...and I guess everybody agrees there has been tremendous development regarding development
of NiTi materials, instrument designs, and the way we are using them.
And yet it's, as you point out, it's very important to remember that instrumentation
is a facilitator.
Instrumentation is creating possibilities for us to do effective irrigation and disinfection,
and closer to the end of the treatment, also high quality root filling.
We should take these images as positive motivation for us.
We have to create the good pathway into the root canal system.
And that's what we do with instrumentation.
After that, we have to go to work and do effective
disinfection and irrigation with our irrigation solutions.
I would like to show you just a couple of beautiful SEMs
from Franklin Tay's group from University of Georgia.
The lower one on the left side shows clearly untouched area.
We can see some predentin in there and necrotic pulpal remnants.
And on the right side, in the same image we can see smear layer.
The area is flat so instruments have really touched this area
but we can't see any dentinal tubules so it's the smear.
On the slide on the right hand side, we have made some progress.
The organic matter has obviously been removed from all areas by sodium hypochlorite.
And some of the smear layer has been removed but some still seems to be there.
So we are making progress, but we haven't yet reached the goal of irrigation.
But this is not enough for me and most of our colleagues because we know that
bacteria may still be hiding in the dentin and we would like to do the final rinse.
We would like to do the third irrigation of the root canal.
And we have been using hypochlorite and have been using chlorhexidine for this.
There are increasing number of reports that the problem of coming back to hypochlorite
may be that it may weaken dentin.
If you have long term exposure to hypochlorite after EDTA, it will tremendously change negatively
the structural strength of dentin.
And if you have short term exposure, just even 30 seconds/one minute exposure, to hypochlorite
after EDTA or citric acid, we are of course seeing surface erosion of root canal wall dentin.
Even though we don't know today how potentially harmful this surface erosion is,
and how deep it can go, we do know that it can go at least 100 microns.
But how much more, we don't know, and what's really the impact?
It's something that we would rather be without.
So, basically, it would be great if we could do this without any negative impact on dentin
and optimally, actually avoid the third irrigation.
What is the possibility of actually creating a solution that can do it all?
That can give me exactly what I want?
Get that smear layer out of there, kill my bacteria, create a clean surface, and it's
not going to cause the erosion that you so beautifully portrayed.
As a clinician, I'd love to have something like that.
What are your thoughts?
Well, my thought is that actually, the last several years, this particular challenge has
been the focus of my research activities very much.
And really, to get rid of the smear layer, but at the same time be very effective against
residual micro organisms, which still have escaped the effects of bleach.
And I'm very glad and happy to be able to tell you that now we have the solution.
We have been successful in our research and development and now we have a product
which will answer the challenge.
Here it is.
The product is QMix® 2in1 and the goals were to have a product that does what EDTA does.
And we have it.
To have a product that at the same time kills bacteria effectively and we were able to do that.
And the third goal is that it should be simple and easy to use chairside.
So, Markus, what you're telling me, you've accomplished your goal.
You are giving to us, the clinicians, this solution that can remove the smear layer,
we can gain access to the bacteria, we're kind to the dentin, and we've accomplished
all these fantastic ideas that we had with one solution, and one application, which is,
I think, unbelievable for the clinician.
But interestingly enough, what you've come up with now we can achieve all of our goals
from disinfecting to removal of smear layer,
not worrying about staining, and can be used in conjunction with the sodium hypochlorite.
I think this is fantastic.
What a breakthrough!
And I think that clinicians out there are really grateful to have this available to
them and for all your efforts, and the continuing efforts to ensure that this is at the highest
level of quality possible.
Now if you take a look at chairside handling, it's pretty straightforward.
What's really positive - it's premixed, it's ready to use, has a good shelf life.
The time frame is very small.
Now, added to that, personally in my own practice, especially in pulps that are necrotic,
I go ahead and do some agitation.
For example, just using, for example, the EndoActivator® to do some sonic agitation,
30 seconds or so, and then add an additional amount of the QMix to the canal.
I feel with a tremendous level of confidence that I am really achieving those goals that
we've been talking about, right down the line.
And so, go ahead, the protocol - you mix it with your instruments in canal,
irrigate with sodium hypochlorite. You can rinse that with water or saline,
and then follow with minimal 2mm of QMix.
Dry your canal and obturate.
It couldn't be simpler to achieve the magnification that we are with this type of product.