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Predictable Instrument Removal Using Indirect Ultrasonics

Mauricio L. Basso, DDS; Neville J. McDonald, BDS, MS
Discipline of Endodontics University of Michigan School of Dentistry

Technique-PREDICTABLE-INSTRUMENT-REMOVAL-USING-INDIRECT-ULTRASONICSIntroduction

  • The fracture of endodontic instruments during root canal mechanical instrumentation is a mishap procedural that creates a difficulty in routine root canal therapy.
  • Although fractured instruments may not compromise the outcome of the treatment, the retained file fragments may impede microbial control beyond the obstruction.
  • Attempts to remove fractured instruments may lead to transportation of the prepared root canal or perforation, and/or over enlargement which could lead to the weakening of the tooth.
  • The separation rates of stainless steel instruments have been reported to range between 0.25% and 6%, while NiTi instruments between 1.3% and 10%. Many techniques have been used to remove separated instruments; however, it is not possible to use the same technique for every clinical case.

Summary

  • The aim of this table clinic is to present an instrument retrieval technique using the diamond dusted probes from Laschal FXP System along with an ultrasonic device.
  • Laschal FXP System along with ultrasonic device is a valuable alternative method to retrieve separated instruments from the root canal system. When it is not possible to retrieve the instrument from the root canal, using Laschal FXP System, it helps to create space between a file and the root canal wall, facilitating the bypassing of the separated instrument.

Acknowledgment

Dr. Carolina Cucco, Dr. Darya Dabiri, Dr. Diogo Guerreiro, Dr. Indaia Leibovicth, Dr. Jeffrey Lasner and Rackham Graduate School.

 

References
  • Crump MC, Natkin E. Relationship of broken root canal instruments to endodontic case prognosis: a clinical investigation J Am Dent Assoc 1970;80:1341-7.3.
  • Hulsman M, Schinkel I. Influence of several factors on the success or failure of removal of fractured instruments from the root canal. Endod Dent Traumatol 1999;15:252-8
  • Iqbal M K, Kohlu M R, Kim J S. A Retrospective Clinical Study of Incidence of Root Canal Instrument Separation in an Endodontics Graduate Program: A PennEndo Database Study J Endod 2006; 32:1048-52
  • Maradati A A, Hunter M J, Dummer P M. Management of intracanal sperated instruments. J Endod. 39: 569-81

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Dr. Marc Habib

Dr. Marc Habib

Doctor Marc Habib did his undergrad studies in Dentistry at the Saint Joseph University of Beirut and graduated with honors. He was awarded the Zareh Ouzounian prize of Endodontics in 2004. He graduated in 2007 with a Masters Specialization in Endodontics followed by a Masters in Biomaterials of the oral Cavity at the Saint Joseph University as well. Very skillful using the operating microscope, he is a highly skilled professional with extensive experience in endodontics. Senior lecturer giving courses in the Endodontic University Diploma program at Saint Joseph University (Beirut), University of Jaume I (Spain) and visiting lecturer for the Masters of Advanced Endodontics program of the University of Sienna (Italy). He is the Treasurer of Lebanese Society of Endodontology, member of the European Society of Endodontology and member of the SIE (Italian Society of Endodontics). Since 2009 he has been a member of the organizing committee for the annual international meeting of the Lebanese Society of Endodontology. Gold Member of the Style Italiano Endodontics group. Opinion leader and speaker at numerous conferences and workshops in the UAE and abroad. He limits his practice to endodontics in his private practice at Beirut Endodontic Clinic (Lebanon) and at Drs Nicolas & ASP clinics (Dubai UAE).  

WHAT MAKES LASCHAL® INSTRUMENTS SPECIAL…

LASCHAL® Instruments, a true gem in dentistry! No equivalent to their alloy quality, innovative designs and tool precision especially for scissors and micro endodontics forceps.
Dr. Judson Wall

Dr. Judson Wall

Dr. Wall has been helping patients to feel better for over twenty years. He is a graduate of the University of Utah and received his Doctor of Dental Surgery from the West Virginia University School of Dentistry. He has an impressive list of accomplishments and credentials, including Accreditation by the International Academy of Oral Medicine and Toxicology, a Fellowship with the American Academy of Craniofacial Pain (July 2010), a Fellowship with the Academy of General Dentistry (June 2007) and an Associate Fellowship with the World Clinical Laser Institute (July 2005). he is internationally sought after as a lecturer, teaching and training about metal-free dentistry, zirconia implants, TMJ dysfunction and sleep appliance therapy. Dr. Wall teaches dentists from around the world how to perform holistic dentistry. He hosts in-person training in his state-of-the-art facility in Bountiful, Utah. Dentists travel from far and wide to learn how to diagnose and treat patients in a manner that will have lasting beneficial systemic health effects.  

WHAT MAKES LASCHAL® INSTRUMENTS SPECIAL…

I appreciate the precision of the LASCHAL instruments, which is especially helpful in delicate surgical areas. The small size of the LASCHAL instruments makes tissue tearing a thing of the past. Manipulating small needles is much easier with LASCHAL forceps than with traditional needle forceps. I also love NOT getting the suture caught on the forceps hinge. Frustration be gone!
Dr. Juan Carlos Ortiz Hugues

Dr. Juan Carlos Ortiz Hugues

Specialist in Endodontics, DDS Certified Ergonomics Assessment Specialist I-II Master of the Academy of Microscope Enhanced Dentistry AMED USA Author of the book: Ergonomics Applied to Dental Practice. Quintessence Publishing, 2024. www.quintpub.com Associate Ergonomics Professional (AEP) by the BCPE Board of Certification in Professional Ergonomics Private practice limited to Micro Endodontics since 2008 in David, Panamá Speaker in Advanced Microscope Ergonomics in Latino America and the United States since 2016 Trainer of the Academy of Microscope Dentistry AMED U.S.A. Advanced Microscope Ergonomics, Charlotte, USA.  

WHAT MAKES LASCHAL® INSTRUMENTS SPECIAL…

LASCHAL Instruments are smartly designed for a broad spectrum of procedures as a microscope dentist and specialist in endodontics; I have a kit of 10 instruments to support and make easy the complex procedures in endodontics for instrument removal, forceps to facilitate endodontic instrumentation in a patient with limitations to open the mouth, post removal, gutta-percha removal in endo retreatments and for apical surgery. What I love about LASCHAL instruments is that they are of high quality, perfect to work with in high magnification, and delicate with small diameters that do not disturb the vision while working. At the same time, they are solid and lightweight, easy to grip, lock/unlock when you need it and handle which makes them perfect ergonomically for the hands of all dentists in every discipline. The versatility and variety of instruments for any situation in dentistry make LASCHAL the top instrument manufacturer for dentists worldwide.
Dr. Stephen Buchanan

Dr. Stephen Buchanan

Dr. Buchanan graduated first in his dental school class from The University of the Pacific in 1978. He received his specialty certificate from the Temple University Post-Graduate Endodontic Program in 1980. In 1986, he became a Diplomate of the American Board of Endodontics. Dr. Buchanan has practiced endodontics since 1980. In 1989, Dr. Buchanan was the first to reconstruct micro-CT scans of endodontic anatomy. He invented the Continuous Wave of Obturation technique in 1990, the first variably-tapered shaping technique in 1991, the first rotary negotiation technique in 2016, and the closed system negative pressure irrigation and filling technique in 2019. His instrument and device designs include: System-B; EOU; ElementsFree obturation heat sources; Buchanan Heat and Hand Pluggers; GT, GTX, and Traverse Rotary Negotiation Files; Buc ultrasonic tips; LAX guided access burs; TrueTooth and TrueJaw 3D-printed procedural training replicas; and most recently, the PulpSucker multi-canular negative pressure irrigation device. For over 30 years, Dr. Buchanan has shared his clinical competency by teaching procedural endodontics at worldwide events and at DEL, a teaching institute in Santa Barbara, California founded by Dr. Buchanan.

 

WHAT MAKES LASCHAL® INSTRUMENTS SPECIAL…

LASCHAL® instruments are the best I’ve used in both design as well as in their awesome manufacturing. Their ouchless suture scissors allow me to remove sutures without hurting patients, and the way they designed the scissor joints so they never grab a suture is exceptional. The unique locking release is so much simpler than Castro Viejo’s suture needle pliers and it only takes a quick move of my thumb to release. Top that off with the remarkable range of their pliers and it is easy choosing LASCHAL®.

Dr. Robert Miller

Dr. Robert Miller

Dr. Robert J. Miller is an internationally recognized lecturer, academician, author, and researcher. A 1981 graduate of New York University College of Dentistry, he completed a post-graduate residency at Flushing Hospital and Medical Center. He has approached dental practice with a vision for incorporating advanced technology to provide paradigm-changing dental medicine. Dr. Miller’s private practice in Palm Beach, Florida includes a multidiscipline state-of-the-art facility including 3D imaging, lasers, and navigated implant placement. He is a Fellow American College of Dentists, Diplomate American Board of Oral Implantology, Honored Fellow of the American Academy of Implant Dentistry, Diplomate International Congress of Oral Implantologists, Diplomate Academy of Osseointegration and serves as Chairman of the Department of Oral Implantology at the Atlantic Coast Dental Research Clinic in Palm Beach, Florida.

What makes LASCHAL® Instruments Special…

From periodontal plastic surgery to aesthetic implant cases, precision and ergonomics in my instrument setup are of critical importance. Starting with flap design, tissue manipulation, and suturing techniques, having instruments that complement my surgical skills allows me to complete my procedural base to the highest standards. LASCHAL® instruments are my choice across the wide spectrum of my skill set.

Dr. Mohamed Fayad

Dr. Mohamed Fayad

Dr. Fayad received his DDS in 1985 from the College of Dentistry, Cairo University. Dr. Fayad received his Master’s in Oral Sciences in 1994 from the University of Buffalo at New York. He received his Ph.D. in 1996 as a joint supervision between University of Buffalo at New York and Cairo University. He received his Endodontic training at the College of Dentistry at UIC. Currently, he is the director of endodontic research, and a clinical associate professor in the Endodontic department at the College of Dentistry at UIC, dividing his time between teaching, research, intra-and extra-mural continuing education, and private practice. He currently serves on the Scientific Advisory and Manuscript Review Panels of the Journal of Endodontics, and Evidence Based Endodontics Journal. He served on the AAE Research and Scientific Affairs Committee and co-chaired AAE/AAOMR committee drafting the joint position statement on CBCT (2015). He has numerous publications and chapters in peer-reviewed journals and textbooks (Pathways of the Pulp, Contemporary Surgical Endodontics, and Endodontics Principles and Practice). He is the co-editor of the CBCT textbook (3-D Imaging in Endodontics: A New Era in Diagnosis and Treatment) by Springer (2016). He is a recipient of the Calvin D. Torneck Part-Time Educator Award for 2022 by the American Association of Endodontists. He is a diplomat of the American Board of Endodontics and gave numerous presentations nationally and internationally.

What makes LASCHAL® Instruments Special…

LASCHAL® instruments are state-of-the-art surgical technology that has been a great addition to my practice. It added an extra dimension to endodontic microsurgical procedures performed on a daily basis.

Dr. Victor Sternberg

Dr. Victor Sternberg

Dr. Sternberg has a B.S. from City College 1965 and his D.D.S. from Tufts University School of Dental Medicine 1969. He also completed his Graduate Periodontology studies from Columbia University. Dr. Sternberg is a 2-year Captain for the U.S. Army Dental Corps. He entered private practice limited to periodontics and implant dentistry. He carries his educational expertise to an Associate Professorship at Farleigh Dickinson University School of Dentistry and Touro School of Dentistry, and lectures at the American Academy of Periodontology and numerous study groups in the New York metropolitan area.

What makes LASCHAL® Instruments Special…

As a practicing periodontist now in his 5th decade of practice, I am aware of the value of instrumentation in performing many of the challenging surgical procedures necessary to the profession. I have been using the LASCHAL® instruments for decades. The unique design makes suture removal and tissue control significantly more effective and less stressful. The instruments, which were designed by a dentist who understood the needs of his fellow practitioners, have filled a need that was missing from more traditional instrument makers without the intimate knowledge of our profession as LASCHAL® has demonstrated. All my surgical setups in my office use the LASCHAL® instruments. I highly recommend them to all fellow practitioners who want to make their procedures less stressful and more effective.

Dr. Michael Pikos

Dr. Michael Pikos

Dr. Michel A. Pikos, Oral Maxillofacial Surgeon, graduated Summa Cum Laude and Phi Beta Kappa from The Ohio State University. He is the founder and CEO of the Pikos Institute. Since 1990, he has been teaching advanced bone and soft tissue grafting courses along with full arch immediate reconstruction courses with alumni that now number more than 5500 from all 50 states and 43 countries. He has lectured extensively on dental implants in the U.S. and internationally and is a well-published author including his recent book “Bone Augmentation in Implant Dentistry.” Dr. Pikos maintains a private practice that is limited exclusively to Implant Reconstruction Surgery in Trinity, Florida.

What makes LASCHAL® Instruments Special…

I have found the LASCHAL® instruments to be durable, lightweight, relatively maintenance-free, and reliable for all my hard and soft tissue grafting protocols.

Dr. Robert Horowitz

Dr. Robert Horowitz

Dr. Robert A. Horowitz graduated from Columbia University School of Dental and Oral Surgery in 1982. After completion of a one-year GPR, he finished a 2-year specialty periodontics residency at NYU and the Manhattan VA. In 1996, he completed a 2-year fellowship program in Implant Surgery at New York University concentrating on bone grafting procedures. As a Clinical Assistant Professor in Periodontology and Implant Dentistry at New York University since 1996, he teaches, lectures, performs and assists in surgeries and conducts research in bone grafting and other topics related to periodontics, biomaterials, oral surgery, and implant dentistry. Dr. Horowitz teaches and supervises clinical treatments in the Departments of Oral Surgery, Periodontics, and Implant Dentistry, and conducts research in the Departments of Biomaterials and Biometrics and Oral Diagnosis/Oral Pathology/Oral Medicine. Dr. Horowitz also has faculty appointments as an assistant professor in Bucharest, Romania and in Chandigarh and Gurgaram, India.

Dr. Horowitz has published over 105 papers and 6 book chapters. He has lectured and taught hands-on courses in many regions of the US and internationally. He is a reviewer for the Journal of Periodontology, Quintessence, Compendium, Journal of Biomedical Materials Research, and other high impact peer reviewed journals in the US and internationally. Dr. Horowitz was guest editor for an issue of the Indian Clinical Dental Research Organization of which he was honorary chairman for one year. He has performed research (and authored manuscripts) in periodontal regeneration, perio-plastic surgery, bone grafting, extraction socket augmentation, growth factors/enhancers and the placement of dental implants in areas of limited available bone. Ongoing research includes bone replacement techniques and materials, periodontal regenerative materials and procedures, growth factors/enhancers, minimally invasive surgical techniques, live CT scan guided surgery, implant surfaces/designs and the use of surgical enhancements to both fixed and clear aligner orthodontic therapy.

What makes LASCHAL® Instruments Special…

LASCHAL is a highly advanced surgical instrument company with a foothold in the dental and multiple specialties of multiple medical areas. Their instruments are made of the highest quality metals that never tarnish. They ALWAYS grab the tissue, needle or anything they are designed to hold. They work the same way the hundredth time as they do right out of the autoclave on their first use. I could not practice the intricate surgical procedures I do without them in my armamentarium.

Dr. Todd Sheffler

Dr. Todd Sheffler

Dr. Sheffler has a B.S. in Biochemistry from the University of Pittsburgh at Johnstown 1987, a D.D.S. at Baltimore College of Dental Surgery, Dental School, University of Maryland 1991, and a G.P.R. Veterans Administration Medical Center, Baltimore, MD 1992.

He is in Private Practice in Concord, New Hampshire at the Caring Family Dentistry and The Dental Implant Center of New Hampshire. He is a member of the American Dental Association, the International College of Oral Implantologist, and the American Academy of Implant Dentistry. Professionally, Dr. Sheffler was a Speaker for Millennium Dental and Keystone Dental, an Innovator of BLAST Protocol for Millennium Dental, published in Inside Dentistry and Implant Practice, and a Managing Partner of the Perio Profit Center and the Center for Clinical Excellence.

What makes LASCHAL® Instruments Special…

LASCHAL® is my go-to for specialized instruments. They fill in the gaps other manufacturers ignore. I find LASCHAL® instruments to be of the highest quality and a very easy company to work with. I am proud to say they are one of the corporate partners of my Wellness Profit Center.

Dr. Katsushi Okazaki

Dr. Katsushi Okazaki

Katsushi Okazaki, D.D.S., Ph.D., is a Clinical Assistant Professor of the Department of Endodontics at New York University College of Dentistry, operating a variety of clinical training programs as the course director and served as Director of Endodontics course in Linhart Continuing Dental Education program at NYU College of Dentistry. Furthermore, K. Okazaki is a Clinical Associate Professor of the Department of Endodontics at Tokyo Dental College, JAPAN, engaging dental education and research. Dr. Okazaki is also an Adjunct Faculty member, Tohoku University Graduate School of Dentistry, operating research activities. He is a co-author of the book chapter in the seventh edition of Ingle’s Endodontics and as the main author of the book chapter in Diagnosis of pulpal-periapical disease, In Endodontic Prognosis. K. Okazaki has received his DDS, earned a Ph.D. in Anatomy and Physiology and served as a Teaching Fellow in Oral Anatomy at Aichi Medical University in Japan. After Postdoctoral Research in the Department of Development and Surgical Sciences at the University of Minnesota, K. Okazaki completed Postgraduate Programs in Endodontics at New York University College of Dentistry in the USA. K. Okazaki received the Distinguished Educators Award in 2015, the Research Award in 2018, and the Outstanding Professional Distinction in 2019 from NYU. K. Okazaki lectured on various topics on Endodontics to post-graduate students, as well as pre-doctorate students.

Dr. Okazaki focuses on the cutting edge of 3D-guided Endodontic Microsurgery. K. Okazaki gave a speech at American Association of Endodontists (AAE) Annual Meeting in 2021 and 2023 on 3D-guided Endodontic Microsurgery and Extended Reality (XR) in Endodontic Education and Treatment Simulation, respectively. K. Okazaki actively supervised and conducted more than 30 research projects in Endodontics, including international research projects supported by the Japanese Government.

What makes LASCHAL® Instruments Special…

LASCHAL® instruments are truly exceptional due to their lightweight, flexible, and durable design that offers unparalleled ease of use. Crafted with expert precision and designed to meet the unique needs of dental practitioners, they have an ergonomic layout that guarantees maximum effectiveness and user comfort. In addition to its superior technical features, these instruments are particularly noteworthy for their ability to enable delicate suturing techniques under a microscope. The SofTouch Suture Scissors™ is the only tool of its kind that can remove buried sutures without damaging the surrounding tissue, making it an essential tool for dental professionals seeking to perform precise and efficient suturing procedures. Overall, these instruments represent the pinnacle of dental surgical technology, incorporating a unique blend of expert craftsmanship and cutting-edge design that sets it apart from its competitors. It is the ultimate solution for dental professionals seeking to deliver the highest standard of care to their patients.

Dr. Arun K. Garg

Dr. Arun K. Garg

Dr. Arun K Garg is a nationally recognized dental educator and surgeon who for over 20 years, served as a full-time professor of surgery in the division of oral and maxillofacial surgery and as director of residency training at the University of Miami Leonard M. Miller school of medicine.

Frequently awarded faculty member of the year by his residents, Dr. Garg is considered the world’s preeminent authority on bone biology, bone harvesting and bone grafting for dental implant surgery and has written and published nine books and a dental marketing kit which has been translated in multiple languages and distributed worldwide. He has been a featured speaker at dozens of state, national and international dental association conventions and meetings including the American Academy of Periodontology, the American College of Oral and Maxillofacial Surgeons, and the International Dental Implant Association.

What makes LASCHAL® Instruments Special…

LASCHAL® Dental Instruments are truly unparalleled in the dental industry for their remarkable durability and precision, allowing for an exceptional level of accuracy that consistently ensures optimal patient outcomes. Their unique blend of innovative design and superior quality sets them apart, making them an indispensable tool for every dental surgical professional aiming to deliver the best care possible.

 

Dr. Randolph Resnik

Dr. Randolph Resnik

Dr. Resnik is the founder of the Resnik Implant Institute and worked alongside Dr. Carl Misch for over 30 years. He is internationally known as a leading educator, clinician, author, and researcher in the field of Oral Implantology and Prosthodontics. He received his dental education from the University of Pittsburgh along with his specialty degrees in Prosthodontics, Fellowship in Oral Implantology, and a Master’s degree in Radiology.

Currently, Dr. Resnik maintains faculty appointments at Temple University (Oral Implantology and Periodontics), University of Pittsburgh School of Dental Medicine (Graduate Prosthodontics), Allegheny General Hospital in Pittsburgh (Oral & Maxillofacial Surgery and General Practice Residency).

He is a frequent lecturer, both domestically and internationally. Dr. Resnik has been involved with numerous implant-related research projects including a 22-year Prospective Study on Maxillary Sinus Radiographic Pathology, a 5 – year Prospective Dental Implant study on a Bone Quality Based Implant System, and committee member on approximately ten Master’s Thesis Research projects at Temple University Department of Periodontics. Dr. Resnik is a diplomate of the American Board of Oral Implantology and the International Congress of Oral Implantologists (non-active) and a member of the prestigious Omicron Kappa Upsilon National Dental Honor Society. Dr. Resnik is the author of two textbooks in Implant Dentistry - “Avoiding Complications in Oral Implantology” and Misch’s Contemporary Implant Dentistry by Elsevier Medical Publishing. He maintains a private practice in Orlando, FL limited to Oral Implantology.

What makes LASCHAL® Instruments Special…

LASCHAL® has an unbelievable product line that fulfills the everyday clinical needs of the dental implantologist.

DR. STEPHEN NIEMCZYK

DR. STEPHEN NIEMCZYK

Dr. Niemczyk graduated from the University of Pennsylvania School of Dental Medicine, receiving his D.M.D. in 1982 and his postgraduate Endodontic certificate in 1984. Since 1995, Dr. Niemczyk has been the Director of Endodontic Microsurgery at the IB Bender Postdoctoral Endodontic Program at Albert Einstein Medical Center in Philadelphia and was recently named the Assistant Program Director in 2018. He is the 2020 recipient of the AAE Calvin D. Torneck Part-Time Educator Award, and serves as a surgical consultant to the Naval Postgraduate Endodontic Program at the Walter Reed National Medical Center in Bethesda, MD, and the U. S. Army Endodontic Residency Program in Fort Gordon, GA.

Dr. Niemczyk has lectured extensively in the U.S., Central America, Europe, the Middle East, and Asia on topics ranging from Microsurgery and Intentional Replantation to advances in Non-Surgical Endodontics and Cone-Beam CT. He has authored numerous papers, chapters on Microsurgery in Dental Clinics of North America, Ingle’s Endodontics 7th Edition and CBCT in Non-Surgical Retreatment. He is a member of the Scientific Advisory Board for the Journal of Endodontics and the Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. He is the founder of Endodontic Microsurgical Innovations, dedicated to the development of new treatment techniques and instrumentation. He is a Diplomate of the American Board of Endodontics, and maintains a full-time practice limited to Endodontics in Drexel Hill, PA.

What makes LASCHAL® Instruments Special…

LASCHAL® has always been cutting-edge regarding surgical instruments, but it is their desire to collaborate with practitioners in new product innovation that makes them unique. There is no one else that can transition an idea from prototype to stereotype with such ease and efficiency, incorporating over 30 years of manufacturing excellence. Thank you for your expertise and commitment to the profession!

Dr. Arnaldo Castelucci

Dr. Arnaldo Castelucci

Dr. Castellucci graduated in Medicine in 1973 and specialized in Dentistry in 1977. From 1978 to 1980, he attended continuing education courses on Endodontics at Boston University School of Graduate Dentistry. As well as running a practice limited to Endodontics, Dr. Castellucci is Past President of the Italian Endodontic Society, Past President of the International Federation of Endodontic Associations, Active Member of the European Society of Endodontology, and Active Member of the American Association of Endodontists.

He is Assistant Professor of Endodontics at the University of Cagliari and Professor of Micro Surgical Endodontics at the University Federico II of Naples. Recently, Dr. Castelucci was nominated Assistant Professor of Endodontics at Boston University, Faculty of the Henry M. Goldman School of Dental Medicine.

A well-known international lecturer in 65 countries all over the Globe, Dr. Castelucci published more than 60 articles on Endodontics in the most prestigious Endodontic Journals and several prestigious endodontic textbooks.

He is the author of the textbooks “Endodontics” and “Micro Surgical Endodontics”, full of illustrations and videos, both edited by EDRA.

WHAT MAKES LASCHAL® INSTRUMENTS SPECIAL…

I have been using many LASCHAL® instruments for many years and I am sure that we cannot find anything better. I am talking about the needle holder, scissors for the safe removal of the sutures without poking or irritating tissue, special forceps to hold hand instruments when working under the microscope without covering the view, and many more precious instruments for both non-surgical and surgical endodontics. With LASCHAL® instruments, many endodontic procedures become much easier.