Reading Dr. Blatchford’s column, “Better, not bigger - Dr. Susan Weyers” (February DE®, Page 90) made me go to my office desk and open the top drawer. Practicing for 28 years, I have learned that far too few of my colleagues understand the big picture. In a world filled with talk of profits and the latest “toys,” Susan stood out as someone who had really cared about life and was positive with everyone with whom she came in contact. I opened the desk drawer and quickly found her “card.” By chance, I had been privileged to sit next to her at a CE course in Sedona last May. I asked for her card because her attitude made my wife and I want to stop by to see her office if the opportunity presented itself.
Reading her words made my wife and I realize just how fortunate we were to meet and share her energy when we did. Enjoy the journey.
Robert J. Oro, DMD, MAGD
Debra A. Oro, DMD, FAGD
Oro Valley, Ariz.
Editor’s note: Dr. Susan Weyers died in November 2006.
Response to "Warm Carrier-Based Obturation: The Great Divide" by Dr. Richard Mounce
Dr. Mounce, your commentary in the January 2007 issue of Dental Economics (Page 56) on Thermafil and its look-alikes is little more than a deliberate denigration of carrier-based warm gutta percha, and a thinly veiled commercial for Resilon and Real Seal, which you state are “bonded into the canal.” I have no problem with Resilon and Real Seal, but having read the research, I am compelled to point out there are significantly varying results as to this claim. No more than 50 percent of the articles support it. In the interest of my personal credibility concerning the Thermafil product, you should know that I no longer have a financial interest in it or in the Tulsa Dental company.
The only “divide” I find appropriate in this article is the divide in the personality traits between general dentists and endodontists uncovered in the 1990 Survey of Relationships done by the American Association of Endodontists and presented at its 1993 annual session. This survey pointed out that, as a rule, general practitioners are innovative, relaxed, sociable, openly friendly individuals whose greatest sense of satisfaction is enjoying what they do in their practices. Endodontists, on the other hand, are characterized as conservative, structured, private, reserved individuals whose greatest pleasure is making money. Dr. Mounce, that is the divide, nothing more.
Dr. Christensen’s comments related in the article, “… this concept [Thermafil] probably provides better patient service than traditional endodontic treatment” echo those made by the late Dr. Herb Schilder. Dr. Schilder, upon first seeing and using Thermafil on extracted teeth, commented, “I’ll say nothing negative about this product, as it is vertical compaction of warm gutta percha. If anything, it will help polarize my technique. I consider Thermafil a Ford and my techniques a Cadillac, and there are more Fords sold than Cadillacs.” He was a very perceptive man.
We endodontists like to consider our specialty as evidence-based. Let’s put the record straight. As of 2001, when I last counted, 22 studies had been published comparing lateral condensation to Thermafil. Thermafil was found to be significantly better in 10 of those studies, lateral condensation significantly better in only two studies, with no statistical difference in the remaining 10 studies. Five studies were published comparing vertical compaction of warm gutta percha and Thermafil. It was a tie, with Thermafil performing significantly better in two studies, and vertical compaction being significantly better in one study. System B was not found to be significantly better in any study, and the remaining three studies showed no significant difference in the two techniques.
At present, there are well over 100 articles published in jury reviewed journals and well over 80 percent of those articles show Thermafil significantly better than or equal to the techniques to which it was compared. Having said that, it would appear that Dr. Christensen and Dr. Schilder were correct in their assessments of Thermafil.
Dr. Mounce, you wrote that you do not personally know any endodontists who use Thermafil or similar products. You have met me! You have attended Cliff Ruddle’s courses, and he has used it. How about James Gutmann, Jerry Glickman, Steve Buchanan, David Rosenberg, Andris Jaunberzins, Steve Niemczyck, Lou Berman, and Chuck Goodis? And, yes, they have given me permission to reveal their names. Introduce yourself to these enlightened gentlemen.
A great quote from the old movie, “The Man Who Shot Liberty Valance” is, “When the legend becomes fact ... print the legend.” Dr. Mounce, you devoted many lines of text relating to the difficulty in retreating Thermafil cases. You were “printing the legend.” The three studies published on retreatment of Thermafil revealed it took only 30 seconds to a minute longer to remove Thermafil compared to other techniques - no big deal. However, if you have a problem, I would refer you to Dr. Edmond Koyess (firstname.lastname@example.org), who developed a wonderful technique for endodontic retreatment utilizing ProTaper files.
Frank Weine stated, “Unless gutta percha is condensed, it has no advantage over silver points” and, in the 1970s, Dr. Richard Walton proved a seal is only established 1 mm or so in advance of the depth of penetration of the spreader when using lateral condensation. Several studies have found heat carriers do not plasticize gutta percha any farther than 3 or 4 mm past the depth of their penetration. What technique delivers sealer and thermoplasticized gutta percha to the terminus of the root canal and allows condensation of the gutta percha to the full working length around significant curvatures? Only one: the carrier-based technique (Thermafil).
This indeed raises the question of why more endodontists are not using this technique on their difficult cases. It is not because of the scientific evidence because the evidence clearly demonstrates Thermafil is the best in those situations. Could it be the endodontists’ personality makeup (conservative, structured)? Dr. Mounce, look in the mirror. You will be looking at the answer to that question.
Wm. Ben Johnson, DDS
Founder, Tulsa Dental Products
Professor of Endodontics, LSU College of Dentistry
Clinical Professor, Baylor College of Dentistry
Assistant Clinical Professor, Nova SE University School of Dentistry
International interest in AACD Accreditation
Hello Dr. Sesemann. I am a 1981 dental school graduate and general dentist in Finland, and I just read your article in DE (“Everybody wins!” February, Page 62). I am interested in Accreditation in AACD. We met in London last November after your great presentation with Mr. Culp - thanks for that!
So, I think that now I have to take the next step. I copied your article to all my team members and asked them to read it. They were thrilled to get started! In Atlanta, I have to get through the written exam; is it hard to get through? I ask because the next opportunity [to take the exam] will be so far ahead. I am doing quite a lot of esthetic dentistry in my practice, but I would like to be the first Accredited member of AACD in Finland. (It’s the passion - as we talked in London.) I have read many of the books mentioned in the referral list for the exam and will read many more, but can you give some hints to be “sure” to get through the exam?
In your lecture, you gave a password and username to access the lecture material in your fantastic Web site. May I use the esthetic questionnaire form freely translated into Finnish for answering those important questions from patients who ask for help with their esthetic problems?
Hannu Vartiainen, DDS