Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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50 Years of Dentistry with Dr. Guy Moorman : Howard Speaks Podcast #60

50 Years of Dentistry with Dr. Guy Moorman : Howard Speaks Podcast #60

3/25/2015 10:18:11 PM   |   Comments: 0   |   Views: 898

Dr. Guy Moorman started dental school at Emory University in 1965 and has been going strong ever since. After 50 years of dentistry and a love for root canals, Dr. Moorman has advice for the new dentist who is about to do their first molar endo.

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Dr. Guy Moorman's Biography:

-Born 1944 in Douglas, GA 

-Went through K-12 here

-Attended Emory University undergrad from 1962-1965

-Entered Emory University Dental School in 1965 and graduated in 1969 (this year will be half century mark…golden anniversary I guess you might say) Only went three years to undergrad and did not graduate before entering dental school.  I figured one degree was enough.

-Lost my father and mentor to a heart attack in 1967 at the very young age of 53.  He was a country veterinarian. 

-Married Jeanette Fraser Elliott a drop dead gorgeous nursing student and then nurse in 1968.

-Joined the US Army Dental Corp in 1969.  Most of us joined one of the service branches due to Viet Nam and they were drafting dentists.  

-After completing my service in the US Army I returned to my home to practice dentistry.  Had some great friends in dentistry here but they were afflicted with the problem too many of us older dentists get…I know all I need to know so I’m going to stop CE and just sort of cheat my way through State requirements for the board.  

-Jeanette and I have three children, Chris, who is a professor in wildlife biology in the forestry department at NC State, Allison, a stay at home mom with a law degree, and Whit, a social worker with our school system here in Coffee County

-Love golf but broke my ankle on a motorcycle in 1976 and it now stops me from playing

-collect straight whisky, both Bourbons and Single Malt Scotch and now single malts from all over the world



Howard Farran: It is an honor to be meeting you today. Those of you who don’t know us, I feel like I’ve known you for 25 years. I mean, gosh darn, you’ve got 6000 posts on Dentaltown, I’m your biggest fan. You seem to talk the most about endo, of everything you post on I would say…is it fair to say 80% of your posts are probably root canal related?

Guy Moorman: Yes, yes. That’s my favorite interest. 

Howard Farran: Yeah, and may I just- I just love you like a brother, I’m a big fan of your posts, big fan of your cases, you’re always keeping it real on Dentaltown, thank you so much for joining me today for an hour, Guy. 

Guy Moorman: You’re welcome. I am honored. 

Howard Farran: So it’s Guy Moorman, and you’re in Georgia?

Guy Moorman: Yes, Douglas, Georgia. A small Georgia town, and that’s what’s so great about Dentaltown, and some of the others because when you’re in these small towns, you can get very professionally lonely, and- as you know, I mean you don’t have anybody to talk to, and the internet brought Dentaltown, and the first one was the Internet Dental Forum which I’m not a member of anymore, but now I spend most of my time on Dentaltown. There was another one but this turned into a full political nightmare, so I just go to dentistry, I want to talk about dentistry, not politics. 

Howard Farran: You mean like the politics of the country, like political?

Guy Moorman: Yes, yes. Political politics, not the dental politics.

Howard Farran: We like to, on Dentaltown, if dentists want to talk about that, it’s fine. Under leisure there’s a political section, we just don’t let the section on politics or religion or sex, something like that, show up on the today’s active topics, so when you go to Dentaltown, you look at today’s active topics, it’s just pretty much clinical dentistry, but if you are a die-hard and into politics and all that stuff, I do believe that if dentists want to talk about it, they can, so if you go to the leisure section there’s a forum there but I- you know at 52 I don’t like to talk about religion or politics because I’m thoroughly convinced you’re never going to change anyone’s mind anyway. 

Guy Moorman: And I’m 71 and been in these breeches for 50 years, so-

Howard Farran: Well Guy the reason I wanted so desperately to interview you is because you know there are so many Townies who’ve read your 6000 posts over the last, you know, decade, and so I want to start this off- you just said you’ve been doing this for 50 years. When I’m at dental schools, I’m at a half dozen dental schools a year, and the things the kids tell me, the first thing they tell me about is what you’re most passionate about, which is endodontics, which is- it’s so overwhelming, so I want to start this conversation, Guy, pretend- what would you tell a 23 year old kid that just walked out of school, and has a root canal scheduled tomorrow, and is probably not going to sleep very well tonight, and it’s just so overwhelming, I’ve only got you for an hour, what would be the low hanging fruit for you to tell these people getting into a molar endo?

Guy Moorman: Getting into a molar endo I would- Dentaltown’s a good place to start, there are some good people on there, we have four, five endodontists on there, we had a lot more at one time, and we’ve lost some because of an incident which you’re very well aware of, that they’re leaving, it’s kind of sad but…

Howard Farran: No, no, go ahead, what was that incident, what was that?

Guy Moorman: It was Barry Musikant who was an excellent endodontist, but all Barry wanted to talk about was SafeSiders in every conversation that came up, Barry just inserted SafeSiders into it. It didn’t matter what it was, and after a while he threatened to sue another endodontist that was on there, and that’s not acceptable on Dentaltown.

Howard Farran: Yeah, under the terms and conditions that you get, a lot of people- let’s just refresh a couple of things. A lot of people, you know they tell me that they have free speech and they’re upset when they’re banned or something, and the bottom line is, the constitution says free speech between you and the government, but you’re not going to walk into my front room and my house and start free speeching. I have the right to shoot you. So on Dentaltown how we play that is, it’s a party at my house. I mean I own it, it’s not the government, I have no partners and anybody can discuss anything until the cows come home, as long as it’s like a party where you’re having fun debating. But once they get mean and nasty and personal, you know that’s not a fun party, and I think dentists are so beat up by insurance companies and patients and staff that Dentaltown should be a fun, safe harbor to go and show this. But I do want to say one thing about Barry since you did mention him, is I love Barry Musikant and what’s so unique about Barry is if any of you dentists go to Manhattan and walk in his office, he’s got like six endodontists, they’re open seven days a week and my God, any- I can name you 20 people that just walk in there and Barry literally sat down and talked with them for two hours showing them stuff. But you’re right, if you only tilt the hammer, everything looks like a nail, and he just wants to use his SafeSider file which is a great file and all that, but you’re right, no matter what question you ask on Dentaltown he would start to solve it with the SafeSider. 

Guy Moorman: I agree, I actually used SafeSider technique for a couple of years, and I then I took a course and I found out that maybe it required me to remove too much dentin in the cervical area of the tooth which is critical. And that’s a big issue now, and it’s- there’s a battle over access. I don’t know if you’ve noticed that but there’s a minimalist movement where they want to get it smaller and smaller and smaller. And I just took two courses, one was by Dr. Martin Trope and the other one was Cliff Ruddle and both of these guys are excellent orthodontists and I think their advice to young dentists who mostly was there was you can’t work though a pinhole, you need to be able to see. Now as you get better and better and better you’ll notice your access is getting smaller and smaller and smaller. But don’t try to do it, that would be a young guy if he started that before, before saying, I would tell him, you need to get where you can see all the canals, and just don’t open up the orifices too big, that’s where the vital part of the tooth is. And we had a discussion the other day, and you’re lucky you’ve got some good, good, good administrators on there that will- if it starts to get a little bit nasty, they’ll calm it down, or they’ll take the post off, which is great. Because I’ve had some of mine removed and it’s you know, sometimes you get a little too involved in something, and your administrators, Peter’s one of them, I don’t know the other one.

Howard Farran: Wacko? Peter Wacko?            

Guy Moorman: Yeah. That’s right, Peter Wacko. He’s a great one, and Howard Goldstein used to be on there and now he’s in charge of education I think on Dentaltown, and he was a great one. But that the two that I knew the most.

Howard Farran: Can I add one thing on that? That comment you said was- for me it was, you know, when you’re doing molar endo and you look at this field and they’re writing down three or four different filings, you know it’ll be like 19, and the other one will be 21, the other will be 18, the other will be 23, and for me- all that counts, what I like to do is, I like to prepare the final restoration first. Because then you’ve got- when you reduce it to the two millimeter, the occlusal clearance, that makes it easier to see straight down into the canal. A lot of times when you’re removing all the decay and all that stuff, the top is parallel, it seems like my working links when I prepare the tooth for the final restoration forest, if I have four canals, they might be all four 18, and it’s kind of a neat thing because if three of them are 18 and one of them is 19, I pretty suspect that 19 is long, and when I prepare the tooth first and get it all ready for the final restoration, then I can make my access, I know I can make my access prep bigger, because I like the visibility too. 

Guy Moorman: Yeah and I do the same thing. I never work on- I don’t even do a powder treatment on one that has decay in it, and that’s a big complaint I have, a lot of people send these cases, I’ve seen them, to an endodontist, and they look at it and say okay this needs endo, and it’s a mess. And what they should do is prepare their final restoration like you said and they don’t necessarily have to prep the tooth, but at least do the build-up and then go to there and do your powder. So when you send it to the endodontist, he doesn’t have a mess of decay and stuff he has to get out before he goes. A lot of times when he takes it out he’ll find that tooth is not restorable. And we should do that in the office, that’s not the responsibility of the endodontist. And that’s the big complaint I have, and I think endodontists do too, but it’s not going to change, Howard, I don’t know. I think we’re getting lazier it seems. I went to a Pentron meeting in Boston one time and there were three of us that were general practitioners and then there were like 15 that were teachers and researchers and people like that. Leinvelt, Hearns and some of the others were there and ironically they were developing a bonding agent like a generation seven, and they polled the room, and all of us put why don’t you just use generation four? Because it has such powerful bond strength. But one of the large practitioners there said he wanted the seven and he was the one that was using it because it was easier, and he didn’t understand, they were introducing Artiste at that time which has now sort of slowly fallen out of favor. It’s a great material and I still use it, but he said we don’t need the three shades. Well that’s- I couldn’t disagree with him more, I told him that. But we’re just getting lazier, we don’t want to have to think, we want somebody to do it for us, and you know when I started it was not a whole lot to learn in dental school. I mean you learn to give anesthesia, you learn to do the cramp grips and you learn to do amalgams and composite was not- when I was in dental school we didn’t have composite, it didn’t exist. The first time I saw composite was when I went into the military in 1969, there it was adapting and toothpaste, and you filled it, it was just- and that was amazing since we’d been using glass ionomer silicate, silicate cement or something like that. And you had to fill it and wait a day for it to set up and get them back and polish it, but things have – things have gotten now to the point where these young guys have so much to learn. Guys and girls. We have a lot of women in dentistry now. And I think that’s good. I wish all of them would stay in it. A lot of them don’t, but there’s so much to learn that you can’t learn in dental cchool. It’s impossible. And that’s the reason I think that we should have rather than having a state board to get your license, we should have, require a residency of at least a year somewhere. Of course that would take a major change in the way we do things, hospitals would have to open up residencies there, or somewhere in the military. And we rotated through surgery, X-ray, we had endodontics, we had prosthodontics and pedodontics which I did not like. But we rotated through all of that, two weeks at a time. So I had a rotating residency and it prepared me for when I got out and got home. I was ready for just about anything that I was going to see at that time. But now things have gotten, I mean we’ve got implants and we’ve got so much now that it’s just- it’s so much fun, you can do stuff that I could not even imagine when I got out of dental school. It’s just, and I saw the old blade implants come and go. And I have a patient that actually still has three blade implants, they’re loose but things now, implants are so predictable, endodontics are predictable, of course we’re getting a lot of, with the new cone beam stuff, if you look at all these root canals, they’re failing and you know a lot of that comes from, I don’t know if you remember, there was a- back in even the fifties, there was a first sign of infection theory. If you had arthritis and you pulled your teeth, you know, if you had- if you had a bad back, an arthritic back and you pulled your teeth, and you supposedly got well but sadly a lot of people pulled their teeth and didn’t well. So that was not great. When I started lots of people had their teeth extracted to get over a bad knee. And it turned out- well it wasn’t their teeth, it was something else. But now we’re finding out that the oral cavity does have an effect on a lot of other things in our bodies, our heart, our liver, kidneys, joints but not the way that we thought back in the ‘60s when I was in school. But- yeah I’m not real sure Howard that endodontists, I don’t think we had an endodontist in Emory when I was there, I don’t think we did. I know there was no program there, there was no residency in endodontics, because the way they started it, they had their grandfather in and a lot of guys that had been doing endodontics, just to get the specialty started. So a lot of endodontists back then were grandfathers.

Howard Farran: And you still see that today. I’m not a lawyer, and I don’t want to pretend to be one, but state boards are different in all 50 states so if you’re listening from around the world, the United States, the laws are confusing because some things fall under one law from the federal government for the whole country and half the laws are state, but a specialist, there’s nine specialties according to the ADA in the United States, so the specialty of endodontics a lot of people have to go to school now to be an endodontist specialist, but you can have a practice limited to endodontics when you’re not a specialist. Because when I go into small towns, I’ve met a dozen dentists, where they were a small town of 3000, 4000 or 5000, where there were four dentists, the other three guys hated doing root canals and one dentist said you know what, I’ll only do endo, so I’ll send back the crowns, the filling, the cleaning, the hygiene, I’ll just have a practice limited to endodontics. And they’re just crushing it. They never went to endo school so rural America has this. But I’m going to start pinning you down on some specifics because you’ve been doing this for 50 years and when you and I got out of school, you know the data is still showing on a build-up, on a root canal build-up that a silver filling on average lasts 14 years, and a composite on average lasts 7 years. I mean we’re talking about like an MOD or two or three. 5So I want to stop you right there. What’s the better build-up? Would you, if it was for you or one of your three children, would you rather put a couple of double spills of amalgam in there or would you rather do a composite? Talk them through the pros and cons of those two.

Guy Moorman: You know, you asked me which would I prefer as a build-up. As long as it’s not packed down into the canals, I would prefer amalgam, because number one it’s easier to see your margins when you’ve got the cramp grip on and you don’t have to worry. What I do is I use a purple flowable that Ultradent makes and when I finish, when I do my build-up around all the margins, I put that purple flowable so when I come back prep it, I don’t cut my margins on composite. Most of what I do now is I do most of my build-up of composite. And that is because of demand. Patients don’t like the black stuff anymore and then we hear the stuff about the mercury, but let me tell you Howard, if mercury killed you I’d have been dead a long time ago because I have breathed it, I have handled it, I have done everything you can think of with the stuff, and some people would argue that I’m crazy, but I’m not dead. 

Howard Farran: I would argue that all seven billion people on earth are crazy. I don’t think, and if anybody tells me they’re the normal one, you know they’re bat-shit crazy okay? We’re all crazy but it’s funny because when I got out of school in ’87, our restorative professor made us sign an ethical contract that we will not do these posterior composites. I mean that’s how old school I am, back in ’87. And I just want to say that to the kids who are out there wondering what my view is on the mercury is that when mercury, in a silver filling, when it’s half mercury and it bonds to silver, zinc, copper and tin, it’s an insoluble salt. And if you triturate amalgam and swallowed it, twenty four hours later you’d poop it right out into the pan. But it’s the mercury in the ocean that, due to burning coal, mercury in the ocean has gone from one part per million for the entire ocean in like 1950, to now four parts per million, but that’s free ethyl methyl mercury, it sinks to the bottom, it’s gobbled up by any bottom feeders like shrimp and lobster and clams and oysters, and then if it’s a big fish that drinks a lot of water like a big tuna or something like that, that’s ethyl methyl mercury that’s absorbable. So it’s so funny because I see these bat-shit crazy dentists that are anti-amalgam and extremists, and then they’re sitting there and they’re like real healthy and they don’t eat red meat and they’re sitting there and they’re eating all this seafood, and I talked to a doctor who studies premature loss babies, whether that be, you know, an accident or an abortion or whatever, and there’s a lot of mercury toxicity in the brain, and even a child three months, you know, conceived, but it’s all ethyl methyl mercury and it’s all traced back to dietary seafood, not the mothers- not in amalgam. And amalgam in the mouth is an insoluble salt and has some anti-bacterial properties where composites don’t, glass ionomers do, but my gosh to me, I think on a guy like me, like you’re talking to me, you don’t know that I have seven gold inlays and on lays and crowns. I’d rather have gold, metal, I mean take a metal nail and then take a plastic nail and tell me which one you want to put in your molar for 40 years? I call it the aesthetic health compromise. Now obviously if you’re a woman and you put on mascara and eyeliner and do your hair and nails and mani and pedi and you’re totally into cosmetics, I get it, and we’ll do all the tooth color stuff, but gosh when a small fat bald guy like me walks in? Wouldn’t you just throw in an amalgam in a build-up that’s going to last twice as long as a composite? I mean if you’re doing something for me on the aesthetic health compromise, the only thing you could do is maybe put a bag over your head so you couldn’t see me and I just want it to last. So I want to pin you down on another specific. I want to get you on specifics. Molar build-up, post or no post? What are you thinking when you’re thinking about a post? What should a young kid walking out of dental school think about, they just did a molar endo on a molar, what should their brain be thinking when they’re analyzing a post? 

Guy Moorman: Well number one, your failure, if you have a failure, is going to be from a lack of- just if you don’t have enough tooth there, it’s going to fail. I use post but I make sure my posts are essentially the same size as my endo prep, my canal. I don’t like to enlarge it greatly with- and you think you get all sizes of post and all they’re good for is to retain the core. You’re going to make them prettier, you’re going to send a prettier prep to the lab. They will not keep a crown from failure. In my opinion they will not. Do I use them, I use a lot of them because I like to have them- my posts, my build-up to be nice, and shaped well, and when I send it to the lab I want them to have an easier job, I don’t want them to have an old chunky looking something for them to work with. And people send those things to labs. I’ve been to labs and seen them, you know it’s a little bit embarrassing for me but that’s the way they do it. Now to be honest, it’s harder to put a post in if you’ve got amalgam, if you use amalgam unless you use a metal post. And I’m not real fond of metal post. If I can get away from metal post I would. I’m not real fond of it, a lot of people say cast post look great, and in my 50 years I’ve seen more split roots from cast posts than I have from any other type of post. And I think that’s because it’s extremely difficult to get an exact copy of the canal that it will fit and after you’ve seen it breaks down, it starts moving and you see split roots. But that’s just my opinion, I don’t have any science to show that but I don’t use cast posts anymore. Metal post ironically, the only metal post I use are the flexi flange, various posts, the EDS post, because I think it creates less press in the tooth than others. I used one the other day and people say I never use posts, but a lady came in with a front tooth that was sheered off. She’d fallen off the back of a truck, she’d been riding with her grandchild which she shouldn’t have been doing, and it broke her crown and her tooth and everything off. So what are you going to do? Well you know I’ll build you up something that- well what I did was I took a flexi flange and I ground the threads off except at the top which is where it bonds, or where it really holds and the rest of it cement and I put that in and in her case since the tooth was already non vital, I had to do a root canal the same day, you know, so you come in, you’ve got to do a root canal on somebody on Saturday morning by yourself and all the trays are set up, but I put it back together with a post, and that was the only way I could repair it was with a metal post. A resin post or a fiber post would not have worked. I put one pin in, it’s an anti rotational device, and that things is solid as a rock.  

Howard Farran: So you were all alone when you go in there, Jeanette doesn’t go in there and assist you?

Guy Moorman: No. No, not anymore. She used to but not anymore. I know most of these people and we don’t- she used to if it was somebody I would know, she would go, but now a lot of my calls come from the ER, I’m on staff at ER and the governor of Georgia just made a statement that all ER’s will be covered by dental. They will have dental coverage. So a lot of people are going to have to start getting their hospitals staffed, because the governor has made that statement. 

Howard Farran: Well it’s sad because you know I’ve been out here in Phoenix since 1987 and I mean they go the emergency room and anything with a tooth, I mean they can’t do anything. I’ve had people walk into my office with a two foot by two foot sagittal X-ray of their head trying to find- are you kidding me? How? So they don’t have any intraoral photography, they don’t have any- they have no way to diagnose so they give everybody the same thing, Amoxicillin and Percocet which is probably good public health policy you know?

Guy Moorman: Yeah.

Howard Farran: But I want to get a little bit more specific on you. So when we got out of school, X-rays were only two-dimensional and now we have three-dimensional X-rays with these CBCT’s. So you practiced probably 25 years without ever having access to a three-dimensional X-ray on a molar. What do you think about CBCT’s? Can you be a good endodontist, can you do good endo with a two-dimensional X-ray? Or would you say a three-dimensional X-ray is standard of care? Talk about that?

Guy Moorman: Well at this point in time I don’t think CBCT is going to be standard of care because so few people can afford them. They are doing- you know 80% of root canals in this country are done by general practitioners, and Ruddle when I was there and both of them said you know a lot of endodontists don’t think we should be teaching general practitioners and he said who’s going to teach them to do better endo if we don’t do it? And I respect both of those guys tremendously, and that’s the reason I went, was because I wanted to meet them before I quit. And you know it was- and like Martin-

Howard Farran: Who, Martin Trope and Cliff Ruddle?

Guy Moorman: Yeah. 

Howard Farran: Legends. 

Guy Moorman: And Martin Trope, it was a small room, it was like 13 people, and he walked and he looked at me and he said what the hell are you doing here? And he said you’ve been doing endo for so long I don’t know what- and I said well I wanted to meet you Martin and I wanted to listen to you. What you had to say and I’m sure I’ll pick up something, right? Well I came back, I’m now using Biolase files because I’ve listened to Martin and I think his thoughts are excellent. And we have not been preparing 8 bits for the root, and at one point in time I was doing that and using an 02 taper to go down, an 04 or 06 and make the apex larger and I got quite a lot of flack on Dentaltown for over-preparing my apexes. And now Martin’s come along and we’ve got Biolase files that have that.

Howard Farran: Well I think the next question should be, basically is what do you think is the number one cause of failed root canal, and is it really cleaning, shaping, obturation or it is really missed anatomy? I mean there’s a lot of people who think the number one reason of, the most common reason of a failed root canal is a missed canal? Do you agree with that? Or go through why you think root canals fail. 

Guy Moorman: That is a cause and I’ve retrieved a lot of endo, because you were mentioning people that- I have three dentists here in town that refer cases to me rather than do the molar endo. There are some people that are not able to leave town, or the nearest endodontist is 70 miles from here, and so a lot of people would rather just come to me and let me do the endo and the three dentists trust me to do the job of the endo. So I missed the question, go back to it will you Howard?

Howard Farran: Well I’m focusing this on someone who just got out of school. You’re sitting there doing a root canal, there’s so much talk about, you know, cleaning, shaping, obturating, EDTA, you know all that stuff. But would you say it’s fair to say the number one cause of a failed root canal is missed canal? Would you agree with that statement or would you disagree?

Guy Moorman: I would say let’s call it missed anatomy. Because a lot of times I see, retreated one that was done by my partner, and he’s a solid practitioner. But he had created anatomy that he didn’t fill. He had a stripped perf on the apex and so when he filled it, the apex was wide open for about three or four millimeters up the canal, because he had transported it, he went down with an F3 ProTaper and the canal wouldn’t take that. So he created anatomy that he didn’t fill. MB2’s, the number’s gone down. Martin said that we find, his residents found 52% of the MB2’s which was a smaller number than I thought because when I got out of dental school, Howard, my endo book did not even have upper first molar’s having MB2’s. That wasn’t in there, and then later on it was 25% up the first half, and then it was - and you wonder why somebody didn’t just take 100 of them and slice the roots and say I’ll be damned, they’ve all got a MB2 except a few. And I think 90% of the upper first molars had MB2’s. 

Howard Farran: But do you consider– but if the MB2 joins the MB1 in like the first third of the root, and it’s probably less of a problem than obviously if the MB2 goes all the way to the apex? 

Guy Moorman: Yes. I mean if it joins and you miss it, then I don’t think you miss anything because you’re going to fill it. I think that it would be nice to clean that canal out and disinfect it and do everything we do to it, but it’s going to be sealed up pretty well if you do a good job of endo. If you do a good job of obturating-

Howard Farran: And that is the huge advantage of a CBCT. I mean you know, what I’m reading from guys like you on Dentaltown is that you know the most common failed root canals are maxillary first molar because it’s a missed MB2, the second one would be a second mandibular molar because the canal has two canals, sometimes one, sometimes two. Even mandibular incisors often have a lingual secondary canal that’s often missed. But I want to go back to one comment about some of these instructors that don’t think general dentists should be members of or learn endodontics from endodontists and you were saying that Cliff Ruddle was talking about. And I just want to say that there’s some out there that I want to throw under the bus, but I think they’re arrogant, and I think they’re bad people, because there’s 19 022 small towns in rural America and those people are paying taxes to pay for these public dental schools and the specialists who try to keep specialty stuff out of the curriculum and the general dentists, you know I think they might have an argument for the 117 largest towns in America where half of America lives, and the nine specialists are all there, but when you get back into rural America, I mean I’m from Kansas, I mean it’s just town after town after town, there’s no specialists, in fact I would venture to say that 20% of all the towns in the United States don’t have a single specialist. So when you go to that dental school, or some of these lead endodontists will have program where general dentists can’t apply, I mean that’s just- that’s arrogant. And then they’ll tell you that they graduated with $300 000 in student loans, dude, your tuition didn’t even pay for half of the costs of that dental school, and that was the rural America paying taxes to fund your little state education, and then those arrogant idiots don’t want to teach general dentists, and then those people go back and when you’re in a town of 1000 or 2000 or 2500 and there’s zero specialists, the bottom line is, you know there’s another specialist that no one ever talks about. They always talk about endodontists and periodontists, and pediatric dentists, and oral surgeons and now oral and maxillofacial radiologists, they never talk about the public health dentists. And I think deep down inside we’re all a specialist, because at the end of the day we’re all a public health dentist. I mean when I opened up my dental office, I spent a day a week for two years, I spent every Friday for two years, no revenue, just trying to get Phoenix to fluoridate their water because I knew in a town of this big you know, this town’s a monster, it’s the fifth largest town in America, and I knew getting fluoride in the water would be ten times more important than me standing on an assembly line, drilling, filling and billing. We all have patients that walk in that need emergency care that we know we’re never going to get paid and all that stuff, so I think we’re all specialists, we’re all public health dentists, and you know there’s seven billion people on the planet, everybody’s got different needs. But I want to pin you down to some more specifics. Apex locater, do you use them, which one do you use, tell us your thoughts on apex locators? 

Guy Moorman: I think they’re an integral part of doing endo. I don’t think you can do endo competently, now I might be going out on a limb here, I don’t think you can do it competently without an apex locator. Because the radiographic apex is going to be wrong about 50% of the time. And you have to use that apex locator during the filing because you’re changing the length as you go down. So I check mine three or four times to make sure that- well number one that you’re not straightening the canal out too much. If it starts getting too short then you know you’re straightening it out too much. I think they’re integral to doing good endodontics.

Howard Farran: Are they all the same, do you like one more than the other, any thoughts on brands? 

Guy Moorman: I use two, I hate to say this but I’ve got six apex locators. I use, because that’s how important I think they are. I use the J. Morita primarily.  

Howard Farran: Which is that, Root ZX, J. Morita from Japan?

Guy Moorman: I use that one primarily. Parkell’s apex locator is excellent, so I have two Parkell’s in case my Morita goes down. I have got two Parkell’s and they’re very accurate. I actually have one from China, it’s excellent.

Howard Farran: What’s the name of the one from China?

Guy Moorman: I don’t remember, I bought it on eBay. I hate to say that, but I bought it on eBay just to have another one. 

Howard Farran: Why do you say you hate to say that? Why does that bother you?

Guy Moorman: Well you know it was sold on a dental site on eBay. You can buy– I actually have a motor that I bought that I haven’t used yet because the one I’ve got is working fine, but I’ve got that backup. If it stops I’ve got another motor. It’s the apex locator is just like the CBCT. I think eventually that will be the standard of care, but that won’t be in my lifetime, my practice life. 

Howard Farran: Well in a way the CBCT, I don’t like the name CBCT because when you talk to the maxillofacial radiologists they say that the name is wrong anyway because the dental ones aren’t even the CBCT under the strict definition. I just like to think of it as we’ve gone from two-dimensional to three-dimensional and a Root ZX is three-dimensional I mean because- 

Guy Moorman: Three-dimensional. 

Howard Farran: So an apex locator is really the entry level three-dimensional. 

Guy Moorman: Absolutely. And if 2I have a case that I’m concerned about, we have an endodontic group here that have called me and they will do one free for me and put it on a CD and the patient will bring the CD to me, and I can plug it in and we can look at it and see if I’ve missed an MB2 or what. I’ve found one upper molar one time that had six canals and every one of them had a separate exit. I mean it was about just merging, there were six canals, actually two parallel canals, I’ve never seen that before. But you just, the anatomy is so complex on a lot of them, that if I get concerned about it, I send them to the orthodontist and get me a three-dimensional view, a real three-dimensional view. 

Howard Farran: And that’s another thing I tell kids. There’s book smart dentists and there’s people who got through dental school, you’ve got to be book smart to get through dental school, I mean anyone who gets A’s in calculus, physics, chemistry and biology, you’re book smart. If you got a dental degree, a med school, a law degree, you’re book smart. But it’s the street smart ones that are crushing it and I’ve never met a specialist with a CBCT where if somebody in their neighborhood sent a patient over, they’d be glad- are you kidding me? They want your referrals, they’d like to meet your, you’re coming to them instead of them begging you to go to lunch or something, I mean I think it’s the best continued education. I mean there’s dentists in this valley like Brad Gettleman, one of the greatest endodontists I’ve ever met who, he has an open door policy and any kid that walks in there and wants to watch him do root canals all day, and he just thinks it’s fun. He just enjoys having a buddy for the day. I want to go back to, on the Root ZX. Talk about are you doing hand filing, I mean most people think of an apex locator, you’re putting in a hand file and you’re measuring there, where do you leave hand files and go to rotary files and do you put the apex locator on the rotary file? I mean some people leave the apex locator on so when they’re doing 300 rpm they have the apex locator on the whole time. So start with the first question and that is where do you branch from hand files to rotary files?

Guy Moorman: Okay generally I never go higher than a 15 hand file. 

Howard Farran: What do you start with, a six or an eight? 

Guy Moorman: Six. 

Howard Farran: Six?

Guy Moorman: Yeah and usually I like for my patency to be a 10 because of the technique I use to operate. If I get it too big, I’m going to get a massive portal, which won’t hurt anything it just looks ugly. But I like to keep it at 10 and sometimes at 15. Of course you get some that already have a huge portal of exit and it doesn’t matter what size file you use there, but it’s – I don’t see when you get past a 15, now with Martin’s technique with the Bio Race files was, you take it to a 20 hand file. 

Howard Farran: Which file was he talking about, Martin? Bio what?

Guy Moorman: The Bio Race. They have several, he’s got another one… 

Howard Farran: Bio Race? 

Guy Moorman: Yes.

Howard Farran: Now is that his file or who makes that file?

Guy Moorman: I think Brasseler makes it. 

Howard Farran: Brasseler, okay Brasseler’s out in Georgia, that’s your neck of the woods. Aren’t they in Savannah, Georgia?

Guy Moorman: Savannah. 

Howard Farran: And where’s Martin out of?

Guy Moorman: Martin practices in Philadelphia. 

Howard Farran: Philadelphia, okay. 

Guy Moorman: Martin does a lot of development. I think you know, he was integral in the development of Rezlon which is now called – I think it was an excellent material, used…

Howard Farran: Ultradent did that, didn’t they? Ultradent? 

Guy Moorman: No that was Cebron that had Rezlon. Ultradent has EndoREZ. 

Howard Farran: Okay, EndoREZ. 

Guy Moorman: And Endo-Rez is still available and both of them have the same weakness in that, they can’t stand having any oxygen when the sealer is curing. And if you leave peroxide or any bleach in there, then the sealer is not going to set. And I think what happened, it was just two technique sensitive for the average dentist, like I said we’re lazy, we don’t want to go to the trouble of cleaning out the canal and when they dropped, took it off the market, we obviously had to go to a different sealer. I’m using, now I’m using- the epoxy, I can’t remember, something plus? 

Howard Farran: AS 26.

Guy Moorman: Yeah, plus yeah. 

Howard Farran: Is that what it is?

Guy Moorman: Yeah, it’s an excellent sealer and in fact- I still go through the same process of removing the bleach. I don’t like to leave any bleach in the canal, but back then a lot of the people just, a doctor, Dan Fisher, he came on Dentaltown and said we can not use RC-Prep with EndoREZ and I said, I posted that, well yes you can because I do and I have great success with it. And he called me on the phone and he said Guy, you’ve got to go back on air, and tell them not to use it, because all of them are doing what you’re doing. A lot of them are leaving the RC-Prep in the canal. You’re cleaning it out, that’s the reason it’s working. And so you’ve got to go back on there and tell them not to use RC-Prep. Use Vaseline or something, but don’t use RC-Prep. So now we use his…

Howard Farran: I’ve got to stop you right there.  There’s a lot of people who don’t know what RC-Prep is. Will you explain what RC-Prep is?

Guy Moorman: RC-Prep is a lubricant for files. It has EDTA in it, and it obviously has some peroxide in it. 

Howard Farran: Explain what EDTA is for them too?

Guy Moorman: That is a form of acid that removes the smear layer from the root, inside the root, so you can get some kind of penetration of your bleach and your – any lubricants that you put in there, you need to remove the smear layer so you can get some better penetration. 

Howard Farran: So do you always use RC-Prep on all your endo?

Guy Moorman: Not any more, I use – I use EDTA Prep. I use Ultradent’s, I think it’s File-Eze what it’s called I believe.

Howard Farran: And it’s just a straight EDTA?

Guy Moorman: Yeah and it’s a lubricant, it’s a gel form.

Howard Farran: For our viewers, he mentioned a conversation with Dan, and that’s Dan Fisher, the founder of Ultradent out in South Georgia Utah, outside of Salt Lake. He’s one of the sweetest, nicest hardest working guys in all of dentistry. The guy does it like 18 hours a day, seven days a week, and he’s got to be – how old is he, he’s got to be over 60? I’m thinking he’s got to be. 

Guy Moorman: He’s over 60 because I went to – and he’s kept going. I went to an Ultradent Elite meeting out there and – and when I got there it was almost like a funeral, and everybody – nobody was talking, and it turned out Dan had lost his son shortly before. And I don’t know exactly what the circumstances were, it didn’t really matter, he had lost his son, and so we did not expect to see Dan, but at the end, the closing, the closing, and I had just lost a grandson shortly before that-

Howard Farran: Oh, I’m sorry.

Guy Moorman: And Dan shows up for the final closing lecture, and does a magnificent job, pumping us up and showing his class. Clearly he’s a classy – and I went to a meeting in Atlanta and he saw me, came up and spoke, and invited me to go out to dinner with him. And I thought that was very unusual. We went out to dinner, and but we were talking about endodontists not wanting to teach general practitioners. Ben Johnson was introducing the Vortex Blue, at that time, the same time. And he was giving a course in Atlanta, and I was already there, so I called him and asked him if I could take the course the next day. And the lady told me that it was only for endodontists, they didn’t allow general practitioners to take it. So I called Thompson and told him that I thought they were missing about 80% of the market out there and it was pretty stupid to say something like that. Well I got a call from Ben and he apologized and he said that the next course we had, I could come free, he would be glad to…

Howard Farran: I’ve got to tell you my Ben Johnson story. First of all I hope I don’t get this wrong, I don’t want to throw Ben under a bus, but  I don’t think he actually went to endo school either. I think he just limited himself to endo back in the day. 

Guy Moorman: Well, I think you’re right. 

Howard Farran: Yeah so I don’t think, and he’s got to be the greatest most famous endodontist in the world, he’s from Tulsa, Oklahoma and that’s where Tulsa Dental was started which was later sold to DentsPly, so all that Tulsa dental product stuff you see was started in Tulsa, Oklahoma with Ben Johnson. I’ve got to tell you – I’ve got to tell you how street smart they are, I’m most proud of this story. So Tulsa Dental was coming out with all this stuff, and I’m in Phoenix Arizona and I’m confused and I called them up and everything, and I said I want to talk to the dentist, Ben Johnson, the endodontist, or whatever. So he got on the phone and all this, and I just had all these questions, and he said – I said to him, you know what I really wish, I said Phoenix to Tulsa on Southwestern Airlines is only like $200 back in 1987. I said I wish I could just fly down there and spend the day with you. He said do it. I said really, when? He goes, I don’t care because I’m in my office seeing patients Monday through to Friday, eight to five. So I hopped on an aero plane and went down there and spent the whole day with him. And this is a priceless course, I mean people will go out and spend $3000 for some weekend course in some hootey-flootey root canal deal or whatever, and they’ve got rocking hot endodontists in their same zip code that, you can just call them up and say buddy can I come watch you? I mean you know so, I mean I bought a round-trip plane ticket on Southwestern Airlines and got to spend the entire day with Ben Johnson. I mean how cool is that?

Guy Moorman: That’s the way Ben is. Ben did not have a clue that I was turned away and that was what he said. I did not know that. If I had known that I would have invited you personally to come. But the way I got started, we go back to the endodontists teaching was…my endodontist was in the same town as I was, which is south of Savannah, and he was just getting killed. There were so many people referring to him. He just couldn’t do it all. And he had seen the stuff that some of us were doing on bicuspids and anterior teeth and he called us, three of us and wanted to take us all to dinner and we all met in an in-between place right across Georgia and we went out to eat dinner and he said okay, you guys have got to help me. You’ve got to do your own molars. He said I can’t do it, you all refer more of these to me than anybody else and all of you are capable of doing your own molars. And he said I’m going to come to Douglas, we all meet there and we’ll have three days, three weekends where I’ll come over and we will just talk endodontics and I will show you slides and stuff. So that’s how I got started in it, and then after that he recommended I take a course at University of Florida which was three long weekends and Dr. Ritucci taught that. And that’s how I got started in rotary. It was- the only that that was available was profiles back then. That was when it first came out, and it was more or less a crown down technique. But that’s how I got started, was when the endodontist told me listen, you’ve got to help me. And at one time there were a lot of endodontists on Dentaltown and on Roots. Roots was not very good for general practitioners because Sirona was pretty rough on us, but Dentaltown was great. Endo files was great. We had people like John Levin was on there, I remember. He lives in Lafayette, Louisiana. He’s one of the best endodontists I’ve ever seen. Bill Watson was on another group. Bill Watson was probably maybe the best endodontist I’ve ever seen, and that includes all of them. But you don’t hear much from Bill. 

Howard Farran: What was Bill’s last name?

Guy Moorman: Watson. 

Howard Farran: Okay.  Where was he? Where was he?

Guy Moorman: He’s out in – I’m trying to think. He sort of disappeared because he had like eight children, he had to work pretty hard, and he was, he might have been, I’m not sure but…

Howard Farran: That was a good point, when all these students are worried about all their student loan indebtedness, well they can now bounce it off with a nice clean vasectomy. Don’t take advice from me, I had four boys before I had my vasectomy. I want to pin you down on a couple more things though. But when you said 15 was the largest hand file you go then you switch to rotary, do you leave the Apex Locator on the rotary file or do you just periodically pull out the rotary, stick in a hand file and check with the Apex Locator?

Guy Moorman: I try, I don’t leave it on, it irritates me on the file. So I take it off the file and…

Howard Farran: Off the rotary file?

Guy Moorman: Off the rotary file. And after about, well a couple of files, I will go back to it, but now…

Howard Farran: And when you’re doing rotary, are you doing crown down, bottom up, combination?

Guy Moorman: No, I’m doing whichever the…I’ve got my own technique and I use several files. I use ProTaper Next, I use BioRace. I still use some ProTaper, I have profiles still from way back, that if I want to enlarge an Apex I have O2’s. I use K3’s to finish my shaping of the canal, because K3’s are about the only file I’ve ever seen by now that’s landed. It has lands on it, so you’ll get a true taper. When you slow down to come out, it will not be a variable taper that you pick up with non-landed files. Most of them is a variable taper, so if you just use that file, a lot of times the cone will not go down. And the technique I do for operations, I need a master cone to fit well. I use something called system A that was taught to me by an endodontist, Jerry Avalon who, Jerry went into a state of depression and we sort of lost him for a while and he showed back up but he was a great endodontist with the University of Virginia. But he taught this system A and we used a PacMac. You can just use one cone. If you have a cone that fits well, just put the one cone in. If it doesn’t fit as well as you want it to, you can just wedge a couple of cones beside it. I don’t do lateral condensation, I just wedge it in there, go down with the PacMac until about 5 or 6mm and the apex tends to push the PacMac out, then I condense it with pudder. So I’m using the one vertical when I do it, but I’m using a PacMac, I don’t have- actually I do have but I just don’t use it. I’ve got a lot of Endox stuff that I don’t use anymore. 

Howard Farran: My advice to the file companies is, it would sure be nice if every single person who made a file would make a, get a perched master cone with the same theme- they go to these extremes to make a Cadillac, Ferrari, Lamborghini file, and then they’ve got to purchase some used car from another planet. I wish they’d put the same effort into the exact specifications, so if every master cone was exactly the same shape, size and length, that would be so much easier. And yeah I almost rather pick a file system that matched up my Gutta-percha obturating system than vice versa. And I also want to highlight something just in case some of these younger kids missed it, you said something very profound that a lot of you will miss, and that is they’re talking about bonding strengths on the build ups and files and all that, but you mentioned the ferrule and 28 years of watching these, if you don’t have 3mm of natural real tooth, they call it the ferrule, and if you don’t have 3mm all the way around the tooth, your crown’s not going to stay on, I don’t care what your build up is, I don’t care what your bonding agent is, you need 3mm of real stuff, and if you don’t have it you’ve got to go down, crown length or whatever, or in these modern days just pull the tooth out and go file. I cannot believe the hour has gone by and we have – it has been an hour but Guy, I just want to thank you for 50 years of doing dentistry. You know, a decade of – I mean I’ve read, you’ve got 6000 posts on Dentaltown, I probably read 10 000 of your posts back in the early days of our RusiX when it was only – we only had emails, and you’re a legend in dentistry, you’ve done so much. I can’t tell you how many times I’ve been to dinner, and in the conversation we’re talking and people will just say well Guy said this, Guy said that. Guy Moorman said this. And I just want to thank you for all that you’ve done for dentistry, all that you’ve done for endodontists and thank you so much for sharing an hour with me. 

Guy Moorman: Thank you Howard, I really appreciate it. I enjoyed it. I enjoyed meeting you. You’ve done a magnificent job for dentistry also, if you look at what you have done with Dentaltown, well actually it is the site now, where else would you go if you want to go learn? 

Howard Farran: Dentaltown is only valuable because guys like you share so selflessly. I mean my God you…and to my viewers out there, I don’t think there’s a question you can’t ask Guy. I mean about, just post it and he’s always there answering them day in and day out. And for that I thank you so much. 

Guy Moorman: Thank you. 

Howard Farran: All right have a great day. 

Guy Moorman: You too.

Howard Farran: All right, bye-bye. 

Guy Moorman: Bye-bye. 
Category: Endodontics

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