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Welcome to The Ruddle Show. I’m Lisette and this is my dad, Cliff Ruddle.

How you doing today?

Good, how about you?

Excellent. And it’s been one month since we’ve been able to contact you, and here we are all together so let’s have a great show.

All right. Well we thought we’d start off today talking about math. So maybe you’ve wondered how much math you use in your daily dental practice, or maybe you haven’t even wondered at all. Maybe you’ve heard a kid struggling in math; maybe it’s your own kid saying something like well, I don’t need to know math because I want to become a dentist. Well, most dental schools do require some math for admission, and some even require statistics in calculus.

So we were thinking about this the other day, and we sat down and we started brainstorming about all the ways we could think of that math is used in endodontics in particular, but also in dentistry. And we were surprised to find out it’s used a lot more than we initially thought, right?

Well absolutely. I mean you probably – she already said it – but consciously or unconsciously, whether you know it or not, you’re probably using it a lot more than you think. Restorative dentists – that’s basically the crowd out there – you’re doing the golden proportions. And so whether you know it or not, you can look it up later, but the magic number is 1.6. So in art, esthetics, natural sciences, you find these things in nature that make beauty.

You’re using angles all the time. Implants... Implants you’re using X-Nav, some of you are, and it gives you XYZ. But you are able to put that implant in precisely. We used to have bi-directional equal angles of reciprocation for shaping files; now we have bi-directional, unequal angles, and that’s – WaveOne Gold is an example where angles come in. We have measuring. You have a periodontal department; the hygienists are measuring and probing the pockets. We get to working length and we have to have a number. And we can either get it through measuring with a ruler, or we can use our digital radiographs and get it that way. CBCT, I’m looking at measurements all the time between the mandibular canal, the sinus, etc. Measurements, percentages. There’s percentages in solutions: 5% sodium hypochlorite; could be 8, could be whatever. Whatever you decide, right? CHX, 2%. Oh, EDTA, 17%.

So we have percentages. We have percentages on files. We have fixed tapered files, we have regressive tapers, progressive tapers; we have to know all this stuff because it’s part of the tools we use every day.

Fractions. You know, teeth can be broken up into thirds. Roots, thirds: coronal, middle and apical third. Crowns are about 10mm; roots are about 3,4, 5; each third. So we can use math to take big problems and break them down to smaller problems; and by solving each small problem, we solve the entire issue.

Yeah, even percentages. Like I remember when I first had my root canal, he was telling me, well this – because I needed two – and he was saying this tooth probably 80% we have a chance of success. This one maybe 50%. And it turned out to be 100% though, for me, so I’m happy about that.

All right, so clearly you need some math knowledge for practicing clinical dentistry. But you also need math for just running your practice -- setting your fees, balancing your budget, working with the insurance companies. Then knowing what a discount represents. And we’ve actually done a segment on this, and you might want to go back and check out that show, because you might not really understand what you’re giving away when you give like a 10% discount.

So I guess if you go into inventing, you need even more math though, right?

Well, it depends on what you’re inventing. But you probably will utilize some math, physics, chemistry like TCA, ATP (adenosine triphosphate). Engineering, there’s all kinds; electrical engineering, there’s mechanical engineering. So depending on the product, you’re going to get into those worlds and you’re going to learn more. Metallurgy. All the files are heat treated now, so there’s pre-machining heat treatment, there’s post-machining heat treatment, there’s temperature ranges and all that. So yeah, you have to know quite a bit.

I’ve heard you talk about cross-sections of files. I’ve heard you talk about torque values and what’s the ideal one. So I know that -

Speed, torque, yeah, all that stuff.

I remember one EndoActivator paper we did – actually it had a mathematical formula in it. I think you have that to show.

Oh, got it right here.

We were talking about sonic energy and amplitude and frequency and sine waves, so this was actually in our paper.

You know, that formula; it sounds crazy, but that is a prognosticator for cleaning a root canal system. So this is assuming you’re using some kind of a sinusoidal wave. It’s not a GentleWave idea, it’s not a laser idea; this is more like if you’re agitating with a polymer. So there are mathematical formulas that the team can look at and begin to use to try to improve your agitation.

Okay. So math is used; it’s pretty intertwined with dentistry and endodontics, I think we’ve found out. And we’re going to do this segment again, this intersection segment. We’re going to pick a different topic next time. Maybe we’ll pick social studies or history or art. I actually think this was really fun; I’m kind of nerdy like that. But this was a fun segment for me; I can’t wait to do the next one.

Oh, I feel like I got a diploma. I take the tassel and I’m now a mathematics man.

All right. Well we have a guest presentation today, so let’s get to that.

Today we have a guest presentation, and it is by Dr. Reid Pullen, who is an endodontist from Southern California. He is very passionate about endodontics and is fast becoming a leader in the field. Dr. Pullen is going to talk today about an innovative, mechanical glidepath file, the Slider, which is part of the ProTaper Ultimate Series and inspired by the concept of rotary first.

The title of Dr. Pullen’s lecture is “The Super Slider Rotary Negotiation: A New Paradigm In Endodontics.”

But before we get to it, why don’t you first tell us how you know Dr. Pullen and the circumstances surrounding why we’re showing this presentation today. I think it involves some deal you made with him.

Well, probably first he was one of those people that says I know Cliff Ruddle. And Cliff Ruddle has never seen him or met him, because I saw him in an audience. And I think he alluded to this, or will in his lecture; he was a face in the crowd for me. But that’s when he first met me. I first met him when he came to Santa Barbara. And he came – Phyllis started this Ruddle with the Residents, and he came up with Jim – or I’m sorry; Jim Simon was replaced by Steve Davis. So Steve Davis was his mentor at the Long Beach VA. He brought his group up with some other colleagues, and I met Reid there, and I thought immediately he stood out among residents. So I won’t tell you why, but I’ve learned to do that in the years.

So that was kind of our interactions. And then of course as he grew – early in his career he was very good, so he became an opinion leader for Dentsply Sirona. And I started to see him at meetings, and I saw him present. And just through that, I loved his passion; he was pretty excited. And we would have ongoing discussions. As an example, he came to Santa Barbara, drove up here and we had lunch together and stuff. But I made a deal with him, because he’s an opinion leader. So he wanted to know all about ProTaper Ultimate, so I baptized him in Ultimate; but I wanted him to have his own discovery.

So I said Reid; if you can do 500 canals with ProTaper Ultimate Slider – it’s a new file – I’d like you to come on the show and tell your experiences. He said well what if I don’t like it? I said I’d like you to come on the show and tell your experiences. And what if I break a lot? I’d like you to come on the show, Reid, and tell your experiences! So I don’t know what’s going to happen, you don’t know what’s going to happen, but would you do that? He said I’d be thrilled. I said okay. I didn’t talk to Reid for months, and all of a sudden I said Reid; would you like to be on the show this season? And he said Ruddle! I am at 1169! So he’s done 1169 canals and he has stuff to report. So I’m pretty excited about that.

I know he’s real excited that he got to be a diplomat. I just want to toss that out, because that’s a milestone. A diplomat of endodontics. A diplomat. And then of course he started his practice from scratch, and that’s not so normal in these days. Now he has practiced for quite a few years now, but still even then, it was – usually it was associateship, partnership, something like that.

So those are the things that I would say the most. And then on a personal level, this is what really connected. You played baseball, I played baseball. You played basketball, I played basketball. I didn’t really play football – flag; he played tackle. He was a college football player at Cal Davis; UC Cal Davis. And then of course he was a coach; coached all those sports, plus he coached his kids in soccer. Coached all of his kids in that – three kids. And then as he got older and he got tired and he got worn out; he couldn’t jump anymore, he couldn’t block those tackles anymore, he couldn’t hit the ball quite as far as he’d like to hit it, he was missing a little bit. He went into the easier sports like jujutsu and golf and surfing.

I think he’s a black belt in jujutsu, right? I think it took him 12 years to -

12-year journey. So anyway, you can begin to see as the audience out there. Reid’s not just a typical – well maybe he is a typical dentist in that a lot of dentists have very unusual proclivities for things you might not always think. But I refer all my golf out.

All right. Well just to tell you a little bit about Dr. Pullen professionally. He graduated from USC Dental School in 1999, and served three years in the Army Dental Corps in Lamifil, Germany. After returning to the US and being in private practice for a couple of years, he decided to become an endodontist. And then he graduated from the Long Beach VA Endodontic Residency Program in 2006; started a private practice limited to endodontics Brea, California. And then as you mentioned, he went on to become a diplomat of the American Board of Endodontics in 2013. He’s also founder of rootcanalacademy.com, and the two-day Root Camp Boot Camp course. So you might want to check that out.

So that said, we are very honored to have the opportunity to show you this presentation.

R-R-R-R-R [drum roll sounds]

Let’s see it.

[Pullen Presentation Begins]

Hello everyone. My name is Reid Pullen. I’m an endodontist in Southern California. I’ve been an endodontist for 18 years in clinical practice; it’s call Brea Endodontics. I’d like to say it is a huge honor to be on The Ruddle Show, Cliff Ruddle; thanks for inviting me. I want to say that I was a general dentist for five years -- three years in the military and then two years in private practice. I had an inkling that I wanted to be an endodontist, and so I came to this lecture in Anaheim at Disneyland by this famous endodontist named Cliff Ruddle. And I watched him lecture for the day and that was it.

After I heard Cliff Ruddle speak, I said I’m going to be an endodontist. I was set, and I am so grateful for that lecture and for your mentorship, even as a general dentist through your lecturing. And then as I became an endodontist, you helped; you mentored me throughout those times, and you helped me become a better person and a better endodontist. So thank you so much for that, and let’s get into the presentation.

I want to talk today about something called – I call it the Super Slider; or the Sexy Slider. This is a new paradigm in endodontics, because this file will make you so efficient, so effective, and help you get an excellent result. So we’re going to talk specifically about one NiTi file called The Slider.

Now this comes from the ProTaper Ultimate instrument family, and this is The Slider; this is what we’re going to focus on. The ProTaper Ultimate is kind of a new instrument system that is the evolution of ProTaper Gold. So basically Cliff Ruddle, John West, Pierre Machtou, as you know from The Ruddle Show, they took ProTaper Gold and they made it a little bit smaller from 1.2mm diameter to 1mm diameter. And they wanted to focus on a minimally invasive type shape, and so that’s how the ProTaper Ultimate family came into existence.

But they created a Slider, and I want to talk about the Slider because it is really an exciting file. Here it is, the Super Slider, and it’s something we call a rotary negotiator. And this is kind of a new concept in endo. We were always taught as students in dental school, and even as we got out and even in the residencies, endo residencies, to always use a hand file to negotiate down the canal. Well, in this file system, ProTaper Ultimate, the Slider actually replaces the hand file; okay, most of the time – I’ll talk about that. You can use the Slider as your rotary negotiator, and it’ll advance down the canal to working length, through the apical minor constriction to patency. And you can actually negotiate to patency and get a working length and a glide path in just seconds.

Now, the cool thing with the Slider is I use it – I use a Slider; with any file system that I use, I start with the Slider. So obviously, ProTaper Ultimate is a great system; I’ll use the ProTaper Ultimate. I also love ProTaper Gold and WaveOne Gold. But any of those file systems that I’m using, I will start with the Slider and I will use that as my rotary negotiator.

So here is just kind of a look at the ProTaper Ultimate, and specifically the Slider, which is made of M-Wire, so it’s a little more resistant to cyclic fatigue – it’s a heat-treated file system. And when you look at the dimensions of the Slider, you can see it’s got a 16th tip size, so that’s perfect. Basically, a glide path is when you at least get a 15-hand file down to working length; and that’s kind of our goal to get an open glide path. This satisfies that by having a 16th size tip and a 2% taper at the tip.

You want to run this at 400 rpms and 4-5.2 Ncm torque, okay? A little bit different than the 300 rpms that you run ProTaper gold, or 500 rpms if you’re using Vortex Blue. This is 400 rpms and you’re using the 4-5.2 Ncms on the torque. You’re going to use very light pressure; especially with the Slider. Remember, you’re using – you’re asking this to negotiate down the canal where no file has been before. So this is a file that’s advancing; you want to use very passive hands when you’re using the Slider.

I always start – I find the canals first; easier said than done on some cases, right? I find all the canals, and I always start with a coronal negotiation with a 10C shorty. In fact, this is I think the tip of the day, right here. Every time you find a canal, always explore that coronal third with a 10C, 21mm file. The C-file is a little stiffer than a K-file; the 21mm file is shorter than a 25. Dip it into RC Prep and get in there and explore each canal; and just make sure that it’s open in the coronal third. Make sure that there’s not any calcification, or that a pulp stone fell into one of the canals. Just make sure it’s nice and open, nice and smooth, about 10 or so millimeters down; then you can go in with your Super Slider and you can start to do your rotary negotiation. So I always start with my 10C shorty; make sure I’ve got a nice open canal in the coronal third.

Then I go in with my Slider. I say it’s the first file in; I mean it’s the first rotary file in the canal, and this is really the workhorse. Now what do I mean by that? I’m going to explain; I’m going to show you why I call this file the workhorse.

All right. So remember, we’re using this file instead of the 10K hand file or C file to negotiate the patency; to negotiate down to working length. So before they put this file out, they wanted to test it. And so Dentsply Sirona sent this file system out to a bunch of endodontists. They tested it; they came up with 63% of the time, this group of endodontists were able to get down to working length, down to the apex with the Slider, without using hand files; 63% of the time, okay?

So I wanted to do my own little tests because when I started using it, I was getting pretty good results. So I wanted to see if that number held true, or was it lower or higher; but I was getting pretty good results. So I went ahead and started testing this. I’ve been testing this for over a year; I’m at 1,169 canals, and I am at an 80.5% success rate. Okay, this is pretty killer. Because as an endodontist, I’m treating some very difficult cases. 80.5% of the time, I can get this Slider to reach working length, without the use of a hand file, within one to three passes. Sometimes the first pass it won’t advance down to working length; it might take two passes or three passes. But a lot of times I’m able to get – 80.5% of the time – get down to working length without the use of a hand file. And this is brilliant when I do this; it makes the treatment so fast. This is where I reached the apex passively.

Now, what are the benefits? Why is this the workhorse and what are the benefits of using the Super Slider? Well, step one. 80.5% of the time you’re able to negotiate to patency, efficiently and effortlessly. It just slides right down the canal to the end, pops out the minor constriction, and you can then get in an accurate working length by hooking up your apex locator right to the Slider. You can slide it to the Slider shank or to the handle; doesn’t matter. You can get a nice, accurate reading.

Third, it will cut a nice, open glide path. So you’ll be able to negotiate to patency, achieve an accurate working length, and achieve an open glide path in seconds. Sometimes on a simple to medium difficult case, I can do this in three canals in less than 30 seconds. And it just makes your life easy. It’s simple because you’re able to get a nice, quick working length, cut an open glide path. You negotiate it down, you get a nice working length, and you cut an open glide path; and then you’re ready to shape. And the shaping then is easy.

The hard part is all the stuff before the shaping; finding the canals and then getting down the canals. That’s the hard part. If you can do this; if you can find a file that can help push you to be better and to do this faster and safely, then that’s the bonus, and that’s where the Super Slider comes in.

Okay, so what about this 20% of the time? I’m successful 80.5%; what about 20%? What happens then? So sometimes you put the Slider in and it’s hitting a brick wall. It just won’t go around – it’s usually a little apical curve. It just won’t go around that apical curve, and you go bam! You feel it hitting a brick wall. Hitting a brick. Once you do this, just forget it. Take it out, take the Slider out; take a deep breath and go traditional. Negotiate to patency with either an 8 or a 10K file. What I typically do is I’ll put a little 45° apical curve or bend of that 8 or 10K file, dip into RC Prep, and I’ll go in there and I’ll take it on a walk around the apex. I’ll take it on a walk around, trying to find where that little curve is; that apical curve. So no big deal. If it doesn’t work 20% of the time, you just do a traditional hand file. You get working – you get patency, then you get working length, then you’ll do a glide path – an open glide path. Okay, so that’s what happens 20% of the time.

Now what about the dark side; the dark side of using rotary negotiation? That would be file separation. Okay, so it can happen. If you don’t have – if you’re rough with this, you can separate. Now I’ve separated – you saw how many canals I did. I did over 1000 canals; over 1100 canals; I’ve separated three times. Now two of them were early and one was recent. I was being a little bit rough. All three of them I was being rough; two of them I was able to bypass. One of them I got stuck; it was stuck at the end, done. No big deal; a lot of times it will still work. It’s not pretty. We don’t want that. But it’s very rare. And if you use passive hands – which I’m going to show you right now – you can prevent this. If you feel like the Slider is hitting a brick wall, you stop, you pull it out, and you go traditional hand files to negotiate to patency. Okay?

So here’s the feel. You almost hold the file; it’s passive. It’s just a passive feel. You barely – you’re not pushing on the file; you’re letting the file kind of just lead you in there, lead you down the canal. So you hold it with very light pressure; you always dip the tip of the Slider with RC Prep or ProLube. This is the only NiTi file that I dip. I don’t dip my files; I’m not a dipper. I only dip the Slider with RC Prep, because I’m asking it to negotiate down to patency where no file has been before. So it’s doing – it has to kind of rip through that tissue; I want a little bit of lube in there to help it do that so it doesn’t get caught up.

The key is, when you’re using the Slider, don’t be a construction worker. Don’t hammer this Slider into the canal when it’s not going. If you’re hitting a brick wall, don’t hammer it like a nail; I want you to do your Zen endo. Take a deep breath, breathe through your nose, and very light pressure with this baby. Use your Zen endo when you’re using the Slider. If it’s not advancing to working length, then get out; get out and use hand files. But again, 80% of the time it’s going to go down to working length within 1-3 passes; so it’s really a beautiful, beautiful thing.

Here is the Slider dipped with RC Prep; I’ve got the dip. Dip the tip in there. Use your file lubricant. You can use Glide or ProLube or whatever you want, doesn’t matter, just use file lubricant.

And now I’m going to show you a video of a mesial buccal canal of an upper molar. Hard to get in there, to get that into the MB canal. I don’t have a coronal flare yet; I don’t do a coronal flare when I use this. I’m going to do the MB canal; I’m going to put a little teeny bend on it, just enough. Dip it into RC Prep, and then have the patient open a little bigger. Tooth #3 and there it goes; there we go. Got in there and now I can run it and see if it will run down to my estimated working length.

So let’s look at it; let’s watch this now. There we go. Now, I’m running it, nice easy, engage, disengage, nice and smooth, passive hands. I got down to my estimated working length. Hook up the apex locator – look, I’m long. I’m long, I’m long, I’m long. Perfect, right there. Push the stopper down, get your working length. That’s excellent right there. I just negotiated patency, obtained an accurate working length at 19.5mm, and I cut an open glide path in the MB canal of #3 in seconds. Boom! I just took away three big pillars of endodontics; three big pillars of endodontics in seconds. Negotiated patency, accurate working length, and an open glide path. So this is beautiful.

I would wipe the file; I would just go right into the DB canal. So I do it sequentially. MB canal, get my working length, go to the DB canal, then I go to the palatal canal; so I do it one after the other. In some cases in under a minute, I’ve got three working lengths, three glide paths that are open, ready to shape – the shaping is easy. The shaping is the easy part now. Finding the canals and getting down the canals is the hard part. So there we go; that was our working length.

Let’s look at a case – this is tooth #16, or #28 if you’re international. Tooth #16, very difficult case to treat. It’s a wisdom tooth, it’s infected. Let’s take a look at the CBCT. So here’s our cone beam. You can see the palatal canal in the MB 1; you can kind of see an MB 2 in there, vaguely. That’s the coronal view right there, the coronal view. Here’s sagittal view; you can see the palatal root. You can see there is a mucositis of odontogenic origin, because we have a periapical radiolucency on all three roots really; the palatal root and mesial buccal root, it shows here.

But then you look at the axial view and you can see that, unfortunately, there are four canals in this thing. MB 1, you can see the MB 2, you can see the DB and you can see the palatal. So I said shoot! This was an older individual, #16, four canals infected. I go dang it; I had some anxiety before I treated this case. But what happened, what I found was the Slider and the Ultimate, ProTaper Ultimate system, made it so easy and so fast to treat this, that I walked out of there just in awe of how simple it was to treat.

So I’m going to show you the MB canal, just showing you how I was able to get working length on this case. There’s my Slider; dip it into RC Prep or Glide or whatever you want. Get some lube in there. Let’s go to the MB canal. Now passive hands; in and out. Engage; disengage. Many in and outs. Nice and gentle; nice and smooth. There we go. That just walked – that Slider went right down to working length. Just hook it right to the handle; that’s your apex locator. Boom, got it! I was able to get working length. I was then able to get working length on all three of these canals. And then I later found the MB 2; had to work that one up too. I went up to a ProTaper Ultimate F2. But the Slider advanced to patency in all three canals, and it took me about a minute to get down each canal, to get a working length and cut an open glide path. So it was pretty cool.

Yeah, I finished this in a minute, and I was extremely happy with the result. Nice shape, nice cleanout. And I took a post op CBCT, just because I wanted to take a look at it. This is the coronal view here. And you can see the palatal root was perfect; MB 1 is good. The MB 2 is a little short on the fill, which I was slightly disappointed with myself. But let’s just – we won’t go crazy on that. Here’s the axial view. You can see how beautifully – how this minimally invasive file system, ProTaper Ultimate, cut these beautiful smaller shapes, and they stayed centered right in those roots so a really nice shape there. On the MB 2, I went to the F – I went to an F1, so I used a real small shape on that, on the MB 2. So that’s that; that’s the case.

Now, the last thing I want to talk about is I’ve been using the Slider. I use it with ProTaper Ultimate, or I’ll use it with ProTaper Gold, or I’ll use it with WaveOne Gold too. So I kind of hybridize it sometimes. The Slider is such a valuable file, because I’m able to negotiate to working length passively without the use of a hand file 80% of the time. So why not use it for every case that you do, even if you’re not going to use the Ultimate system? Which is a great system, but I’ve been doing this Slider Gold technique; or I call it the FAB technique because it’s just fast and beautiful. It’s such a great technique. It’s a hybridized technique.

I hesitated to talk about this; it can be a little confusing. But it’s just a hybridized technique where I start with the Slider, I do my rotary negotiation, get my working length, get an open glide path. Then what I do is I go to the ProTaper Gold Shaper 1. I leave it on the same RPMs, 400 RPMs, and I cut my middle flare. So I just run the ProTaper Gold Shaper 1 to working length; it cuts a middle flare. Then what I’ll do is I will finish the apical third with the WaveOne Gold Primary; and that’s that reciprocating file that reciprocates. And I will plus it. If you need to, this is just shape larger. If you need to go a little bit larger, WaveOne Gold medium, or you could cut with an F3, ProTaper Gold F3; if it’s a palatal root or a distal root that’s bigger, do that.

But most of the time, I’m finishing with the WaveOne Gold Primary. The reason this technique is so awesome, is because it is so fast. The rotary negotiation using the Slider, like I already said, on these simple to medium difficult cases, it takes less than a minute to get the Slider down to working length and to get your working length and glide path.

The ProTaper Gold S1, or Shaper 1, is one of my favorite files in the world. The Slider and the ProTaper Gold S1 are my two favorite files; I just love those. It just cuts a beautiful, balanced middle flare. I mean it just opens that middle third of the canal, and it gets it ready so you can just finish the apex. So I have probably shaped 10-15 thousand cases with ProTaper Gold; I just love that system. I love the WaveOne Gold system, and I love the ProTaper Ultimate system too for the smaller cases.

Then I come in and I quickly will shape the apical third using the WaveOne Gold Primary, which is a reciprocation. So you just have to change the setting one time and it’s crazy. This FAB technique, the Fast and Beautiful, gives you these fast and beautiful shapes. I call it also Fast as Bolt; FAB, Fast as Bolt. Usain Bolt, who has the world record in the 100 meter and 200-meter races in the Olympics. It’s that fast. It’s so fast, and you can just cut these shapes.

I want to show you an example of one. Here's tooth #15, or #27 in international speak. You can see the curves on this mesial buccal root; it’s got some curves. You can see the working length, it’s about 21; estimated working length is about 21. I was able to use the Slider Gold or the FAB technique. I used my Slider and my ProTaper Gold S1, and I followed up with the WaveOne Gold Primary. I shaped this case in like a couple minutes. And it was incredible. And I got a really nice, beautiful result; Fast and Beautiful, right? It’s just a very fast technique; very cool technique.

You cut and you can shape your canals fast, very efficiently. It gives you plenty of time for an activated irrigation. When you activate your irrigant, your sodium hypochlorite and your Q-Mix or your EDTA, you then get enhanced disinfection. And the easiest way to do this is by using the EndoActivator. The original EndoActivator on the left ran at 10,000 cycles per minute. The new EndoActivator runs almost twice as strong, 18,000 cycles per minute, and it is sonic activation at its finest. This is just a simple device to use to get a really clean canal. There’s lasers out there; the Light Walker Laser is good using SWEEPS technique. But they’re expensive, so some dentist don’t want to spend $100,000 on a laser. You’ve got this EndoActivator, especially this new one, 18,000 cycles per minute. You can get some beautiful cases with this. So if you can shape those canals fast, then you have plenty of time for enhanced disinfection, and to get the cleanest canals possible, and boom-boom; you got it.

Love to for you – a shameless plug for rootcanalacademy.com. Please go on the website; I’ve got lots of great instructional books, and they’re fun. I have a great time with these books; they really help you to be a better dentist when you’re doing root canal therapy. So please go see rootcanalacademy.com, right there. Love to see you; love to chat with you. And my favorite book is this WaveOne Gold. I’ve got six full cases; you get a QR code. Under the Microscope; you can watch my full cases where I’ve narrated them, and a step-by-step guide of how to do endo from start to finish. It’s one of my favorites, and it’s a surfing theme so lots of surfing in there too; pictures of my family surfing.

And then anyone interested in a two-day Root Camp Boot Camp, please go see rootcanalacademy.com. These are the dates coming up for this year; would love to see you. It’s a two-day course, wonderful course. I do a live patient demo, upper molar, and you can see that real clear.

So thank you so much. I’m really grateful to be able to share with you, and I hope I helped you. Always wanting to help you guys get better. If you need to get ahold of me, there is my email. Thank you so much, and you guys have a wonderful day. Thank you.

Okay, that was an engaging presentation; very clear, great visuals. And I really liked that I felt like we were getting to know not only Reid Pullen the clinician, but also Reid Pullen the person as well.

Oh yeah.

He seems very friendly, honest and open, and I really thought he did a good job talking about the benefits of the Slider and how to use it more like a Zen master and less like a construction worker. That was my takeaway; I thought that was funny. But his humor was great, it makes him feel very approachable. And I imagine having a good sense of humor is a great quality to have as a teacher.

A great sense of humor is a great quality to have for any person in this world on the planet now.

True. What did you think of the presentation?

Reid, you really hit a home run for me pal. You made it clear, it was concise, it was reproduceable. The three tenets he stressed, I’m not going to say more, is he really wanted to talk about working length. He wanted to talk about – geez, I’ve got to look down here – patency I think of in a little bit different, in a different order. But working length, then he wanted patency, and then he wanted you to have a glide path; a smooth, reproduceable glide path. That was the three things.

So he showed us how to do that, and that was even more remarkable. And I’m going to add something that he didn’t say and it’s not in our script, but there’s all this buzz lately on the Forum about you’ve got 2%, 4%, 6%; well now you can get something in between, like a mini-cut, a 3%, a 5%. He talks about all those percents from 2% to 8% are on one single file. So I thought that made it simple.

And then I liked – well you mentioned he’s a happy spirit, he’s a good guy, he’s got a great sense of humor, he ties his world into the endo so it’s relatable. But beyond all that, I want to talk a little bit about his success of 80%. It’s actually, Reid, 80.5%. I’m going to say 80%. Because when we sent these out – when Dentsply Sirona sent out the Sliders, and they sent them out to the international opinion leaders, there were maybe 60 testers. And they had the files for like 30 days, maybe 45 days, and they had to fill out big reports, send them back. The company did all the analysis and they found out that these dentists were able to get to length, rotary first, no hand files, 63% of the time.

Well Pierre and I and John had thought it was 80% a long time ago, but you and I talked about why might that be? Well, if I’m an opinion leader, and I get some files, and I find cases and I start to use them – whether it’s extracted teeth or patients of record – I’m going to try them for about 30 days and then I’m going to fill out my report. And I’m not necessarily using them on every case. So I think the difference was, by the time you get to 1,169 canals, you’re doing a lot more than the people that had a chance to do maybe 30, 40, 50 canals. So I would say a big one was experience.

But there were several little additional things, and I don’t have – oh, I have something here – but a few little tricks of the trade. He showed how he cradles the handpiece in the webbing between his thumb and his index finger. He’s not up here with his finger going peck, peck, peck. So he’s letting the file run, progress, advance.

He’s taking multiple passes. If it starts to bog down, he’s removing the file.

I heard him say 1-3 passes.

1-3 passes. So you don’t take the whole apple at once; you take it in bites. And he’s learned that and he’s teaching that. So I think the way he held his handpiece, the way he’s very passive and easy and lets the file tell him what to do. If the file is bogging down, he takes it out. And he even talked about the 20% when he can’t – and I won’t go into all that – because it’s not going to always fit to length, the big three. So he talked about ways he then catheterizes and reaches length and patency. So I liked all that.

So I think his experience, the number of cases he got to do, with the way he holds the handpiece and his passive technique; and be willing to try. You know, people like Reid; they’re willing to get in there and try and fail. But he’s willing to try.

We saw at the end of his presentation, when he had a picture with his course attendees; they had books like this. And we actually got a copy of the book.

Can I trade?

And you can see that there’s so – it’s so beautiful; there’s so many big pictures.

I don’t know how to do this on camera, but everything is pictures and words, and pictures and words. And if I was able – anyway, if you look at the back of it, he has nine books, not one book. I wrote the preface for one of them, so you should just buy that one just so you can read what Ruddle said about him.

Okay. Well I have a question for you, and maybe some of our viewers might have the same question. The Slider is a rotary first, mechanical glide path file. And it is part of the ProTaper Ultimate series – I’m getting to the question. And then the ProGlider is also a mechanical glide path file, with the same D0 diameter as the Slider. So why is the Slider rotary first, but the ProGlider requires you to first negotiate with a 10-file?

Because I said so. No. People ask that; that’s a great question. You know, from the ProTaper Gold family we have the ProGlider, and from the Ultimate family, ProTaper Ultimate, we have the Slider. The difference is the Slider has a different cross-section. That’s probably 90% of it. It is a changing parallelogram, it’s a rhomboidal cross-section, and it changes over the active portion; it’s balanced beautifully. We alternated – alternating offset machining was also employed; that’s a patented technique. It was on some other of our shaping files, but it was never on a glide path file. And the metallurgy is still M-Wire; it’s 400% more resistance to cycling fatigue. It’s a little stiffer than the other heat treatments where they get too flexible and they can bend over and they can unwind. So dentists tell me they always want it more flexible. No, sometimes you need more rigidity.

So I would say changing the M-Wire a little bit, the cross-section which was significant; because ProGlider is a convex, triangular cross-section, so it’s a different cross-section. That’s why it has safety and efficiency, and that’s why about 80% of the time, when you find the orifice, you take the file and in you go. And in 1, 2 or 3 passes, you reach length. No hand files; that’s revolutionary.

Now a lot of other people are copying it. They’re changing angles and nomenclature and saying we can do it too. Can you do 80.5?

Okay. All right, well I think I understand a little better now. Moving on, I really liked that he was open about his file separation. He said he was going to talk about the dark side, and then he threw a bunch of light on it and owned it. And I just thought that was kind of cool that he talked about that. Do you have any comments about it?

Well I’m going to use some math. Didn’t we just talk about math? He said he had three breakages; two happened quite early in the journey. And he attributed those to roughhousing. And then he said he had one recently, and he attributed that to maybe being in a little bit of a hurry.

I heard him say he was aggressive.

He said he was a little too aggressive. He thought maybe he was jujutsu; chopping blocks.

I would think his martial arts training influenced that.

Well you saw in his movie, he did have a hammer. You don’t know. Reid might be – maybe he put his hammer away.

But anyway, three breakages – let’s get back to math. That is turning out to be 99.7% success. Would you like to join Ruddle in any endeavor in life, and I could say Ruddle says you’ll have success about 99% of the time. That means the reciprocal, breakdown/breakthrough, was .3 of 1%. So that’s an astonishingly small number of breakages. And the main thing is, if you don’t know why those three break, it’s still a little bit of a dilemma for me. But if you can understand exactly why your files broke – then like the hand; turn the breakdown into a breakthrough – and that’s what he did; he identified why it happened.

I do remember the kids’ coaches in sports saying that sometimes a loss is better than a win, because you learn more from a loss.

Well, there’s a lot of truth in that; if you accurately discern the cause of failure.

All right. Well Dr. Pullen also spoke of his silver gold technique; aka the FAB technique; Fast and Beautiful, Fast as Bolt. And in that, it’s a hybridization of the Ultimate Slider, the ProTaper Gold S1, and then the WaveOne Gold Primary.

And I know you’re not big on hybridization, and I think he maybe didn’t mention that. So tell us how you feel about his technique though.

You know, I’m not a big hybrid guy, because I’m going to use a few analogies, and just bear with me. I’ll try another camera; this one’s getting very old. Okay, Reid played basketball. I imagine when he played basketball and it was competition, was the rim always the same diameter? Was the ball, like the NBA ball, the WNBA ball; they’re not the same diameters? So you usually show up and there’s familiarity.

When you play tennis and you bowl a racquet; there’s the weight of the racquet, there’s the grip, there’s the size of the head, there’s the string material, there’s the tension on the string. Do you have a different racquet, different head, different size every time you step on the court?

When you play what? Golf. I don’t golf; he golfs; I saw golf, jujutsu and surfing. Does he use different clubs every time he drives the ball? Or has he got his clubs kind of figured out and he’s got the clubs he carries? The ones that he needs; not different clubs from different companies on every single time he plays a round.

And finally I guess in baseball, which I played a lot of. I had my bat, it was a certain length, the handle was a certain size, the barrel was a certain size, it had so many ounces. And you don’t change bats every time you go to the plate.

So that’s my complaint with dentists that are always hybridizing, because sometimes you can get off in the weeds when you try to mix and match. But in this case I thought it was brilliant. Reid, I thought it was brilliant! You know why? Because I don’t want to brag or be over confident here, but everything he did was Ruddle endodontics. He did what? The big three. He catheterized the canal with a mechanical file 80% of the time. He got working length and he got patency in the glide path. Okay, he got that.

And then he used the S1 from ProTaper Gold. He opened up the body. Ruddle calls that pre-enlargement. That’s why we built the file that way. So I built that file with my team and he’s using that in exact length to open it up. Once he has the upper two-thirds opened up – oh God, we’re using more math; coronal one-third, middle one-third, 3-4-5, 3-4-5. Then he grabbed the primary WaveOne Gold reciprocation to do the deep shape. It’s got 7%, so it’s a tip of 2507. And so our teams built those files.

So he’s taking files that we built, because these aren’t – we never saw these files, Lise, as a file to cut a hole in a tooth. We thought the files were to embrace the philosophy of treatment. And the philosophy of treatment is to have a shape that’s root appropriate, to have a shape that can exchange irrigant into the instrumental portions of the canal, and then we wanted a way that we could fill root canal systems. So everything he did was in the spirit of Ruddle Endodontics.

And I thought I heard you also say too that using the reciprocation in the apex, or the apical one-third, might be actually a little more safe.

It’s been shown that. I’m a not going to a lit review, but a lot of papers have shown the absolute safety of a reciprocation method. Because that engaging angle of 150° is always under the elastic limit of the file, and then it disengages.

Okay. Now I don’t want to embarrass you, but I’m going to. So in his presentation, Reid, Dr. Pullen, said a lot of very nice things about you. And he even credited you for sealing the deal on his decision to become an endodontist when he heard you lecture. And then he also says that he thanks you for your mentorship, and helping him become not only a better clinician, but a better person as well.

So I thought I would take a moment now to talk a little bit about legacy. I mentioned in the first show of this season that legacy would be an ongoing theme throughout this season on our Road to 100. And legacy is basically the impact you have on other people, how they think, what they do, what they say as a result of having met you and known you.

So how does it feel to learn the impact that you’ve had on Dr. Pullen – and countless others for that matter – because I’ve seen many emails and stuff where doctors have said that they thank you so much; you’ve changed their lives. Literally that’s what they say -- changed their lives. So how does it feel to have this impact on others?

Well, I guess accidents happen. Remember, David Landwehr said anything can happen to anyone at any time. So accidents do happen.

You know, you don’t start your career – and Reid and I have never talked about legacy. I should, because he – well I must stop. If you really want to work on legacy, go back to the show we did on Path of the Heart. It was an obituary. So go way out in the future and write your obituary. And when you write your obituary, you now are oh geez, I’m still alive; that’s great. So now you have a road map.

So you don’t really think of it like that. I thought about the road map and all that, but I’m not thinking about everybody else. There’s an old Asian expression: before enlightenment, chop wood and carry water. And after enlightenment -- chop wood and carry water. So you stay humble, you keep working tirelessly, endless repetitions. Remember the plateau; I’ve talked about that endlessly. Most of life is the plateau. And then you buy a book and whoa – there’s a big gem right there. Boom, you jump up! And now endless repetitions; months can go by. And then you take a class, and then you have another bump. So you’re always working. And if you stay working, if you’re kind and you’re humble and you’re engaging like Reid is, people want to be around success. There’s an old clue: model success; success leaves clues.

You said you made – you went to that class and you wrote the obituary and how you wanted to be remembered. And so you kind of had a general framework in mind. But I don’t think every day you were thinking, I’m doing this for my legacy. For the legacy every day. It was just like you said: chop wood, carry water. Before enlightenment, after enlightenment; chop wood, carry water. You just worked every day, did your best.

Well and I’ll throw it right back at you. So you woke up one morning and said gee; where can I go buy a black belt? No, you earn it. And I made a little note here that I don’t know that leaders are born. I don’t know. We’d have to have a big talk about it. There would certainly be traits and characteristics and genetics that might prognosticate that. But leaders are developed.

So you’re a leader of your office, okay? So you start – if you want a legacy, you start by what do you want your staff to say about you? You know on the tombstone out there, or the little urn. Here lies my boss; he was the greatest guy I ever worked for. Okay, well if you want that to happen, then treat your staff so you can meet the destination.

So I think you just work hard. You lead by example. You lead your patients, you lead your referrals if you’re an endodontist, you lead your staff. And good things can happen if you keep working, if you have passion, determination and desire and you just keep at it. And then if you want to teach and stuff, you’re going to start having an impact. You’ll get immediate feedback when you see the doors swinging at 10:00 or 11:00 in the morning; that seat left, that whole row left. Or are they there at 4:30 in the afternoon, on the edge of their seats because they just can’t get enough?

So you’ve got to learn to keep people engaged. They’ll never remember what you say, but they’ll always remember how you made them feel.

Okay. I know just from watching you that I have seen that you’re a very hard worker; you work very hard all the time. But I do think that you might have had a master plan of how you saw yourself in the future; like how you wanted to be remembered. But I also have seen – things have come up in your life that were very unexpected; and you had to make a course change and you had to be open to other opportunities. So just staying – working hard every day, but staying open; being aware, staying in touch with the people around you, looking for opportunities, willing to make adjustments.

Yeah. Yeah, go ahead.

I want to get back to Dr. Pullen’s presentation. Again, thank you very much for this great presentation. And what do you want to say?

Well Reid; I’m really proud of you. I’ve kind of watched your career, and you’re getting to be one of the old guys. Of course that makes me ancient. So keep it going. We need more people to keep coming behind us because we need to keep the message alive. And Reid, thanks for being all that for everybody else.

I think your legacy is coming along nicely.

Okay, so we’re going to have a little fun with our close today. We’re going to do superlatives, and that’s where I ask you about what you think is the best and the worst in endodontics. These questions are meant to be short answers, so I’ll give you a little time at the end to expand on any if you want to. Are you ready?

I’m ready.

Okay. So the best article you read in the last year or most interesting topic?

It was easily Nagesh Bolla. And he’s from the Sibar Institute of Dental Sciences in India. His article was entitled: “Cleaning Efficacy of the SmartLite Pro EndoActivator Determined by the Endocator, a Chairside ATP Test; an In Vivo Study.” That was pretty thrilling. Next?

Okay. Worst article you read in the last year for whatever reason?

Well, you’re setting me up for people to be disappointed, angry, many emails coming in. So I will not mention names or a specific paper, but there’s actually been, sadly, a lot of papers that I would say are the worst papers; but I would say over a period of time.

And for what reason in general that you found them bad?

Well, I think it’s nice to have a different opinion; I’ve said that over and over. I don’t have a problem if you use a different file or believe something completely different. But when you’re starting to be clever or your condescending, or you don’t understand what you’re talking about, then I start to see arrogance.

Okay. Most relevant dental journal that you find yourself consulting lately?

Well, I wouldn’t say one. But I like best, out of all of them, the International Endodontic Journal, IEJ. JOE is okay; I know that’s going to crush a lot of you. I don’t mean that, but it’s not really a clinical booklet to help a clinician get better. And it’s gotten, over the years, really thick, and it’s very scientific. It’s good though, because I find some stuff there. And then I like, for just a good clinical booklet, Endodontic Practice United States: EPUS.

Okay. Worst controversy for endodontics?

Well there are so many, but one would the just the fact that I would say the word TRIAD.

Is the TRIAD dead?

Is the TRIAD dead. And the people that say it’s dead, they’re all instrumenting, they’re all trying to clean with their little gadgets, like my little gadgets, and they’re all filling and making white lines, and they’re not doing a TRIAD, but they are doing a TRIAD.

Okay. Best controversy for endodontics?

The best one is probably minimally invasive endodontics. And where I would spin that is okay; we don’t have all the solutions. You’ve got these little skinny shapes. I think 1% of the people in the world probably have GentleWave? No! Less than 1% on a 5-cent stock.

Lasers; very little application in the world, although fabulous. So I would say that it’s driving manufacturers and well thought of clinicians to explore the frontier, the future.

So out of these skinny shapes we’re going to see the emergence of new technologies.

Okay. Best case you saw in the past year?

Beth Damas! Dr. Beth Damas. Beth showed us how to take young, immature roots and how to be a little patient with vital pulp therapy. Get that patient’s own pulp to induce root maturation; get that to stipulates those roots so you get closure. And now we have endodontically strong teeth and more fracture resistance. So Beth, that was a great job.

And let’s see here. Best new technology of the last couple of years?

Well for me it’s easy. They’re still not quite here, but the Endocator would give you a chairside disinfection test. We would love to have that. We could compare your GentleWave with this, that and the other.

And then I would say the Innerview. I attended a thrilling meeting last night that I told you about, and it’s going to be a big part in the future of diagnostics.

Okay. Most suspect technology of the last few years?

Most suspect? Well, I would say probably the Tricalcium Silicate family of sealers. Because the formulations vary, as we said, from 5-50% are what you want. And so because of that, we have a lot of washout; we have a lot of disputes, we don’t have international agreement. And I think there’s a lot of things we don’t know that we don’t know. And then because of the skinny shapes, of course, it led to the single cone technique, and I think we can do way better than a single cone.

Okay. Best question you’ve received in the last year?

It wasn’t the last year, but it was absolutely the best question I’ve ever received in my life. It was in Amman, Jordan, and it was ironically from a guy from Beirut, Edmond Koyess. Edmond is a fabulous person, and Edmond posed a question to the 10 dentists at dinner. And he said Cliff, when does endodontics truly begin? That was a Zen question, I think because of Zen and the surfing and the waves of Reid; I think he would like the Zen part of that.

Okay. And then the last one for you is most misguided dental question you heard in the past year?

Well, the colleague on the AAE Forum that was begging manufacturers of the Tricalcium Silicate cements – sealers if you prefer. He was begging those colleagues, the manufacturers, to get more radiopacity into the formulation; not seemingly understanding that if you add something here, something’s got to be struck. You have 100%, got all these little pieces and the recipe that go together, and this guy wants more of this to be shoveled in, not seemingly recognizing that he could alter the physical properties that are the most desirable.

Okay. Well I know I made you be brief, and that’s sometimes hard. So is there anything that you want to go back and say little bit more about? Or are you good?

I’m good.

Okay. Well then that’s our show.

There was a worst answer.

Oh, okay. Well that’s our show for today. We hope you enjoyed it and we’ll see you next time on The Ruddle Show.