It has been 61 years that I have now been a dentist. In mydental school days, “cavity toilet” was a key word prior to placingany restoration. A wipe of the finished cavity floor with phenolprior to placing the restoration was a routine never forgotten.Even in those days, sealing bacteria under a filling was consid-ered improper. This was independent of all the caries removal.Much of this needed routine may have been forgotten with theuse of using an acid etch, such as phosphoric acid, to prepare theremaining tooth structure to accept the new composite sealer.But the remaining bacteria in the cavity prep would be foreversealed under the restoration.

Dr. Gordon J. Christensen, the founder and director of the Practical ClinicalCourses, recently stated in his “ask Dr. Christensen columns”, that the technique hefavored was the use of glutaraldehyde solution, prior to placing any liner in a cavity prep,prior to placing a composite filling. The glutaraldehyde does not alter the bonding effector may improve the bond of these agents. This reminds me of the old technique of “cav-ity toilet” necessary to disinfect that cavity prep prior to placing the restoration.

And that brings us to the relationship of Glutaraldehyde formula CH²(CH²CHO)²,with Paraformaldehyde HO(CH²O)nH, the solid form of the gas formaldehyde, whichis also an equal disinfectant.

Back in the 1950s Dr. Angelo Sargenti researched the results from Balint Orban,a noted periodontist of his era. Dr. Orban wrote that a dilute solution of paraformalde-hyde (7%), wiped deep into a periodontal pocket, disinfected that pocket and inducedreattachment.

Dr. Sargenti reasoned that if this 7% paraformaldehyde could repair periodontalpockets, then it would be ideal to disinfect root canal pulpal tissue that has become gan-grenous and seal the canal, with a sealant that prevents reinfection. And so, N2 RootCanal Sealant was born. Dr. Sargenti developed a technique and sealant that wouldallow a dentist to cleanse and reshape a canal, remove the debris mechanically (enginedriven), and introduce the sealant to completely disinfect the canal(s) and seal them andthen the sealant would harden so it would not leak out and become the filler. In vital pulpcontamination, Dr. Sargenti worked out a procedure that a portion of the apical pulpcould remain, and with the far reaching action of N2 the portion of vital pulp remaining,maintained its vitality and health.

Recent published research (2013), by Dr. Robert Teeuwen of Germany, hasproven again that the early teachings of Dr. Sargenti are true. Dr. Teeuwen’s root canaltreatments extend to over 16,000 permanent teeth, and include hundreds of these withtheir roots still not fully formed, but with large carious lesions causing the coronal por-tion of the pulp to become gangrenous. He extirpated the pulp up to the level where

Dr. Alvin Arzt

AES Treasurer

GLUTARALDEHYDE VS PARAFORMALDEHYDE

Alvin H. Arzt, D.D.S., MAES

Number 129 Winter 2014 ©AES

AMERICAN ENDODONTIC SOCIETY

AES CENTRAL OFFICE: P.O. Box 545, Glen Ellyn, IL 60138 (773) 519-4879

EASTERN OFFICE: 528 Freedom Blvd., Coatesville, PA 19320-1562 (773) 519-4879

AES WEBSITE: www.AESoc.com

Dedicated toSaving Teeth

cont. page 2

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bleeding was observed and shy of the apical non-formed root area. After a few months,his x-rays revealed that the roots continued to develop to normal length and a scleroticmembrane (walled off barrier), separated the N2 from the remaining normal pulp. Thiscertainly proved that N2 was self-limiting and well tolerated by healthy tissue.

It is no wonder that Dr. Sargenti first lectured in the US in Dallas in the 1960s, andit was not long before over 35,000 US dentists adapted this technique to their usual rootcanal office regime.

With the bad publicity N2 has endured, it seems to have been proven contrivedand not true. In the July 2008, Volume 34, Number 7S, Journal of Endodontics, an arti-cle was published that proclaimed:

Reevaluation of earlier research that examined potential health risks associatedwith formaldehyde exposure has shown that this research was based on flawedassumptions, which resulted in erroneous conclusions. The purpose of this review wasto examine more recent research (2008), about formaldehyde metabolism, pharmacoki-netics, and carcinogenicity. These results indicated that formaldehyde is probably not apotent human carcinogen under low exposure conditions. In spite of all this favorableresearch toward Formocresol and its much reduced relative, N2 which is 5%paraformaldehyde without any caustic cresol, the antagonists refuse to retreat.N2 now contains 5% paraformaldehyde as compared to Buckley’s Formocresol, whichis 19% paraformaldehyde and 35% cresol. Formocresol is probably used today (2013),as frequently as it was used 50 years ago. When a patient comes into a dental officewith a severe toothache, the dentist who is treating this patient, who is in extreme pain,into his crowded schedule, the dentist usually anesthetizes the tooth, opens up thechamber and inserts a cotton pellet with formocresol, into the exposed chamber andseals the tooth temporarily. Then the patient is rescheduled when the schedule allowsmore time, or perhaps the patient is now referred to an endodontist to perform a rootcanal. Formocresol is not restricted to pediatric dentistry as dental teachers recom-mend, but more likely to an adult patient.

What conclusions can we arrive at when Dr. Christensen recommends a disin-fecting agent before applying the restorative material. What can we surmise when theNew York University Dental School research admits that conventional root canal treat-ments have only a 80% success rate. Yet research shows that N2, with 5%paraformaldehyde reaches a 98% success rate. It is clear that bacteria contaminationcan be the criteria between successful treatment and failure.

What dental procedures, including all specialties, involve procedures that canhave the sites with remaining bacteria? Operative, with usual removal of decay, andrestoring with a permanent restoration. This restoration could be a class I cavity, an inlay,a crown, or even a veneer facing. In a simple prophylaxis, where there is deep scaling,every stroke of the scaler could transport bacteria to another pocket. Does this mean thescaler should be disinfected before another area is reached? The usual technique nowis to wipe the scaler clean from blood and debris with a cotton sponge, before the nexttooth is scaled. All this could be considered impractical in actual practice. In implant insertion, the implant is obviously sterile, but is the bone site sterile where theimplant is to be inserted? Antibiotics are often prescribed in conjunction with the treat-ment to overcome any contamination.

It should be considered by all dentists, that in their treatment of a patient, that thetooth or area may need “a cavity toilet” before they consider the job completed.Dentistry has certainly changed in the 61 years of my practice. This past March 2013, Ifinally retired my active dental license. It has certainly been worth it for me and I hopefor my patients.

(Reprinted with permission from The Profitable Dentist Newsletter - Winter 2013 issue 246)

GLUTARALDEHYDE VS PARAFORMALDEHYDE

cont. from page 1

I hope all of you had a wonderful Holiday season with family andfriends. We all work so hard it is nice to have time with our lovedones.

Our annual meeting was held September 20th in Philadelphia.We did not have it in conjunction with the American DentalAssociation. Our arrangements were done by Earle Kuhn and theywere excellent. We had our largest attendance in many years. Dr.Alvin Arzt presented a well-received presentation about SargentiEndodontics. During the meeting an Honorary Mastership was pre-sented to our friend and colleague Dr. Pat Wahl, a noted endodon-tic educator and lecturer. This award was presented to Pat for his

paper “Angelo G. Sargenti: Madman or Messiah? An EndodontistReveals Myths and Half-Truths Behind the Sargenti Controversy”. This is the best paperI have read explaining the truth about our material. If you haven’t read it you may find iton our website at aesoc.com.

At the end of our meeting I had the distinct pleasure of presenting Dr. Alvin Arzt ourfounder and mentor with the First American Endodontic Society’s LIFETIME ACHIEVE-MENT AWARD. Alvin did not know he was going to receive this award. I know of no oneelse who so richly deserves it. Without Alvin’s hard work through the years Dr. Sargenti’ssimplified endodontics would not have helped save the thousands of teeth it has. We allowe Alvin a great deal of thanks.

I encourage you to mark your calendars for October 17, 2014, in Chicago for our nextAES meeting. Dr. Barry Musikant will be joining our lineup. He is the founder of EssentialDental Systems. He is an outstanding Clinician and the inventor of the safe-sider sys-tem of debriding canals.

If you have not renewed your membership I encourage you to do so. Your Board ofDirectors continues to fight every day on your behalf so that you can provide the first inendodontic treatment to your patients.

Our Director Earle Kuhn is updating our list of pharmacies that compound SargentiSealer. Please send us information about the pharmacies that you use so that we canadd them to our national list.

As a personal note: I am always impressed when I attend our meetings by the Doctorsthat I meet who have used Sargenti Sealer with outstanding success for 20-30 or even40 years. We have truly helped many patients keep their teeth for a lifetime.

Proud to be your President

Michael E. Bowman, DDS, MAES

AES PrESidEnt’S MESSAgE

Dr. Michael BowmanAES President

AMERICAN ENDODONTIC SOCIETY2014 ANNUAL MEETING

The American Endodontic SocietyÕs 2014 Annual Meeting will beheld on Friday, October 17 in Chicago. The meeting will be at theHyatt Hotel. The morning session will be a Sargenti Seminar (seepage 7). All AES members are invited to attend the Board meetingthat will be held in the afternoon.

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Dr. Alvin Arzt

Receives Lifetime Achievement Award

Alvin Arzt, DDS, MAES

At the recent Annual Meeting of the American Endodontic Society, AES

founder Dr. Alvin Arzt was presented with a Lifetime Achievement Award in

recognition of his dedication to promoting the use of the Sargenti Method of

Endodontics. Dr. Arzt founded the American Endodontic Society in 1969 as a

non-profit organization to organize and unify dentists with special interest in sav-

ing teeth through a simplified method of endodontic treatment.

AES President, Dr. Michael Bowman presented this special award that read:

“In recognition of a lifetime commitment to the education of the dental

profession in the use of the Sargenti Method of Endodontics.”

Dr. Patrick Wahl

Receives Honorary Mastership

Patrick Wahl, DDS

Dr. Patrick Wahl was presented an Honorary Mastership at the recent

AES Annual Meeting. The Award was in recognition of his article Angelo

Sargenti: Madman or Messiah? An Endodontist Reveals Myths and Half-Truths

Behind the Sargenti Controversy.

A copy of this outstanding article is available to AES members. To receive

your copy, send an email with “Dr. Wahl Article” in the subject line to

aes@aesoc.com.

BIOMIMETIC ENDOBy Kenneth Armstrong, D.D.S., MAES

In October 2013 I attended the 2nd Annual Conference of the Academyof Biomimetic Dentistry. There were times when I felt I was back in dentalschool again, learning new ideas and techniques in dentistry.Biomimetic comes from two words: “biology, “ the science of life or livingthings, and “mimic,” to copy or imitate. Biomimetic means the treatment of atooth that allows it to behave like, or mimic, a natural tooth. Using advancedceramics and adhesives, minimal prepping and sealing of the tooth allowssmall restorations to be placed rather than large crowns. It is truly “ToothConserving Dentistry”.

Recently I came across a paper, “The New Science of Strong EndoTeeth” (1). The paper asked the question if today's endodontic accesseswere as outdated as G.V. Black's cavity preparations? Their conclusion wasthat sadly they were. The authors described the current access prep andcanal shape as “grotesque straight-line access, carving a superhighway to

the apex.” Massive amounts of tooth structure was being obliterated and sacrificed. A literature review(2) showed that apical shaping size and canal taper had no significant relation to better outcomes. In otherwords as Clark et al pointed out, “Big shapes don't create better outcomes. They do however weaken thetooth badly.”

Biomimetic endo would maintain as much of the natural healthy tooth structure as possible, min-imal removal of dentin during access opening, and instrumenting the canals only as much as necessaryto retain as much sound dentin as possible.

A paper by James Gutmann (3) on Minimally Invasive Dentistry (Endodontics) has several ideason conservative endo. One is to consider doing a pulpotomy as a definitive procedure. This is an idealuse for Sargenti sealer. When treating vital teeth, remove the pulp in the pulp chamber and seal off thecanal orifices by entering them a few millimeters and placing sealer in the canals and in the pulp cham-ber. The goal is to leave healthy pulp in the canals, the best sealer of all and truly biomimetic.Gutmann states that Minimally Invasive Dentistry is the application of “a systematic respect for the origi-nal tissue.” He goes on to say that this statement implies that the dental profession recognizes that anartifact is of less biological value than the original healthy tissue.In place of the word “artifact” read “root canal sealer”.

Secondly, Gutmann states that the use of Peeso reamers and Gates Glidden drills deep into theroot canal should be abandoned in favor of minimally tapered rotary instruments, no larger than an .06.Thirdly, he recommends keeping the apical size small when possible between sizes 20 and 40 to pre-serve radicular dentin.

The problem is we all want what Clark et al calls “the look”. That is that beautiful X-Ray of adensely filled canal all the way to the apex. Getting that result can cause a root fracture or so weaken thetooth cervically it breaks off eventually at the gumline. I am also well aware that finding the canal orificesand checking for possible other canals can lead to wider access openings that we'd have wanted. Thereare also cases where the tooth is so badly broken down that saving any healthy tooth structure is a realchallenge.

In summary I would say the Principles of Biomimetic Endo are as follows:1. Try to make a minimal access opening to the pulp chamber and as the paper on the New Science of

Strong Endo Teeth points out leaving a little bit of pulp chamber roof leads to less gouging of thewalls and a stronger tooth.

2.Do not excessively widen the canals. Removing a lot of dentin in the cervical area can lead to cervicalfracture of the tooth. We want to leave a good ring of dentin around the tooth.

3. Leaving healthy pulp sealed over with Sargenti Sealer is good conservative dentistry. There is no bet-ter sealer than the tooth's own pulp. Just as we try to leave healthy tooth structure and only remove decay in our restorations, trying to widen and shape deep in a canal to remove healthy pulp is not in the best interest of the tooth.

References:1.Clark D, Khademi J, Herbranson E. The New Science of Strong Endo Teeth.(116-7) Dentistry

Today. April 2013;32:112.1142. Ng, Mann, Rahbaran,et al Int Endod J.2008;41:6-313. Gutmann J, Journal of Conservative Dentistry 2013,16(4) 282-283

Editor's Note:Minimally removing tooth structure in a root canal preparation will only be successful if an anti-

bacterial root canal sealer is included in the obturation of the canal. N2 root canal sealer is the only rootcanal sealer in use today, that has a far reaching action in destroying any bacteria left in a canal, and atthe same time allowing healthy pulpal tissue to remain vital in the canal.

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Dr. Kenneth Armstrong

AES Secretary

AES member and N2 researcher Dr. Heinz-Friedrich Overdiekof Heidelberg, Germany passed away at the age of 93. Hefinished his study of medicine in 1945 and his study of den-tistry in 1948. A friend of Angelo Sargenti, he practiced andtaught dentistry until 1965 at the University of Bonn. AfterBonn, he was professor/chairman at the University ofHeidelberg. His students were required to use the N2 method,and performed about 40,000 N2 root canals under his guid-ance.

NEW CENTRAL OFFICE ADDRESS

The address to the American Endodontic Society’s Central Office has changed.

The new address is:

American Endodontic Society

PO Box 545

Glen Ellyn, Illinois 60138-0545

Please update your records.

AES Members are Achievers!

Congratulations to Dr. Joe Steven and Dr. Mark Troilo who

were recognized in the December 2013 Dentistry Today as top

100 Leaders in continuing education.

page 6

mEmBErSHip ApplicAtiON(please type or print)

NAmE

ADDrESS

city, StAtE, Zip

OFFicE pHONE FAX

EmAil

prOFESSiONAl DEGrEE(S) ScHOOl yEAr

typE OF prActicE

WHAt prOmptED yOU tO jOiN tHE AES? (cOllEAGUE, ADvErtiSiNG, Etc.)

Dentist/Active . . . $245 Dentist/retired . . . $50 Auxiliary/Student . . . $50 Allied . . . $50

n payment Enclosed please charge my: n mc n visa

card Number ccv No. Exp. Date

Signature

payment by check should be made payable to: the American Endodontic Societymail to: the American Endodontic Society p.O. Box 545, Glen Ellyn, il 60138

or fax to (630) 858-0525

Many of your peers are using Simplified Endodontics!

Recruit a new member for AES!

page 7

AmEricAN ENDODONtic SOciEty

page 8

let’s all pledge

to make a

contribution.

Dear AES Members,

As clinical practicing dentist who uses N2 you know its effectiveness as a endodontic sealer. The

benefits to patients as a cost effective, predictable and comfortable procedure to save natural

teeth are enormous. Please consider a donation to the Professional Action Fund to preserve the

choice to use N2 . If you have given in the past, thank you! But, we still need your ongoing support.

If you have never made a donation; please join us in this effort.

Kim Norman DDS

PAF Chairman

Your financial support is needed immediately. PlEASE SEND YouR TAx DEDuCTiBlE

CoNTRiBuTioN ToDAY to Help us Continue our Program of Action!

Here is my check payable to the AES Professional Action Fund.

PlEASE PRiNT

Name ____________________________________________________________________________________________

Address __________________________________________________________________________________________

City______________________________________ State _______________________ zip ___________

Credit Card No. _______________________________________ CCv No. __________ Exp. Date ________________

Signature ________________________________________________________

Mail to: AMERiCAN ENDoDoNTiC SoCiETY, P.o. Box 545, Glen Ellyn, il 60138

PAF DonationsThanks to all our Professional Action Fund contributors.

PlATiNuM(Donations $1,000.00 and Higher)

Dr. Alvin H. Arzt

Dr. Jason Bowman

Dr. Michael E. Bowman

Dr. Juan Delgado

Dr. Martin A. Drozdowicz

Dr. E. Roy Finley

Dr. Robin Gallagher

Dr. John D. Ryan

Dr. Joe Steven, Jr.

Dr. Mark P. Troilo

GolD(Donations $500.00 to $999.99)

Dr. John D. Harker

Dr. Kimberly C. Norman

Dr. William E. Stein

SilvER(Donations $100.00 to $499.99)

Dr. Kenneth J. Armstrong

Dr. A. John Bahr

Dr. Joseph M. Bolil

Dr. Danny Chacko

Dr. Patrick Del Grande

Dr. Anthony R. DiBiagio

Dr. Joseph F. Eckman

Dr. Werner l. Flier

Dr. Thomas E. Hartnett

Dr. lewis Holtzman

Dr. Walter Johnson

Dr. Douglas E. Kaylor

Dr. Jeffrey Martin

Dr. Robert H. McCoy

Dr. Karen Kile McGlothlin

Dr. Anthony A. Nigro

Dr. Peter P. Perimenis

Dr. Thomas R. Watkins

BRoNzE(Donations under $100.00)

Dr. Robert C. Brooks

Dr. John E. Dreslin

Dr. Joseph T. Discepola

Dr. Alexandria Hammond

Dr. G. Douglas Hoover

Dr. Sheldon Korman

Dr. John D. McMahon

Dr. Donald l. Robbins