the tooth presented can be saved. The third factor encompasses the technicalities and pro- cedural steps involved in the retreatment process. What advancements in endodontic technology or techniques have improved the outcomes of retreatment procedures in recent years? Endodontics is a very dynamic and rapidly evolving specialty. It has benefited from advancements in imaging modalities, such as CBCT, which enables a precise visu- alisation of dental issues. Recent advances in nickel– titanium instruments and their kinematics, along with the introduction of new irrigant delivery and activation instruments and devices, have contributed to improved treatment outcomes. nificantly transformed the specialty—I consider these to be game changers. These technologies have been instrumental in various procedures, ranging from dis- assembly to cleaning, and even in correcting previous mishaps. In addition, I would like to highlight the rapidly evolving advancements in endodontic biomaterials, particularly calcium silicate materials. These have proved helpful in complex retreatments, especially in cases involving root defects or challenging anatomies. Additionally, there have been significant advancements in concepts and materials for the post-endodontic restorative phase, and these play a crucial role in extending the survival time of retreated teeth. How do you manage patient expectations and communicate the potential risks and benefits of under going a retreatment procedure? That’s a very good question, especially for young clini- cians. The key factor in managing patient expectations lies in proper pretreatment evaluation. This involves ex- amining the current status of the tooth, assessing potential complications and, most importantly, evaluating the sur- vival potential of the tooth after treatment. Equipped with this information, clinicians can clearly and easily commu- nicate the benefits and risks involved to patients. Is there anything else you would like our readers to know? I would like to emphasise that retreatments are a unique way to save not only teeth but also the surrounding bone. By achieving the goal of healing, even if the tooth struc- turally fails at some point, a healthy foundation for a future implant has been established. The integration of magnification and ultrasound in endodontic practice is a critical aspect that has sig- Editorial note: This interview originally appeared in today AEEDC 2024, and an edited version is provided here with permission from the author. roots 1 2024 43

feature | the promotion and support of well-being at all ages—and that WHO advocates for eco-friendly, minimally invasive dental care, highlighting the role of oral health in planetary health. While not legally binding, the SDGs and the WHO’s strategy for oral health aim to foster collaborative and measurable action among all stakeholders. The researchers found that AI supported certain efforts aimed at achieving SDGs in oral health, for example, by re- ducing transportation, optimising the delivery of oral care and increasing equity of access to dental services. However, they noted that AI could also be detrimental to achieving some of the SDGs, as its deployment, implementation and main- tenance requires resources that may aggravate inequalities. “Also, AI may be biased, reinforcing inequalities and dis- crimination and may violate principles of security, privacy and confidentiality of personal information,” the authors wrote. They concluded that it was necessary for the oral health com- munity to systematically apply evidence-based assessments to the positive and adverse effects of AI tools on sustainable oral health, and to actively use AI to foster greater equity and sustainability in the delivery of oral healthcare. A call to action for sustainability in AI models for oral health Dr Ducret, who teaches at Claude Bernard Lyon 1 University, told DTI that it was crucial to avoid the risk of selection bias when gathering data for training AI models. “A random sam- pling technique and adjustment of the data set to reflect evolving societal dynamics should be considered in the future,” Dr Ducret said, adding that transparency in data collection processes for the training of AI-powered medical devices was of great importance, as it permits external scrutiny. Avoiding selection bias requires an expansion of data collection in developing countries; however, Dr Ducret said that it was difficult to identify one or two priority mea- sures in this area. He commented: “The aspect that seems most important to us is creating a framework of trust and sustainability around the sharing of data in all countries and to securely keep this data as a valuable resource and recognise a debt towards those who shared it.” The review was a call to action, and Dr Ducret said that the oral health research community is currently highly active concerning AI-related topics. He explained that several of the study authors are members of an interna- tional WHO research group that is set to play a major role in the development of sustainable AI tools for dental care. He explained that this work was ongoing and that some of its focal points included collaborative databases, innovative tools, comparative studies, improvement of the student curriculum and practitioner training. The review noted that it remains unclear whether AI can truly advance the 2030 SDGs in the field of oral health, and Dr Ducret said that it was important to create aware- ness regarding these uncertainties. “Our review helped illustrate the true duality that AI represents for our society. Currently, many of us have the feeling that we are in a strategic period from a technological point of view, but few are informed about and aware of the paradoxes and issues that are associated with this. Even though our article raised all these uncertainties, we remain deeply excited for the coming years,” Dr Ducret said. Editorial note: The study, titled “Artificial intelligence for sustainable oral healthcare”, was published in the December 2022 issue of the Journal of Dentistry. roots 1 2024 45 © WananWanan/Shutterstock.com

industry news | Prof. Simone Grandini at Dentsply Sirona World in Madrid last year. (All images: © Dentsply Sirona) Prof. Grandini, the X-Smart Pro+ endodontic motor boasts an integrated apex locator and a high torque range of up to 7.5 Ncm, alongside a touch screen interface. How do these features enhance the user experience and accuracy in endodontic procedures compared with conventional endodontic motors? This engine is not so different from others at first glance; however, there are numerous small details that make X-Smart Pro+ a special motor. For example, various file systems can be used with it. Even though many of my peers tend to work with file systems with which they are familiar and achieve good clinical results with these, they appreciate the opportunity to try out new files. The endodontic motor can be programmed for each system, allowing the torque and rotation speed to be set manually. This is not possible with all motors. The features you mentioned have proved themselves in everyday clinical practice. We want simplicity and good functionality in one device. X-Smart Pro+ meets this need. X-Smart Pro+ offers both rotation and reciprocation modes, optimising the performance of Dentsply Sirona’s endodontic file systems. Could you explain how these file motions differ in practice and what advantages each provides to endodontists in terms of efficiency and safety during root canal treatments? In endodontics, we have been working with different modes of canal preparation for a long time. Incidentally, the reciprocating preparation method was described in 1985 already. The instrument rotates alternately clockwise and anticlockwise, allowing the instrument to continuously advance apically. This movement pattern ensures that the file is centred in the canal. For us as dentists, this makes it possible to prepare the canal with just one instrument. However, when we have cases that necessitate working in a way that is particularly gentle on the dentine, this is better achieved with continuously rotating files. It is therefore very important to have both rotation and reciprocation available in order to decide on a patient-specific basis which motion will achieve the best results. X-Smart Pro+ claims to maintain apex locator pre- cision during active shaping by employing Dentsply Sirona’s proprietary Dynamic Accuracy technology. Can you discuss how this technology influences the safety and precision of reaching the apex, especially in comparison with manual files and other end- odontic motors in the market? This technology allows for reliable and direct length determination while shaping using an apex locator as precise as the conventional manual method of measure- ment. Another important capability is that this integrated apex locator constantly updates the working length, addressing the concern of measuring a working length that is changing throughout the procedure. This makes it easy to keep the file on target while shaping, ensuring safety while going much faster. To accommodate future treatment options and a wide range of file systems, X-Smart Pro+ is designed with upgradeable firmware. In your opinion, how important is this feature for dental professionals in terms of long-term investment and adapting to evolving endodontic techniques and technologies? This is very important. The development of files never stands still, as the industry continues to pursue improve- ments in preparation. The aim is to further increase the success rate of endodontic treatment, which is currently around 90%, depending on the pulpal and periapical conditions of the tooth at the time of treatment. roots 1 2024 47

tic files and products directly to clinicians without dis­ tributors. “Our sales model yields many advantages for customers,” Dort explained. “The main advantage of ordering directly is the competitive prices, as there is one fewer channel that keeps a margin of the sales price. Another advantage is the speed with which we react to the needs of our customers. We can directly connect with them. And that is not all—we also offer free shipping on all orders!” Made in France and conforming to strict EU controls and standards for medical devices, the company’s instruments aim to ensure the highest quality, consis­ tency and safety. They are designed to be an alterna­ tive to leading reciprocating and gold taper and rotary instruments, offering designs that improve cutting efficiency and increase safety in order to provide the ideal flexibility required for perfect root canal therapy. Dort explained: “At DirectEndodontics, we focus on our customers. Our systems do not require a change of clinical techniques or a change of motors. We want our customers to continue to use the techniques that they feel comfortable using.” Dort explained that one product that is popular with clinicians is Direct­R Gold. “This is a reciprocating file that we sell at a very competitive price for a very high­quality product. Another favourite among our customers, which is also a trendy product, is our DirectBioceramic Sealer, which is a sealer of a very high quality that we sell at an affordable price.” The feedback from clinicians has been positive. “Our customers are very satisfied with our products, and we have received great feedback and very posi­ tive reviews. We put our customers at the centre be­ cause we believe that having access to high­quality products at competitive prices leads to better end­ odontic treatments and better care for the patients,” Dort said. DirectEndodontics was founded by endodontist Dr Charles J. Goodis, whose background in mechanical engineering helped him to found EdgeEndo in the US in 2013. After just ten years of company history, EdgeEndo has become one of the largest endodontic suppliers in the US, serving endodontists and general dentists across the country. Dr Goodis explained in company in­ formation that his goal in founding DirectEndodontics was to bring high­quality European­made endodontic instruments directly to clinicians at a lower cost. “I want DirectEndodontics to be a modern, fresh, digital, mil­ lennial company working with you, the modern dentist,” he said. www.directendo.com industry news | “The main advantage of ordering directly is the competitive prices, as there is one fewer channel that keeps a margin of the sales price. Another advantage is the speed with which we react to the needs of our customers.” – Caroline Dort, DirectEndodontics roots 1 2024 49

Quality inspection of the Zumax optical system. “After more than a decade of continued effort, Zumax has risen to the ranks of world-class brands, becoming a prominent symbol of China in the global dental–medical equipment domain,” commented Li. “Looking ahead, we will continue to persist in technology- driven innovation and focus on providing high-quality products and satisfactory services to our users. Our aim is to make significant contributions to oral medicine in China and globally,” he added. www.zumaxmedical.com Zumax primarily focuses on oral healthcare and generates 85% of its revenue from the dental industry. The company has a significant global presence, particularly in Europe, the Americas, Asia Pacific, Oceania and South Africa, and recently in the Gulf region and North Africa. Zumax’s products are widely used in prominent dental schools worldwide, solidifying its reputation as a symbol of Chinese excellence in dental equipment. Zumax’s products also cover fields such as ophthalmology, otorhinolaryngology and head and neck surgery and are used in both community and general medical practice. Zumax has extensive experience in the industry and expertise in the research, development and manufacturing of medical optical devices. New product development as a driving force New product development is pivotal at Zumax, and Li highlighted its critical role in driving the company’s growth. Each year, Zumax dedicates around 20% or more of its sales revenue to research and development expenditure. Over the next three years, the company plans to introduce new oral microscopes, aiming to provide cost-effective solutions for the expansive private dental market while also preparing to launch advanced surgical microscopes for the high-end product segment. Zumax is known for its original and innovative technological contributions, including the development of integrated microscopic 3D technology and a portable high-definition microscopic imaging system. The company maintains a focus on continuous product improvement, optimisation and innovation, striving to craft high-quality domestic products with meticulous attention to detail. From endodontics to general practice In the future, Zumax will focus on promoting oral microscopy technology, ensuring that dentists recognise its broad appli- cability beyond the treatment of caries and pulp disease. Oral microscopes are also invaluable in periodontics, im- plantology, restorative dentistry, orthodontics and preven- tive dentistry, among others. This broadens the scope of what can be seen and diagnosed, providing a common technological foundation for various dental specialties. In addition, Zumax will gradually shift its market focus towards private dental practices, introducing a plan to enhance training goals and improve personalised service capabilities for private clinics. This initiative aims to ensure that users are proficient in microscopic techniques. Zumax intends to collaborate with training centres rec- ognised by the Chinese Stomatological Association and engage in educational programmes with various dental societies. This strategy highlights Zumax’s broadening scope from endodontics to general dental practice. Zumax dental microscope OMS3200. (All images: © Zumax Medical) roots 1 2024 51

Y R T S I T N E D F O E R U T U F E H T G N I L I E V N U • W O H S Y R T S I T N E D L A T I G I D 28 & 29 JUNE 2024 D I G I DIGITAL DENTISTRY SHOW S T R Y S H O W • T A L D E N T I Register at www.dds.berlin Digital DentistHy Show In collaboration with Digital Dentistry Society U N V E I L I N G T H E F U T U R E O F D E N T I S T R Y

meetings | The Escobar is an extension of the Badeschiff that includes a covered bar area. research evidence, the scientific programme will feature presentations by prominent opinion leaders, including Drs Henriette Lerner, Alessandro Cucchi, Mirela Feraru, Howard Gluckman, Fabrizia Luongo and Setareh Lavasani, and cover a wide range of topics, such as artificial intel- ligence, the digital workflow in maxillofacial surgery and full-arch rehabilitation, and digital bone surgery. Attendees will have the opportunity to earn valuable continuing education credits. Besides a strong educational aspect, the 2024 Digital Dentistry Show will serve as a social hub for dental experts, professional organisations, manufacturers and publishers who are looking to form or expand their network of like-minded, future-oriented individuals. To be hosted at one of Berlin’s industrial pearls, the unique event location offers a rich history and a distinctive modern feel. The adjacent Escobar and the Badeschiff spaces will enhance the relaxed and jovial atmosphere, underlining the informal and engaging nature of the show. The 2024 Digital Dentistry Show is expected to attract over 2,000 eminent dental professionals from around the world. You are invited to be one of them! More information on registration and the scientific programme can be found online at the event’s official website at dds.berlin. Attendees will also have access to the Sonnendeck of the Escobar, where they will be able to enjoy delicious food and drinks. 55

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