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Practice Marketing Center

Dentistry Powered by CEREC®

Cerec® patient marketing materials.

We’ve created a comprehensive set of integrated marketing materials to help CEREC system practitioners start the conversation with your patients about the exciting advantages of CEREC — or answer questions from patients who ask your staff about it. 

Understanding that no two practices are the same, we have developed two sets of materials to highlight how you bring One Visit Dentistry for crowns, inlays, veneers, and more to life in your practice, the choice is yours.    

“Marketing my practice with CEREC has really differentiated myself from others in the community. My existing patients are referring friends and family and new patients are calling asking for a CEREC crown by name. Continuing the highest standard of care and patient experience with all the in-office materials has been a marketing tool in itself. I cannot practice a day without my CEREC technology, and I love that my patients can understand why!&quot;</p>\r\n"}}" id="text-6af102e2e1" class="cmp-text"> “Marketing my practice with CEREC has really differentiated myself from others in the community. My existing patients are referring friends and family and new patients are calling asking for a CEREC crown by name. Continuing the highest standard of care and patient experience with all the in-office materials has been a marketing tool in itself. I cannot practice a day without my CEREC technology, and I love that my patients can understand why!"

Dr. Mona Patel, Bayshore Dental, Whitefish Bay, WI

Download here, use in a variety of ways

Toolkit elements can be downloaded below, customized and used in a number of compelling ways..

• Showcase the message in your office  with a waiting room video, posters, and a patient brochure
• Enhance your online presence  through social media, banner advertising, and your own website
• Reach patients in their homes  with a reminder postcard and informative emails

Plus, our How-To Guide includes marketing tips to help you deploy these tools to maximum benefit.

CEREC How-To Guide

One hour, one visit, for your patients - one hour, one visit printed materials, cerec appointment postcards.

One Hour, One Visit - Customizable, 4x6 in. reminder postcard

CEREC Posters

One Hour, One Visit - Posters for in-office display—2 versions and 3 sizes (8.5x11, 11x17, 24x36)

CEREC Patient Brochure

One Hour, One Visit - Customizable, 8.5x11 in. trifold brochure

CEREC Patient Brochure with Crops & Bleeds

One Hour, One Visit - Customizable, 8.5x11 in. trifold brochure with crops and bleeds

For Your Patients - One Hour, One Visit Digital/Video Materials

Cerec practitioner website assets.

One Hour, One Visit - Text, imagery and video that you can include on your website

CEREC Overview Full Video

One Hour, One Visit - .MP4 video file with a CEREC overview that you can use in-office and online    

CEREC Overview Social Video

One Hour, One Visit - .MP4 video file with the CEREC overview edited down for use on your social media accounts

CEREC Social Media Assets

One Hour, One Visit - A text document (.DOCX), sample mockups (.PDF), graphics (.JPG), and video (.MP4) for social media 

CEREC Email Assets

One Hour, One Visit - A text document (.DOCX), sample mockup (.PDF), and graphic (.JPG) for each of 3 patient emails: CEREC Overview, Restoration Types, How CEREC Works

CEREC Digital Banners

One Hour, One Visit - Fully finished digital banner ads in 6 sizes for use on your website or in paid advertising

One Visit Dentistry

For your patients - one visit printed materials, cerec appointment postcard - one visit.

One Visit - Customizable, 4x6 in. reminder postcard

CEREC Posters - One Visit

One Visit - Posters for in-office display—2 versions and 3 sizes (8.5x11, 11x17, 24x36)

CEREC Patient Brochure - One Visit

One Visit - Customizable, 8.5x11 in. trifold brochure

CEREC Patient Brochure with Crops & Bleeds - One Visit

One Visit - Customizable, 8.5x11 in. trifold brochure with crops and bleeds

For Your Patients - One Visit Digital/Video Materials

Cerec practitioner website assets - one visit.

One Visit - Text, imagery and video that you can include on your website

CEREC Overview Full Video - One Visit

One Visit - .MP4 video file with a CEREC overview that you can use in-office and online

CEREC Overview Social Video - One Visit

One Visit - .MP4 video file with the CEREC overview edited down for use on your social media accounts

CEREC Social Media Assets - One Visit

One Visit - A text document (.DOCX), sample mockups (.PDF), graphics (.JPG), and video (.MP4) for social media

CEREC Digital Banners - One Visit

One Visit - Fully finished digital banner ads in 6 sizes for use on your website or in paid advertising

What is CEREC?

CEREC is an acronym for C hairside E conomical R estoration of E sthetic C eramics, or CERamic REConstruction. Translated, it means that a dentist can economically restore damaged teeth in a single appointment using a high-quality ceramic material that matches the natural color of other teeth.

How does the instrument work?

CEREC uses CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology, incorporating a camera, computer and milling machine in one instrument. The dentist uses a special camera to take an accurate picture of the damaged tooth. This optical impression is transferred and displayed on a color computer screen, where the dentist uses CAD technology to design the restoration. Then CAM takes over and automatically creates the restoration while the patient waits. Finally, the dentist bonds the new restoration to the surface of the old tooth. The whole process takes about one hour.

What does this innovation mean for a patient?

A tooth-colored restoration means no more silver fillings discoloring smiles. The filling is natural-looking, compatible with tissue in the mouth, anti-abrasive and plaque-resistant. Dentists no longer need to create temporaries or take impressions and send them to a lab. Because of this, the traditional second visit has been eliminated. CEREC has two decades of clinical research and documentation to support the technology. The restorations have been proven precise, safe and effective.

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CEREC One-Visit Dentistry

Get a new smile in only visit. if you have ever broken or damaged a tooth, we understand that you want nothing more than to have it restored quickly. that’s why we have invested in one-visit dental technology., cerec dental technology, learn more about this exciting technology to repair your smile., advantages of cerec one-visit restorations, convenience.

With CEREC technology, crowns and other restorations are made and placed in one visit—saving time and the inconvenience of multiple visits.

Because these crowns and restoration are made out of ceramic, they are natural looking and match the shade of your existing teeth.

No Impression. No Temporaries.

Because your crown or restoration is made the same day, there is no need for goopy impressions and temporary crowns.

Longer Lasting

The final result of CEREC one-visit restorations…beautiful, natural and more durable than white composite fillings.

CEREC One-Visit Dental Restorations

Using CEREC technology, we can restore decayed teeth; design and place ceramic crowns; replace amalgam (silver) fillings; and design and place inlays, onlays, and dental veneers in just one appointment.

Our patients absolutely love the convenience and beauty of these dental restorations. Best yet, there are no impressions, no temporaries, no second appointment, and they are all metal free! The final result is a beautiful, healthy, strong and natural-looking restoration.

(716) 674-5950

[email protected].

4111 Seneca Street West Seneca, NY 14224

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• One Visit Dentistry

What is CEREC®? Chairside Economical Restorations of Esthetic Ceramic or CEREC® for short is a new state-of-the-art method of reconstructing tooth restorations. CEREC® uses computer-assisted design (CAD) and computer-aided manufacturing (CAM) to offer single-day restorations for patients. This new technology has revolutionized dentistry by saving you time and the need for additional dental visits. The restorations created are metal-free and tooth colored to restore your tooth to its natural beauty, strength and function.

Advantages to Using CEREC®

Most procedures can be done in one visit - less costly and less time-consuming Fewer injections of anesthetic due to single-visit No need to take messy impressions No need to have a temporary restoration for in-between visits Ability to save as much natural tooth structure as possible Restores teeth to natural beauty, function and strength Metal-free restorations

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One-Visit Crowns

Crowns in Just One Hour

If you have ever had a crown placed over a tooth, you know how time-consuming it can be. The first trip to the dentist for a temporary, a second trip to have the permanent crown placed, and sometimes, a third and fourth trip if the crown doesn’t fit properly.

What was once a two- or three-week waiting time has now been reduced to just one visit and less than two hours! With CEREC® technology, we can design and mill a perfectly fitting crown so there are no return trips to complete the process. CEREC® creates long-lasting, aesthetically pleasing restorations that are superior to plastic or metal fillings.

The process starts by painting a reflective powder over the damaged tooth. With a special camera, we take a very accurate picture that is displayed on our computer screen so we may design the shape and size of the inlay, onlay, or crown. Automatically, CEREC® then creates the actual permanent restoration. It is ready for bonding to the tooth, and you may eat whatever you like once it is in place. What could possibly be easier than this high-tech procedure?

There’s no charge to learn more about CEREC one-visit crowns. Call today at 763-972-2800 to schedule your complimentary consultation.

One-Visit Crowns

What it is. It is a cosmetic crown that is completed in one visit (instead on needing a second visit two weeks later).

Why we do it. We offer one-visit (or E4D) crowns for several reasons. Because your final crown can be seated immediately you avoid the hassle of a temporary crown, as well as the waiting and returning for a second office visit several weeks later. Unlike conventional impressions that can be messy, unpleasant, and cumbersome, a digital scan is clean and fast. The materials used in an E4D crown are porcelain. The same material used in a traditional crown.

What to expect . Your visit will be pain-free and you can return to work or your regular activities immediately.

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Address: 950 14th Ave. Longview, WA 98632

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One Visit Crowns

When other dental practices provide patients with porcelain restorations such as veneers and crowns, they often require patients to schedule multiple appointments and in-between, use a temporary restoration until the final one comes in from the dental laboratory. At Dream Dentistry, we understand that our patients have busy lifestyles and want to make restorative dental work faster and more convenient. This includes offering one visit crowns, veneers, and bridges at our Longview, WA area practice.

What is one visit dentistry?

One visit dentistry means that patients can have dental restorations planned, prepared, and placed during a single appointment at Dream Dentistry. This is highly desirable by our patients because it saves time and money, and eliminates patients having to come back to have a temporary restoration removed. Dr. William Lesh creates the restorations in the office by taking digital impressions of the prepared teeth and converting them into CAD/CAM software. This digital image is then processed by our CEREC machine which mills the final restoration out of a block of porcelain-all while patients wait in the chair! One visit dentistry has completely changed the process required for fabricating and placing dental restorations and continues to be a popular option for our patients.

What can I expect during my CEREC one visit dentistry appointment?

●  Diagnosis. First, Dr. William Lesh will diagnose the patient’s unique situation to determine if a dental restoration can help restore the tooth. ●  Preparation. Second, the tooth is prepared depending on the restoration being placed. ●  Imaging. Third, digital impressions are taken and converted into the CAD/CAM software. ●  Creation. Fourth, with these digital images, the CEREC system creates the restoration right in the office in less than 15 minutes! ●  Placement. Fifth, the dentist bonds the new restoration onto the prepared tooth to complete the process.

Learn about the advantages of one visit dentistry!

If you reside in the area of Longview, WA or the surrounding communities and need dental restorations, we strongly encourage you to book an appointment with Dr. William Lesh of Dream Dentistry to discuss your options. We are located at 950 14th Avenue and accept new patients who call our facility at (888) 449-2086 for a visit.

Dream Dentistry

950 14th Ave. Longview, WA 98632 New Patients: (888) 449-2086 Existing Patients: (360) 200-4924

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At all of our Perry Dental Locations we offer you one visit crowns, fillings or veneers with the Cerec™ system. Many of our patients are candidates for these clinically proven, natural-looking restorations that are delivered to you in a single visit!

The Cerec™ system allows our doctors to take a clean, fast digital scan, so you can avoid the inconvenience and wait associated with conventional dental techniques such as messy dental impressions or temporary crowns. With a Cerec™ restoration, your doctor uses 3-D scanning technology to aid in designing the restoration. This makes it possible for your doctor to complete your crown in a single appointment. Perry Dental has been using this technology for nearly 20 years.

Perry Dental is equipped with an on site milling center that creates your ultimate crown, filling or veneer while you wait, so it can be permanently placed in your mouth the same day, letting you avoid the hassle of a temporary.

With Cerec™ dentistry, our doctors can offer you modern dentistry that fits your modern lifestyle. If you have any questions concerning our Cerec™, same day restoration system, please feel free to speak with one of our Perry Dental team members today!

From the Dentist’s Chair

Castleton Dental

Smile! You're in good hands

• 6535 E 82nd St. Ste 211 Indianapolis, IN 46250
• (317) 849-3597

One Visit Dentistry

Too busy for two dental visits.

Technology has changed our everyday lives; smart phones, smart watches, tablets and self-driving cars are becoming the norm, yet many people are unaware that technology impacts the healthcare industry as well, including dentistry, in new and exciting ways. Cutting-edge innovations in dental require less time in the dental chair, decrease discomfort and create satisfying results. Our single-visit solution, CEREC®, allows dentists to quickly restore damaged teeth natural-colored ceramic fillings and produce excellent orthodontic care while saving patients time and money.

What is CEREC?

CEREC (chairside economical restoration of esthetic ceramics) is a single-visit solution used by thousands of dentists worldwide. CEREC uses a high-quality ceramic material (and now zirconia) that matches the natural color of the patient’s teeth to provide patients the perfect outcome. Efficient, convenient and simple, dentists around the world are quickly switching to single-visit dentistry with CEREC.

How does the instrument work?

CEREC uses CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) technology that incorporates a small, hand-held camera and a computer in one instrument, and a milling unit to grind/mill restorations in-house. The camera is used to capture the 2D or 3D image of the affected tooth/teeth and the surrounding area. This image is then displayed on a computer screen where the dentist then uses the special CEREC Software to create the perfect restorative tooth/teeth. Once the virtual restoration is created, the information is then sent to the milling unit via software and milled onsite within 8-10 minutes.

What does this innovation mean for a patient?

CEREC offers natural-looking crowns, bridges, inlays and onlays that are compatible with tissue in the mouth, anti-abrasive and plaque-resistant. The days of temporaries, messy impressions and waiting days for the lab to return the restoration are history. CEREC has three decades of clinical research and documentation to support our technology, and restorations completed with CEREC have been proven precise, safe and effective.

How can I find out if this is an option for me?

Call the office of Dr. Lucas Marrs at 317-849-3597 . We will be happy to answer your questions on this new technology.

At Castleton General and Implant Dentistry, you can expect only state-of-the-art amenities! We accept all the local insurances.

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Resolving Long-Standing Problems in a Full-Mouth Rehabilitation Case

Single-Visit Endodontics, Part 1: Are We There Yet?

Dentistry Today

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Did you read the title of this article and think, “Single-visit endodontics? Of course, I’ve been doing it for years. What’s so new about that?” If you perform single-visit endodontics, you are part of the change in attitude—from never attempting a single visit to considering it common and routine. What has changed to make single-visit endodontics acceptable? Was it new techniques or was it simply driven by economics?

The fact that there is now widespread acceptance of single-visit endodontics for most vital cases represents significant progress. Until recently, this was not acceptable under any circumstances. But what about teeth with necrotic and infected pulps? In our view, single-visit endodontics is acceptable treatment in most cases, both vital and nonvital. This position is becoming more widely accepted and will continue. After all, when a canal is well cleaned at the first appointment, what more is there to do?

This article discusses the consideration of single-visit endodontics as the norm and not the exception. It also addresses (1) the economics of single visits, (2) when it is not wise to attempt single-visit treatment, (3) what research tells us about single visits, and (4) what an instrumentation technique must do to predictably improve the chances of success.

THE ECONOMICS OF SINGLE-VISIT ENDODONTICS

Based on economics, it is no surprise that single-visit treatment is becoming more widely accepted. Table 1 shows the economics of molar root canal treatment. With the fee remaining constant, regardless of the number of visits, there is a significant financial benefit for completing treatment in a single 1-hour visit because additional visits increase expenses, thereby reducing profits. A very profitable one-visit, 1-hour procedure becomes a loss when stretched to 3 visits. Assuming similar treatment results, patients also benefit. Dental visits, especially if not absolutely necessary, add an additional burden to their busy schedules.

THE BASICS OF SINGLE-VISIT ENDODONTICS

The basics of single visits were given to us in ENDO 101 and they are simple: make a correct diagnosis, clean the canal, and obturate it 3-dimensionally to prevent reinfection by the ever-present oral bacteria. We learned that the most important part of root canal treatment is to clean and disinfect the canal as well as possible. The basics have not changed at all.

To treat a tooth in one visit requires optimal cleaning and disinfection of the root canal system. Research tells us that this is accomplished most predictably when canal enlargement exceeds the diameter of the uninstrumented canal (mechanical cleaning), aided by the antimicrobial action of an irrigant (chemical cleaning). Infected tissue and bacteria located on canal walls and the superficial layer of dentinal tubules are removed by cutting away a thin layer of dentin. Any bacteria remaining deeper in the tubules are isolated by gutta-percha and sealer on the canal side and impervious cementum on the PDL  side. Under these conditions, bacteria become inactive or die.

We disagree with the notion that single visits are not acceptable in infected cases and that medicaments must be used between appointments to kill all bacteria. There is a problem with this position because committing ourselves to removing all bacteria all of the time puts us in an untenable situation. We would have to remove an excessive amount of dentin to deal with bacteria deep in the tubules and find ways to deal with those located in lateral canals, apical deltas, fins, and isthmuses. Realistically, this is not possible in a clinical setting. This leaves medicaments the task of doing what is impossible to do with instrumentation, but we have no assurances that they will be effective in these “hard-to-get-to” places either. We advocate cleaning the main canal as best we can during the first visit and forgoing trying to do what is often impossible. If a thorough cleaning and canal sealing can be completed in the first visit, additional appointments don’t seem justified without clear evidence that patients will benefit.

APICAL DIAMETER AND APICAL ENLARGEMENT

To best clean the most important part of the canal (the apical part), instrumenting to the correct size is required. The size should not be determined by canal curvature nor should it be kept as small as possible. Additionally, it should not be based on what a root canal instrumentation system can or cannot do. Ideally, the apical part of the main canal should be prepared with instruments large enough to obtain a clean canal. Research clearly shows an inverse relationship between instrument size and the number of bacteria remaining in the canal. As instrument sizes increase, the number of bacteria decreases. Clearly, an undersized apical preparation compromises treatment.

To best illustrate the importance of apical diameter, let’s review 2 cases. Figures 1a and 2a show radiographs of failed root canal treatments. When one of this article’s authors (Dr. Wildey) re-treated the teeth, he found the canals underprepared apically. He re-treated them to larger sizes (using LightSpeed instruments), first gauging (sizing) the canals’ apical diameters,  then using the instruments’ tactile feedback to arrive at the final apical preparation sizes. The larger sizes ensured cleaner canals and the lesions healed (Figures 1b and 2b). These 2 cases provide convincing clinical evidence that apical canal diameter and apical canal enlargement sizes are critical elements of successful endodontics.

EVALUATING QUALITY

How do we evaluate the quality of root canal treatment when it can be so subjective? We believe that the final apical preparation sizes achieved with root canal instrumentation are a major determinant of quality and should be routinely included when presenting a case. Just looking at aesthetically pleasing x-rays is not enough to conclude that a case is done well. After all, we all know that x-rays are only 2-dimensional, and that when a case looks bad, it is, but when it looks good, it may or may not be good. Having the apical preparation sizes of all canals can help us decide.

   At a course sponsored by Loma Linda University (January 2003), Dr. Wildey demonstrated how instrument design can help determine the appropriate apical preparation size. He and 4 other well-known endodontists treated maxillary molars (live) while the audience watched on 3 large screens. After making straight-line access as described in an earlier article by Senia and Wildey,1 Dr. Wildey instrumented the canals using the LightSpeed technique2 and obturated them with SimpliFill.3

The final apical preparation sizes of the maxillary molar Dr. Wildey treated at Loma Linda were MB-1 and MB-2 = No. 55; DB = No. 55; and Palatal = No. 60. Obviously, all 4 sizes are larger than traditional sizes—not determined on a whim or a guess but dictated by the original canal diameter. Knowing final preparation sizes will help us evaluate the quality of treatment more objectively. We have to break the habit of evaluating quality of treatment just by looking at x-rays.

WHAT DOES THE LITERATURE SAY ABOUT CANAL SIZES?

Science and logic support the principle that larger apical preparations clean canals better, but how do we arrive at the correct size in a clinical setting? One can start by consulting the literature.4-8 Tables 2 and 3 show the data collected from various anatomical studies. Your first thought about the sizes shown in both tables may be that they are too large. However, before arriving at this conclusion, it’s important to know that the canals were not measured at the foramen or at the narrowest point. In general, they were made approximately 1 to 2 mm from the anatomic apex (coronal to the apical constriction). Compare your final apical preparation sizes with the sizes shown in the literature. If you are consistently smaller, there is a good chance you are underpreparing canals.

Since there is mounting evidence that “bigger is better,” what has been holding us back from giving apical canal diameter (the “forgotten dimension”) the importance it deserves?9 Why do we persist in believing that canals of molars can be thoroughly cleaned with instruments of size 25 or 30 when there is much evidence showing that this is not so? We believe past history provides the answer. Dentists learned that instrumenting curved canals with rigid stainless steel instruments larger than a No. 30 very often resulted in mishaps such as ledges, zips, perforations, and blocked canals. The choice was easy: instrument only with the smaller sizes or expect to have some problems.

Flexible instruments made of nickel titanium (NiTi) now make it possible to safely instrument to larger apical sizes. However, proceed with caution. NiTi instruments can still transport and ledge canals, particularly with increasing tip sizes and tapers. Instrument design that takes maximum advantage of the material is a factor that should be considered.

BIGGER IS BETTER

“Bigger is better” means instrumenting apical canals to the correct size, a size that is usually larger than traditionally accepted. It means that bigger instruments are required to clean the canal 3 to 5 mm coronal to the constriction where the canal diameter is considerably larger than that of the constriction. Bigger is better does not apply to the apical constriction. The apical constriction, when present, is the narrowest part of the canal and should be instrumented (if desired) to a size just slightly larger than its existing “natural” diameter. And finally, bigger is better certainly does not mean over-instrumenting canals and subjecting roots to possible fracture. Because most of the chewing forces are concentrated coronally, a slight over-enlargement of the apical third of the canal (if it occurs) should not be clinically significant.

Our goal is larger and cleaner canals apically without removing excessive dentin coronally. This can be accomplished by using a flexible material (NiTi), a flexible noncutting shaft, and a short blade with a noncutting pilot tip. In the authors’ opinion, this design is best suited to follow the canal. Practitioners have been conditioned to believe that apical canal sizes are small even when research shows otherwise (Tables 2 and 3). If skeptical about the sizes given, we ask you to look at the very tip of instruments, sizes 20 through 35, then ask yourself if canals are really that small. Most likely you will appreciate just how small these sizes really are and intuitively accept the fact that apical canals are larger in most cases.

BEING COMFORTABLE WITH SINGLE VISITS

We would like to make it clear that even though we believe in the concept of single-visit treatment, there are certain exceptions. We avoid single visits when the following conditions are present: (1) cellulitis, (2) acute apical abscess requiring incision and drainage, (3) severe pain when the tooth is lightly touched, (4) a weeping canal that cannot be dried, and (5) difficult cases that extend beyond our allotted time and the patient’s tolerance.

To be comfortable with single-visit treatment requires an understanding of when it is not a good idea and the manner in which the major elements of root canal treatment influence success and failure. The 2 major components of canal instrumentation are working length and final apical preparation size (canal diameter). Let’s discuss their role in single-visit endodontics.

Working Length: Must It Be Perfect or Is There a Biological Tolerance?

Let’s look at the case shown in Figure 2 again and examine how it relates to working length. The pretreatment x-ray (Figure 2a) shows both mesial canals ledged and obturated short. Upon re-treatment, Dr. Wildey was unable to bypass the ledges, resulting in a working length very similar (short) to the treatment that failed. Even though the mesial canals were re-obturated short because of the ledge, the lesion healed (Figure 2b). This strongly suggests that a “biological tolerance” exists for working length if canals are well-cleaned and sealed. Our highly effective body defense system can promote healing even when the working length is not ideal.

Let’s further discuss working length. Where is the ideal working length in relation to the apical foramen? Is the ideal length slightly beyond the foramen, flush with the foramen, or 0.5 to 1.0 mm short of the foramen? (Since the apical foramen marks the end of the root canal, working lengths can be more precisely located when referenced to the foramen rather than the apex.) What working length will ensure greater success given the same quality of canal instrumentation and obturation? There is abundant clinical and research evidence to support that there is a biological tolerance for working length. In other words, the ideal length is not always possible to achieve, but if you are a little long or a little short, there is no convincing evidence that the case will fail just because of this.

Canal Diameter: Must It Be Perfect or Is There a Biological Tolerance?

Does the same “biological tolerance” for working length also hold true for canal diameter? Before answering, it should be pointed out that canal diameter is often considered the “forgotten dimension” of a 3-dimensional root canal system. A review of the literature reveals that much has been written about length control but very little about diameter control. This implies that many believe getting the working length correct is what matters most. But, in a 3-dimensional environment, the existing (preinstrumentation) canal size is a very important factor. If canal size is not considered during instrumentation, then exactly how can one accurately determine when instrumentation has achieved a clean canal?

Can the body’s defense system cope successfully with a debris-filled, infected canal resulting from a size 25 master apical instrument being used in a size 50 canal? Figure 3 compares the cross sectional area of a root canal prepared to a No. 50 file with that of a No. 25 file. While it seems intuitive that the area cleaned by a No. 50 is twice as much as a No. 25, the area of the canal cleaned is actually 4 times larger! This is why a few instrument sizes smaller than the “ideal” size result in a large amount of underpreparation and why emphasis should be placed on instrumenting to the correct size.

Our opinion is that there is little biological tolerance for apical preparation size with necrotic cases. The molar in Figures 4a and 4b  is a good example. It failed even though it had been instrumented and obturated to acceptable working lengths (Figure 4a). When re-treated with similar working lengths but with larger apical preparations (mesials = No. 50; distal = No. 60), healing of the rather extensive lesion took place (Figure 4b). Underpreparation, as demonstrated in this case, results in a continuous battle between the periradicular tissues and bacteria and their toxins. The body’s defense mechanism is now dealing with a very different situation as compared to working length. When working length is not ideal but everything else is done correctly, there is no continuous battle. The bacteria are isolated, and in a well-cleaned and sealed canal, there is no apical recontamination. Apical underpreparation results in debris and bacteria remaining in the canal, making isolation with the obturation virtually impossible.

1 OR 2 APPOINTMENTS?

When canals are cleaned and disinfected at the first appointment, why not complete treatment at that time? Is there reason to expect a higher success rate with a second visit when a biologically acceptable level of cleanliness is attained at the first one? Wouldn’t delaying completing treatment until the second visit perhaps be counterproductive given the possibility of recontamination between visits? Let’s look at the science to answer some questions and help us decide.

The Science of Single-Visit Endodontics: Apical Sizes Revisited

Recent studies support larger apical preparation sizes to remove more infected tissue and bacteria10-13 and provide more canal space for more effective irrigation.14 Simply stated, preparing canals to larger apical sizes is the right thing to do, especially if single-visit endodontics is our goal.

More than 25 years ago, Kerekes and Tronstad provided evidence that root canals are much larger than once thought.4-6 Many years have passed, yet the myth remains that apical canals are very small and that instrumentation need only be to sizes No. 20 to 35 in most canals. More recent studies show otherwise.7,8,15 There are always exceptions, but they are the exception, not the rule.

Shuping et al11 found that molar canals prepared to a No. 36 or No. 46 with 0.04-taper NiTi instruments rendered only 61.9% of the canals bacteria-free even after irrigation with NaOCl. Their study concluded that larger apical preparations are required for better debridement and to give irrigants better access to the apical region. The investigators also noted that if a canal is not instrumented to an appropriate size, the purpose of using an antibacterial irrigant might be negated. Their findings certainly do not make a good case for single- visit endodontics when canals are underprepared.

Siqueira et al12 found that canals prepared to a No. 20 with 0.12-taper NiTi instruments resulted in only 66.5% of the specimens being bacteria-free. They stated that large preparations incorporate more anatomical irregularities and allow the removal of a substantial number of microbial cells from the root canal. They also mentioned that effective irrigation might not occur consistently unless the canals are sufficiently enlarged and that larger preparations may enhance the effects of irrigation in the apical third.

Rollison, Barnett, and Stevens13 prepared canals to No. 35 with 0.04-taper instruments and compared them with canals prepared with No. 50 0.02-taper instruments. They concluded that the 0.02-taper No. 50 instruments removed significantly more bacteria than the 0.04-taper No. 35 instruments. This study further demonstrates that apical preparation size really does matter.

Peters and Barbakow14 concluded that a larger canal preparation enabled more effective irrigation to remove the smear layer and debris. Card et al10 theorized that instrumenting canals to larger apical sizes would result in a significant reduction of canal bacteria and their study supported this theory. Canal preparation sizes ranged from No. 80 to No. 100 in cuspid and premolar canals and No. 60 in molar canals (using the LightSpeed system). The researchers concluded that a high percentage of infected canals would no longer harbor cultivatable bacteria when instrumented to the sizes used in their study. They also stated that with many teeth, this regimen may be a substitute for a 2-stage procedure utilizing an intracanal dressing between visits.

Taken together, these studies clearly indicate that as apical enlargement increases, the number of intracanal bacteria decreases. Is a figure of 89% to 100% reduction of intracanal bacteria, as determined by Card et al,10 good enough to justify single-visit endodontics? We believe it is. After all, there are no assurances that extending treatment to 2 or more visits will ensure a higher success rate, especially when canals are not well-cleaned.

ROLE 0F OBTURATION AND IRRIGATION

Successful single-visit treatment depends on effective mechanical debridement, chemical disinfection, and proper sealing of the canal system. Obturation can only be as good as the instrumentation, since filling material cannot occupy the same space as the debris left by poor instrumentation.

Effective irrigation can only be as good as the space available allows. A narrow, confined space inhibits a free exchange of irrigant. Larger apical preparations, so essential for canal disinfection and removal of debris, also enhance the action of irrigants. Since irrigation with pressure should never be used, larger preparations allow irrigating solutions to be placed closer to working length with added safety—another benefit and another reason that supports the idea that bigger is better.

Times have changed and new technology has given us instruments with better designs and materials. Numerous studies have shown that when flexible instruments are used, instrumenting to larger apical sizes produces minimal or at least not clinically relevant canal transportation. Yes, NiTi rotary instrumentation is a welcome change, and most dentists who have made the transition successfully wouldn’t want to go back to hand filing.

The ability of new rotary systems to reduce treatment time puts single visits within reach of most practitioners and prompts us to take another look at a concept that makes a lot of sense. But just because NiTi rotary systems are faster than hand instrumentation, this alone cannot justify single-visit endodontics. In this article, we tried to give valid, scientifically supported reasons for single-visit root canal treatment. Are we there yet? Think about it—and you decide.

Acknowledgment

The authors want to thank Mr. Steven S. Senia, BSIE, MBA, for his contributions to this article.

1. Senia ES, Wildey WL. “Straight-line” access: a must for faster and better endodontics. Dent Today . 2003;22:40-45.

2. The LightSpeed and SimpliFill Technique Guide . San Antonio, Texas: LightSpeed Technology Inc; October 2002.

3. Wildey WL, Senia ES. Simple, precise, and predictable root canal obturation. Dent Today . 2002;21:60-65.

4. Kerekes K, Tronstad L. Morphometric observations on root canals of human anterior teeth. J Endod . 1977;3:24-29.

5. Kerekes K, Tronstad L. Morphometric observations on root canals of human premolars. J Endod . 1977;3:74-79.

6. Kerekes K, Tronstad L. Morphometric observations on the root canals of human molars. J Endod . 1977;3:114-118.

7. Gani O, Visvisian C. Apical canal diameter in the first upper molar at various ages. J Endod . 1999;25:689-691.

8. Sabala CL, Biggs JT. A standard predetermined endodontic preparation concept. Compendium . 1991;12:656-663.

9. Senia ES, Wildey WL. Canal Diameter: The Forgotten Dimension. Dent Today . 2001; 20: 58-62.

10. Card SJ, Sigurdsson A, Orstavik D, et al. The effectiveness of increased apical enlargement in reducing intracanal bacteria. J Endod . 2002;28:779-783.

11. Shuping GB, Orstavik D, Sigurdsson A, et al. Reduction of intracanal bacteria using nickel-titanium rotary instrumentation and various medications. J Endod . 2000;26:751-755.

12. Siqueira JF Jr, Rjcas IN, Santos SR, et al. Efficacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals. J Endod . 2002;28:181-184.

13. Rollison S, Barnett F, Stevens RH. Efficacy of bacterial removal from instrumented root canals in vitro related to instrumentation technique and size. Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2002;94:366-371.

14. Peters OA, Barbakow F. Effects of irrigation on debris and smear layer on canal walls prepared by two rotary techniques: a scanning electron microscopic study. J Endod. 2000;26:6-10.

15. Wu MK, R’oris A, Barkis D, et al. Prevalence and extent of long oval canals in the apical third. Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2000;89:739-743.

Dr. Senia has been published in national and international journals. He is a diplomate of the American Board of Endodontics, a former member of The Journal of Endodontics editorial board and a consultant for the NASA space program. After receiving both his BS and DDS degree from Marquette University in 1963, he reentered the US Air Force (he had prior service as a pilot) to take a GPR residency program at Chanute Air Force Hospital. In 1969, he received a certificate in endodontics and a master of science degree from The Ohio State University. He retired from the US Air Force in 1981 as a colonel and as chairman of endodontics at Wilford Hall Medical Center and accepted the position of director of the endodontic postdoctoral program at the University of Texas Dental School at San Antonio. He retired in 1992 as a professor and presently holds the title of clinical professor at the university.

Disclosure: Dr. Senia is the co-inventor of the LightSpeed root canal instrumentation and SimpliFill obturation systems.

Dr. Wildey is presently in an endodontic practice in the Dallas/Ft. Worth area. He earned his DDS degree from Georgetown University in 1976 and after graduation served 4 years as a general dentist in the US Air Force. In 1988, he received a certificate in endodontics from the University of Texas Dental School at San Antonio. He can be reached at [email protected] .

Disclosure: Dr. Wildey is the co-inventor of the LightSpeed root canal instrument and SimpliFill obturation systems.

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ANO. Je to možné. Samozřejmě ne u všech pacientů a v každém případě. V dnešní uspěchané době je nejcenější komoditou čas a o ten Vás nechceme připravit. 

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Společnost One Visit Dentistry s.r.o. je stomatologická klinika zaměřená zejména na velké a komplexní rekonstrukce zubů s využitím digitálních technologií a nejmodernějších materiálů. Nejen rekonstrukce úsměvu, ale celých čelistí a obnova skusu, jsou u nás řešeny v jedné návštěvě. Keramické korunky, fasety, inlaye, můstky i korunky na implantátech tak můžete mít opravdu ihned a v té nejvyšší možné kvalitě.

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Zákrok u pana doktora Hajného mě teprv čeká, ale už jen dojem během objednávání a konzultace je naprosto perfektní. Trpím chronickým strachem ze zubaře, trvalo mi dlouho se k "akci" vůbec odhodlat. Obeslala jsem dotazem spoustu stomatologů ale po konzultaci s tímto panem doktorem ze mě hrůza téměř spadla. Všechno mi vysvětlil a celkem rozptýlil moje obavy z očekávaného nepříjemného zákroku. Předtím jsem navštěvovala zubařku na Kladně, která se mnou jednala téměř jako s nesvéprávnou osobou, odmítala mi dávat před vrtáním injekci s tím, že žádné "jedy" do těla nepatří a že se s tou bolestí prostě mám naučit bojovat uvnitř sebe. Před každou návštěvou u ní jsem měla tři dny trauma... Pan doktor Hajný měl pro můj děs pochopení a ať už si myslel cokoliv, nedal mi najevo, že jsem jen hysterická ženská. Takže zatím dojem naprosto perfektní a třeba ještě změním svůj názor na návštěvu zubaře.

Pan doktor Hajný je podle mého názoru nejlepší estetický stomatolog v Čechách. Jsem z oboru a vím o čem mluvím. Sama k němu chodím už 5 let a nedokáži si představit lepší péči. Vděčím mu za svůj krásný úsměv a nikdo z mých blízkých přátel nepoznal, že mám umělé (keramické) fasety, tak jsou přirozené !! A navíc 8 faset mi zhotovil za 1 dopoledne na přístroji Cerec. Přišla jsem v 8h. ráno a ve 13 h.jsem odcházela přešťastná....Ještě jednou velmi děkuji touto cestou.Opravdu mohu jen doporučit..Naprostá profesionalita a lidskost zároveň.....

Initially I was very afraid. But afterwards, I am very happy. Especially, I was amazed by the work of doctor Petr Hajny. He has high culture of work and touch. Teeth are very beautiful. I am very thankful. Good luck to you!

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OBT Dental & Orthodontics was founded on the belief that everyone deserves access to top-quality dental care from providers who are passionate about enhancing dental health. The team of outstanding dentists who make the practice such a special place find their work deeply rewarding and strive to deliver the highest standards of care to residents of Orlando, Florida, and throughout Central Florida.  The dental specialists at OBT Dental & Orthodontics take the time to truly get to know the patients who entrust them with their dental health needs. Customized treatment planning is always available, and warm, personable communications are standard practice.  Preventive dentistry is the foundation of the practice. Comprehensive dental exams, digital imaging, and professional dental cleanings keep smiles healthy. When issues arise, restorative treatments include modern techniques for fillings, tooth extractions, root canals, crowns and bridges, and dental implants.  Cosmetic dentistry is also a big focus at OBT Dental & Orthodontics. There are options to fit every set of needs, from teeth whitening and dental veneers to bonding, inlays and onlays, and more. Orthodontic services work to straighten smiles as quickly and affordably as possible.  If unexpected dental needs develop, emergency dental care is here to help. Same-day visits are often available, giving patients the same high-quality care they expect from routine office visits. ... …

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9753 S Orange Blossom Trl

Orlando, FL 32837

South Orange Blossom Trail / OBT

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My first time at obt dental was certainly my last. I was referred by my insurance company to come to obt dental. My appointment time was at 2:30 and was not seen until 3:45 and I was the only person waiting in the waiting room. I was told I needed a root canal and needed to see an Endodontics. Who had told me I didn't need the tooth and could have it extracted. They wouldn't write me a new referral to an oral surgeon because I needed to be seen by the dentist again. I think that's just was a way to make more money off of me. The woman who I spoke to was very rude and unprofessional. I will not be going back.

terrible service and charged $ 1000 for nothing! 2 hours late appointment! and doctor doesnt speak English

This place is the worst ever!! Why: 1. They are not attentive to your needs; only its pricing demands. 2. Customer support hangs up the phone on you (Unprofessional) 3. Lacks flexibility. 4. Will inconvenience your schedule by rescheduling you multiple times and offering the excuse that "we have no control of the doctor's, we just make the appointments" 5. Unethical by denying treatment due to the patient being hesitant to its recommendation, which is not an emergency situation, not outside of the scope of services, not an infection control risk, inability to pay, or patient noncompliance of the patient. 6. It operates like a triage with cost and not care as a priority. Otherwise, the exam ray technician as well as the treating doctor were both pleasant.

They promote on Groupon for a dental cleaning however when you go then you will find out they won't do the cleaning unless you pay more and more means a range of $300 to $1000. Don't be fooled and go somewhere else.

Prepaid for services that I never received and they have repeatedly refused to refund the money. Don't waste your time going to this office because they're horrible to work with and the dental work they provided wasn't great either.

The personnel are very nice and helpful but I will not return anymore for treatment. Every establishment requires payment on the day of the service as Dr. Aaron Isler at Mid-Florida Endodontic but OBT Dental & Orthodontics is already calling you a week before so that you prepay for the service in order to CONFIRM YOUR APPOINTMENT despite having METLIFE as a guarantee on record. I prefer to return to VA Dental- Lake Nona for the free dental service to which I am entitled instead of using my private insurance METLIFE or CarePlus because I believe on the premise that a prepaid musician don't play well and if someone is harassing you for a payment even though the service is not done YET, its a red flag to move away. I felt like a dollar sign not as a valuable patient.

Friendly staff but they are not very responsive when they have to take care of a problem. Recommend unnecessary test, X-ray and scan.

Place sucks,staff sucks,I repeat don't go here you ...you have been warned.They charge your credit card without your consent,I want to see where I signed for the 10 dollar per visit charge.Really ....were you not wearing gloves and mask before the pandemic and it cost 10 per person per visit more...I want to see your receipt for these very expensive mask and gloves I'm paying for!!I Ask for supervisor and she or he is never ever there...mmmm...is there no supervisor or you just don't want to talk to me.I will keep leaving these reviews until the supervisor contacts me,I'm sure you have my number on file.

This is the worst place every we purchased a groupon for a cleaning for my husband and he has no cavities teeth in good shape he just needed a routine cleaning. This place didn't even clean his teeth because they said he needed a deep cleaning for $600. So its just a scam to up sale deep cleanings. We were very disappointed they should have completed the groupon for the cleaning....

was suppose to have an appointment this morning at 11:00a.m. and they even had texted us and told us to even be there 15 minuets early for paperwork and went in at around 10:45 and we told them that we were there for a 11:00a.m. dentist appointment and was told that we didn't and we showed her on are phone the text from last week and then one this morning and they said that the earlyist they could see us was friday and i work on friday's saturdays sunday's and they even spoke spanish infront of two people who dont speak spanish which is kind of rude loved how good the dentist was ban hate how taribable the resuptionest are so congratlations obt dental you just lost two patients from your practice

had an appointment this morning at obt dental at 9:00a.m. went in and they told me that my appointment was at 11:00a.m. when my mom had it in her appointment book at 9:00a.m. the only reason we go back is because the dentist is always nice it's just the staff out front is the one's that aren't nice

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