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Practice profile Dr. Anthony Horalek Top ten tips # 8 Tip irrigation in endodontics Dr. Tony Druttman ProTaper Next: a clinical study Dr. Edmond Koyess Corporate profile TDO Software PAYING SUBSCRIBERS EARN 24 CONTINUING EDUCATION CREDITS PER YEAR! Ultrasonics in orthograde endodontics Dr. Sanjeev Bhanderi clinical articles • management advice • practice proles • technology reviews August/September 2013 – Vol 6 No 4 PROMOTING EXCELLENCE IN ENDODONTICS MERCHANDISEIMAGING UTILITY ROOM To order please contact your local dealer. For more information, go to www.airtechniques.com. Fits Where Rigid Sensors Don’t. “ScanX Swift is ideal for patients with small mouths, pronounced tori or gag refl exes.” Martin Jablow, DDS UNMATCHED PATIENT COMFORT • Flexible, cordless phosphor sensors for easy, comfortable placement, even for third molars. EXCEPTIONAL DIAGNOSTIC CLARITY • Up to 38%* more image area―capture every root tip (even on maxillary canines). CONVENIENT CHAIRSIDE WORKFLOW • Easy for your assistant; efficient for you. EXCELLENT DIGITAL RADIOGRAPHY • Get 100% of the images you want, even for patients with small mouths, large tori, or gag reflexes. SMART INVESTMENT • Less expensive than rigid sensors (and no insurance needed). * An Independent, non-profi t, dental education and product testing foundation: Issue 9, September 2011 Digital Imaging Without Limits No. 2 in a Series INTRODUCTION Volume 6 Number 4 Endodontic practice 1 August/September 2013 - Volume 6 Number 4 ASSOCIATE EDITORS Julian Webber BDS, MS, DGDP, FICD Pierre Machtou DDS, FICD Richard Mounce DDS Clifford J Ruddle DDS EDITORIAL ADVISORS Paul Abbott BDSc, MDS, FRACDS, FPFA, FADI, FIVCD Professor Michael A Baumann Dennis G Brave DDS David C Brown BDS, MDS, MSD L Stephen Buchanan DDS, FICD, FACD Gary B Carr DDS Arnaldo Castellucci MD, DDS Gordon J Christensen DDS, MSD, PhD B David Cohen PhD, MSc, BDS, DGDP, LDS RCS Stephen Cohen MS, DDS, FACD, FICD Simon Cunnington BDS, LDS RCS, MS Samuel O Dorn DDS Josef Dovgan DDS, MS Tony Druttman MSc, BSc, BChD Chris Emery BDS, MSc. MRD, MDGDS Luiz R Fava DDS Robert Fleisher DMD Stephen Frais BDS, MSc Marcela Fridland DDS Gerald N Glickman DDS, MS Kishor Gulabivala BDS, MSc, FDS, PhD Anthony E Hoskinson BDS, MSc Jeffrey W Hutter DMD, MEd Syngcuk Kim DDS, PhD Kenneth A Koch DMD Peter F Kurer LDS, MGDS, RCS Gregori M. Kurtzman DDS, MAGD, FPFA, FACD, DICOI Howard Lloyd BDS, MSc, FDS RCS, MRD RCS Stephen Manning BDS, MDSc, FRACDS Joshua Moshonov DMD Carlos Murgel CD Yosef Nahmias DDS, MS Garry Nervo BDSc, LDS, MDSc, FRACDS, FICD, FPFA Wilhelm Pertot DCSD, DEA, PhD David L Pitts DDS, MDSD Alison Qualtrough BChD, MSc, PhD, FDS, MRD RCS John Regan BDentSc, MSC, DGDP Jeremy Rees BDS, MScD, FDS RCS, PhD Louis E. Rossman DMD Stephen F Schwartz DDS, MS Ken Serota DDS, MMSc E Steve Senia DDS, MS, BS Michael Tagger DMD, MS Martin Trope, BDS, DMD Peter Velvart DMD Rick Walton DMD, MS John Whitworth BchD, PhD, FDS RCS CE QUALITY ASSURANCE ADVISORY BOARD Dr. Alexandra Day BDS, VT Julian English BA (Hons), editorial director FMC Dr. Paul Langmaid CBE, BDS, ex chief dental officer to the Government for Wales Dr. Ellis Paul BDS, LDS, FFGDP (UK), FICD, editor-in-chief Private Dentistry Dr. Chris Potts BDS, DGDP (UK), business advisor and ex-head of Boots Dental, BUPA Dentalcover, Virgin Dr. Harry Shiers BDS, MSc (implant surgery), MGDS, MFDS, Harley St referral implant surgeon PUBLISHER | Lisa Moler Email: lmoler@medmarkaz.com Tel: (480) 403-1505 MANAGING EDITOR | Mali Schantz-Feld Email: mali@medmarkaz.com Tel: (727) 515-5118 ASSISTANT EDITOR | Kay Harwell Fernández Email: kay@medmarkaz.com Tel: (386) 212-0413 EDITORIAL ASSISTANT | Mandi Gross Email: mandi@medmarkaz.com Tel: (727) 393-3394 DIRECTOR OF SALES | Michelle Manning Email: michelle@medmarkaz.com Tel: (480) 621-8955 NATIONAL SALES/MARKETING MANAGER Drew Thornley Email: drew@medmarkaz.com Tel: (619) 459-9595 NATIONAL SALES REPRESENTATIVE Sharon Conti Email: sharon@medmarkaz.com Tel: (724) 496-6820 PRODUCTION/DIGITAL MARKETING MANAGER Greg McGuire Email: greg@medmarkaz.com Tel: (480) 621-8955 PRODUCTION ASST./SUBSCRIPTION COORD. Lauren Peyton Email: lauren@medmarkaz.com Tel: (480) 621-8955 MedMark, LLC 15720 N. Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Tel: (480) 621-8955 Fax: (480) 629-4002 Toll-free: (866) 579-9496 Web: www.endopracticeus.com SUBSCRIPTION RATES 1 year (6 issues) $99 3 years (18 issues) $239 © FMC, Ltd 2013. All rights reserved. FMC is part of the specialist publishing group Springer Science+Business Media. The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems. While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it. The views expressed herein are those of the author(s) and not necessarily the opinion of either Endodontic Practice or the publisher. Restorative-driven endodontics T he axiom in implant dentistry is “implant dentistry is a restorative treatment with a surgical component,” meaning that the restoration dictates how the implant needs to be placed and where. But, endodontics also is restorative-driven. Essentially, it does not matter if we can find the canals and instrument and obturate them IF we cannot predictably restore that tooth. Basic concepts of restorative dentistry seem to have fallen by the wayside as the bonding evolution has rolled forward. Practitioners have forgotten the concept of a ferrule when placing a crown on a tooth, as bonding can retain the crown to whatever minimal tooth is present. The use of posts among the younger practitioners is not necessary because a core can be bonded to the remaining tooth structure. Long-term survival of endodontically treated teeth is dependent on load handling of the restored tooth. When a ferrule is not present or minimally present, as supported by the literature, stress concentrates at the interface between the root and crown margin. Over time, with repeated loading, recurrent decay can result at the micro gap that opens at the crown margin and/or the crown dislodges often with whatever core material was placed still within the crown. This is more critical in the maxillary anterior due to its off- axis loading under function. Auxiliary procedures such as osseous crown lengthening or orthodontic forced eruption can improve a ferrule but need to be weighed both timewise and financially, compared to extraction and placement of an implant. When after crown preparation, native tooth structure is not present circumferentially to encircle the core, loading on the crown is on the core-tooth interface. A post should be considered to help retain that core to the remaining tooth and again improve longevity of the restoration. Conservative dentistry is often looked on as minimally preparing the tooth. But we need to view this as removing only as much tooth structure as is needed to achieve the treatment goals we have planned. When endodontics is part of the plan for that tooth, conservation of the cervical tooth structure becomes critical and affects the long-term survival of the tooth. Stresses are concentrated at the tooth’s cervical area, and the more dentin that can be maintained in this region, the better stress handling the tooth can sustain. Prior to the introduction of rotary endodontics, hand files were used for the instrumentation. These files were a 0.02 taper and minimally widened the canal in the cervical region preserving dentin. With the use of rotary files, wider and wider taper files were introduced, with tapers of 0.08 up to 0.12 designed to create canal shapes easier to obturate, but at the expense of cervical tooth structure. As rotary files evolved and the understanding of preservation of cervical tooth structure was understood, files were introduced with less taper (0.04 and 0.06) that provided the best of both worlds, better canal shape to obturate than standard hand files, and less cervical tooth structure removed. Conservative endodontics had arrived. Evaluation of the tooth presenting with clinical and radiographic indications that endodontic treatment is indicated needs to start with “can this tooth be predictably restored?” If the answer is yes, then we need to determine what needs to be done to restore the tooth. Will a post be needed? Can a ferrule be achieved, and if not, what do we need to do to create that ferrule? When the answer is “No, this tooth cannot be restored predictably,” then extraction is indicated, and we need to look at what options can be utilized to replace the tooth/teeth that will be missing. Restoration of the tooth is the core of dentistry, and whether it’s implants or endodontics, evaluation and treatment need to start from the restorative aspect. Before determining if the tooth will require endodontic treatment, we need to decide if that tooth can be restored predictably and then determine if endodontics will or can be performed. Gregori M. Kurtzman, DDS, MAGD TABLE OF CONTENTS Case study ProTaper Next: a clinical study Dr. Edmond Koyess describes a new approach to shaping, cleaning, and filing canals effectively 14 Treatment of a crown-root fracture using a composite endodontic post Drs. Jozef Mincík and Marián Tulenko present a case report detailing the treatment of a crown- root fracture 18 Endodontics in focus Top ten tips: Tip number 8 – Tip irrigation in endodontics Continuing his series on endodontics, Dr. Tony Druttman looks at an important type of disinfection .22 2 Endodontic practice Volume 6 Number 4 Practice profile 6 Dr. Anthony Horalek: The art and science of endodontics Determination, creativity, and inspirational mentors are guiding lights in this clinician’s search for excellence. Corporate profile 10 Make TDO Software your next move Providing endodontists with the tools and resources to build and maintain a successful practice. simple, adaptable endodontic solutions Irrigation amplication All grown up Ultradent now offers Consepsis (2% chlorhexidine), ChlorCid (3% sodium hypochlorite), and EDTA 18% in 480ml bottles* to give you the best value on the irrigants you use with every endodontic procedure. And with Ultradent’s economically priced irrigants, you do not have to sacrice ease of use. Designed with a unique ip-top cap, Ultradent’s economy-size irrigants are easy to dispense into a container or even backll a syringe—so easy, in fact, you can do it with one hand. Use NaviTip to easily deliver Ultradent irrigants just short of the apex. Available with regular and sideport delivery. Irrigants Don’t change your technique. Make it easier—and more economical—with Ultradent’s economy-size irrigants. © 2013 Ultradent Products, Inc. All Rights Reserved. 800.552.5512 ultradent.com Unique ip-top cap makes backlling syringes easy. Scan to watch a short video about Ultradent irrigants. *Smaller-volume syringes still available. TABLE OF CONTENTS Continuing education Ultrasonics in orthograde endodontics Dr. Sanjeev Bhanderi discusses the role ultrasonics can play in conventional (orthograde) treatment in the contemporary endodontic practice .26 Intraosseous biocompatibility of an MTA-based and a zinc oxide and eugenol root canal sealer Drs. Osvaldo Zmener, Ricardo Martinez Lalis, Cornelis Pameijer, Carolina Chaves, and Gabriel Kokubu evaluate the biocompatibility of FLPX when implanted in bone tissue of the rat tibia and compare it to Grossman sealer 32 Step-by-step UniCore Post and Drill System .38 Research Comparison of isthmus debris removal using three different irrigation techniques Drs. Kathryn L. Aasen, Brian E. Bergeron, Mark D. Roberts, Van T. Himel, Thomas E. Lallier, and Kent A. Sabey evaluate the effectiveness of debris removal in mesial roots of mandibular molars 40 Endodontic concepts Dr. Julian Webber’s 10 steps to endodontic heaven The most important endodontic principles in 10 bullet points .46 Practice management Negotiating successful payment arrangements Looking for perfect payment arrangements? Janice Keller reveals four easy steps to help you succeed every time, with every patient .48 Endospective The benefits of a “beginner’s mind” Dr. Rich Mounce focuses on regaining the excitement of dentistry .50 Anatomy matters “What’s It All About?” Part 7 Dr. John West recognizes that the best education in the world is an endodontist’s own personal education .52 Diary 55 Materials & equipment .56 4 Endodontic practice Volume 6 Number 4 UniCore 38 ImplPracAD713_Layout 1 7/2/13 7:59 AM Page 1 What can you tell us about your background? I started out life with humble beginnings in the state of Nebraska. I grew up on farms, in small towns, and in Lincoln, Nebraska. I was in foster homes from the age of 4 to age 12, at which time I was adopted and my name changed to Anthony L. Horalek. I attended high school in Palmyra, Nebraska. There were only 29 students in my graduating class. I made the best of it by signing up for the most challenging classes in science, math, art, and business. I was in drama, on the speech team, and I lettered in track and field. My adopted father passed away when I was 16 years old. A little over a year later, my adopted mother and new stepfather decided to move to Oregon. Rather than move again, I asked to finish high school at Palmyra, Nebraska and finished out my senior year by delivering newspapers and finding odd jobs to pay my bills, so I’ve been on my own since I was 17 years old. I wasn’t sure what I wanted to do after I graduated high school, so I decided I would enlist in the military and I signed up to start basic training 6 months after high school graduation. My high school guidance counselor advised me to try one semester of college at Peru State College prior to my enlistment date. I focused on art and biology. I was surprised when I was called for an impromptu meeting with the dean of student affairs, former head football coach and athletic director, Jerry Joy, who advised me to stay in college rather than enlist, so I did. I then transferred to the Kansas City Art Institute (KCAI) on a full-tuition scholarship with only the shirt on my back. I did well; however I met a dentist while working off-campus. He was impressed with my artistic ability and told me that I would make a great dentist. Following his advice, I took some career testing at Rockhurst University in Kansas City and discovered that dentistry might be a better fit for me. I then switched my focus to dentistry and went on to study at the University of Nebraska. While at the University of Nebraska, I applied for and received Reserve Officer Training Corps (ROTC), and Health Dr. Anthony Horalek 6 Endodontic practice Volume 6 Number 4 PRACTICE PROFILE The art and science of endodontics fascinated about what happens “inside” of things. So I was always curious about the inside of teeth. I pondered prosthodontics and endodontics. I’ve always been interested in what can be termed precision science and precision arts. I think endodontics has some characteristics of a precision science and of a precision art. How long have you been practicing, and what systems do you use? I’ve been practicing dentistry since 1995 or the past 18 years. I was a general dentist for 5 years, and I’ve been an endodontist (residency included) for the past 13 years. I use The Digital Office (TDO) software, Carestream 3-D imaging (Carestream 9000 3D), Carestream 6100 radiographic sensors, and Ultradent Products, Inc., as some of my favorite products and systems. What training have you undertaken? I attended the Kansas City Art Institute as an illustrator in-training for 1 year, but my study in this area started in junior high school, when I started teaching myself how to draw. My formalized dental training after dental school was an Advanced Education in General Dentistry (AEGD) with the U.S. Army at Fort Lewis, Washington. After endodontic residency at Virginia Commonwealth University (VCU) School of Dentistry, I took 3 years of continuing education on dental implants. I continue to study implants, although it is not the core of my practice. My military training consisted of Reserve Officer Training Corps (ROTC) and other courses related to military service. A few courses were cadet Basic Camp, Professions Scholarship Program (HPSP) scholarships. After graduating from the University of Nebraska and spending 4 years on active duty, I applied and was selected for endodontic training in the United States Army. This paid for most of my college education. I accumulated a 10-year active duty obligation, which gave me the opportunity to serve with some of America’s finest soldiers, live overseas, and learn more about how our government operates. I was a full-time training developer and instructor for 2 years, as well as an executive officer for a 350- man training company at the Joint Special Operations Medical Training Center (under the auspices of the Special Warfare Medical Group), Fort Bragg, North Carolina. I also taught an introductory biology course for Campbell University during this time. My last duty assignment was in Germany, where I was assigned to Heidelberg Dental Activity (DENTAC) as an endodontist. I decided to make my home in Raleigh, North Carolina, where I have lived and practiced endodontics for the past 7 years. Is your practice limited to endodontics? My practice, North Raleigh Endodontics, is limited in its scope, based on my training, experience, abilities, and in accordance with state law. As dental specialists, I believe we should narrow our scope to match our training and expertise. The breadth of this scope and the language that defines endodontics as a specialty are debatable, and these will also change over time. Why did you decide to focus on endodontics? I’ve always been a curious person and PRACTICE PROFILE Volume 6 Number 4 Endodontic practice 7 Advanced Camp, the U.S. Army Airborne Course, the U.S. Army Jumpmaster Course, the Combat Care and Casualty Course (C4), the Advanced Trauma Life Support (ATLS) Course, the Expert Field Medical Badge (EFMB), the Instructors’ Training Course, the Training Developers’ Course, and the Collateral Duty Safety Officers’ (CDSO) Course. Suffice it to say these short training courses of 2 to 8 weeks in duration each have also influenced how I think and work today. Who has inspired you? In chronological order, the following people have inspired me: James and Alycemae Archer (Lincoln, Nebraska), Dr. Ken Anderson (art professor, Peru State College, Nebraska), Jerry Joy (former college football coach and dean, Peru State College, Nebraska), Jack Lew (illustrator professor, Kansas City Art Institute, Missouri), Jay and Jary Johnson (Des Moines, Iowa), Dr. Sreenivas Koka (UNMC School of Dentistry, Nebraska), Dr. Gary Carr (San Diego, California), Dr. John Khademi (Durango, Colorado), Dr. Joey Dovgan (Phoenix, Arizona), Dr. Jeff Janian (UCSF School of Dentistry, California), Dr. David Sarrett (dean of students, VCU School of Dentistry, Virginia), Dr. Fred Liewehr (U.S. Army Endodontic Program Director/VCU School of Dentistry, Department of Endodontics, Virginia), Dr. Marga Ree (private practice, the Netherlands), Dr. Marc Balson (Phoenix, Arizona), Dr. Rick Schwartz (San Antonio, Texas), and Dr. Nicholas Pediaditakis, (Raleigh, North Carolina). Each of these people has given me something that I try to emulate today, and I am grateful. What is the most satisfying aspect of your practice? This might sound trite, but the most satisfying aspect of my practice is being able to help patients with complex dental problems. I do this by integrating each patient’s endodontic diagnosis and treatment with his/her comprehensive treatment. My professional development has been greatly enhanced by participating in forums that are part of our practice management software. By viewing and exchanging opinions on 20-30 cases per day from top clinicians, as well as posting my own cases for comments, I have found that my development as a clinician has been helped immeasurably. Being part of a community with a shared vision has helped me refine my understanding of what the standards are and enabled me to improve my skills and understanding both in clinical and practice management matters. Professionally, what are you most proud of? I’d have to say I am most proud of a goal I set when I was in dental school. I set a goal as a freshman that I would achieve straight A’s throughout dental school. I fell slightly short and received a 3.98 grade point average. As a result of that goal, I was the first student in the 100-year history of the University of Nebraska Medical Center (UNMC) College of Dentistry to graduate With Highest Distinction. I had not planned for that; it just happened as a product of the other goal. I felt like I had established excellence in something for the first time. I look at grades, credentials, and degrees differently today than I did then. I am now more interested in learning than “getting the grade,” as these are often two different things. The way in which we measure grades may or may not be a reflection of learning and understanding. What do you think is unique about your practice? I make an illustration for every patient and write out my findings and the patient’s treatment options on the illustration. I give that drawing and treatment plan (a visual algorithm) to the patient as a gift after an assistant scans it into our practice management software. I can do this in less than 2 minutes. It seems to amaze patients and referring doctors alike, but it comes naturally to me. It also helps the referring doctor understand what is going on with his/her referred patient because the illustration is included in my report back to the referring office. The illustration also helps me understand what happened long after I saw the patient, without having to search through several pages of treatment notes and documentation. The illustration also serves as part of the informed consent to the patient for the treatment that I provide or do not provide. What has been your biggest challenge? My biggest challenge in life has been finding direction. Picking the right direction or goal is just as important, if not more important, than achieving an established goal to me. I believe that selecting and achieving the most optimal goals helps one achieve his CBCT post-op findings of type 4 canal configuration The North Raleigh Endodontics team Dr. Horalek and Kara treating a patient 8 Endodontic practice Volume 6 Number 4 PRACTICE PROFILE or her potential. We only have so much time and energy, so it is imperative to set goals wisely. My biggest challenge in endodontic practice was becoming established the first 2 years after the practice opened. I started the practice from scratch, right after I exited the military. I made many mistakes the first 2 years. I am a fast learner though, and I have always been attracted to outstanding mentors. I continue to study what traits and qualities of my mentors have made each one successful. I try to adapt those traits and principles to me and into my practice. This has helped me become successful. What would you have become if you had not become a dentist? I would have become an illustrator or a designer. I may still become these things if I am able to. As a child, I wanted to become a police officer. What is the future of dentistry and endodontics? I have not thought about the future of dentistry profoundly, but I am concerned about the many new dental schools cropping up in the United States, without rigorous study on “needs assessment” of the number of dentists needed to serve our population. Are the dental schools opening because there is an underserved population that has a need? Or are they opening as a revenue source for universities? This issue requires more study. Corporate dentistry (without dentist ownership) is also a hot topic presently. I think non-dentist owned corporations have the potential to harm the entire profession if put into the wrong hands. Corporate dentistry without dentist ownership puts the control of practices in the hands of business men, investors, or corporate boards that know very little about the profession of dentistry, other than it has a high margin for potential profit. There is a great danger here that profit-motive could take over dentistry completely if not regulated by dental professionals. I understand there are two sides to this issue, and that not all non-dentist-controlled, corporately-owned dental offices are practicing badly, and some serve underserved sectors of the public. It will be interesting to see how this plays out. Another troubling concern is the possibility that the excessive numbers of dentists that will likely be produced by these extra universities could feed into the (non-dentist owned) corporate dentistry business models. This could result in strengthening these types of entities to the point that our present model of private practice, as we know it, will be snuffed out. Dentists could be nothing more than employees whose treatment decisions are largely determined by business models and insurance policy-driven algorithms. One of my mentors predicts that dental office business models might gravitate toward two different directions: 1) the elite fee-for-service boutique practice, where the patient seeks out the best possible treatment, even if it is more costly, or 2) the corporately controlled, HMO, PPO, insurance-driven, mega-practice. I think endodontics has a bright immediate future, but there is great room for improvement. Cultural problems exist within our specialty that include some of our colleagues prioritizing financial (money) and personal dominion (power) over professional service. While this is endemic to humankind, it is clear to me and others that this culture, taken to the extreme, has negatively impacted the quality and outcomes of endodontic treatment provided in the United States. There’s a lie that says something like this: “The more money I make in practice, the better doctor I am.” This is nonsense. Unfortunately, this is a philosophy that is prevalent within the minds of many dentists in the U.S. today. This has led to the “churn-and-burn” endodontic practice model, where endodontists and dentists complete all treatments (to include complex molars and premolars) in 45- 60 minute treatment sessions. I fear this practice business model is driven by a for- profit-only motive, not by a professional- service motive. As a past president of the American Association of Endodontists, Dr. Marc Balson, once exclaimed, “We have met the enemy, and it is us!” Many patients have been damaged by this philosophy, and our reputation as endodontists has been damaged amongst our sister specialties and referring doctors. I strongly believe it is a hoax to think that we can treat all patients like this and achieve favorable patient-centered outcomes, which should be our top priority as clinicians. While understanding and discussing disease-specific and process outcomes and how they might relate to the patient- centered outcomes are still important as a scientific endeavor, the misplaced focus on those outcomes has probably jeopardized the most important outcome what matters to the patient. On a very positive note, our specialty has a lot of extremely bright and talented people that can help us navigate through these problems. With hard work, integrity, forward-looking plans, and the right leaders, the endodontic specialty will morph scientifically, biologically, clinically, and politically into a specialty that will remain viable and successful. There will be no status quo. What are your top tips for main- taining a successful practice? 1) Surround yourself with only the very best people 2) Strive for excellence at every opportunity 3) Be as honest as you can be 4) Have a vision, and plan, plan ahead What advice would you give to budding endodontists? Find your talent, and do it better than anyone else. Work hard, work smart, and put your heart into it. What are your hobbies, and what do you do in your spare time? I like to cycle, run, and draw. I like to travel a lot on weekends. I like to read and think profoundly about things. Dr. Horalek and Kara treating a patient EP Top Ten Favorites • The Digital Office (TDO) software, the TDO organization, and the many friends that I have met at TDO meetings and through the different forums connected to or spun off from TDO. • Ultradent Products, Inc. I love the quality of the products (Skini Syringes, Valo ® curing lights, bonding systems, bleaching systems, delivery devices, tubes and brushes, UniCore ® glass fiber post system). I’m fascinated by the history of the company, and think highly of Dr. Dan Fischer for his innovation, integrity, work ethic, and generosity to underprivileged young people in his part of the country. • Traveling and meeting my endodontic friends at meetings, to include Dr. Marga Ree! • Playing tricks on Dr. John “Bayes” Khademi. That is really one of my favorite things to do. • The International Academy of Endodontics (IAE), the best new endodontic academy in the world. • North Carolina. I love the beauty and people of this state. • Dr. Gary Carr and his approach to using the “classics” as a basis for teaching and learning. It’s very powerful. • The Iron Horse Classic bicycle race. Memorial Day weekend every year. You need to try it. • My cousin, Wade Jensen. First Sergeant, United States Marine Corps (Retired). A true American hero with a heart of gold, who risked it all, to serve his country with true faith, allegiance, and dedication. • “Super Rick” Schwartz and his relentless work ethic. The man is an animal! . (480) 62 1-8955 MedMark, LLC 15720 N. Greenway-Hayden Loop #9 Scottsdale, AZ 85 260 Tel: (480) 62 1-8955 Fax: (480) 62 9-4002 Toll-free: ( 866 ) 579-94 96 Web:. Digital Imaging Without Limits No. 2 in a Series INTRODUCTION Volume 6 Number 4 Endodontic practice 1 August/September 2013 - Volume 6 Number 4 ASSOCIATE EDITORS