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Dr. Zupanc, a few months ago you took over a dental practice and repositioned it. What are your standards when working with your patients?

With our dental focus on periodontology and endodontics, we are strongly oriented toward tooth preservation and also want to offer our services in cases where others reach their limits. These include, for example, challenging endodontic cases such as fragment removal, perforations, or severely obliterated root canals. Both clinically and in terms of the instruments and endodontic systems we use, we are committed to working at a very high level of quality. 

You specialize in endodontics. What equipment do you use?

First and foremost, imaging is crucial. In our practice, we rely on the Veraview X800 from MORITA, a 2D/3D X-ray combination unit (CBCT) that makes even the smallest details visible. For root canal treatment, I use the Tri Auto ZX2+ endomotor (with integrated apex locator) Tri Auto ZX2+ and the Root ZX Mini apex locator, both products are from MORITA. Finally, I use my microscope throughout the entire treatment.

Why did you choose MORITA’s endodontic solutions?

MORITA is a well-respected name in endodontics and, in my opinion, offers the best endodontic CBCT (cone-beam CT) on the market. I have been working with the Veraview X800 X-ray system since 2019 — initially at a referral practice in Bonn and now also at our practice in Dortmund (Germany). Furthermore, MORITA stands for values such as reliability and high quality. MORITA devices are fully mature when they come to market, which means they require little maintenance and are less prone to malfunctions.

With the MORITA Tri Auto ZX2+ you use an endodontic motor for modern root canal instrumentation. What has your experience been like?

In Bonn, I still worked with a endodontic motor with cable. In our practice, however, I wanted to switch to a cordless motor without a foot pedal. That’s why I opted for a “handheld” instrumentation solution. There are many devices on the market now. What convinced me about the Tri Auto ZX2+ endodontic motor with integrated apex locator from MORITA was above all the OGP2 (Optimum Glide Path) mode and the OTR (Optimum Torque Reverse) mode. These two modes make the motor special.

It is said that OGP2 uses a new reciprocating oscillating motion to reduce the risk of file separation to a minimum. What is your experience?

Because glide path preparation is naturally carried out with very thin instruments, file separation during this step is almost always due to torsional fracture: the file tip binds in the canal, continues to be rotated by the motor, and ultimately breaks. With thin glide path files, torque limitation alone does not reliably prevent these torsional fractures, based on my experience. That is why I found OGP2 so interesting: with its reciprocating oscillating movement, the instrument is advanced in the canal in a way similar to the watch-winding motion we know from manual glide path preparation. Even if the instrument tip binds, this minimizes the risk of the motor “over-stressing” the instrument. Especially for glide path preparation or instrumentation of very tight canals, this is a feature I would not want to do without anymore.

Do even experienced endodontists sometimes break a file in the root canal?

I always like to quote my former boss and doctoral advisor, Prof. Dr. Edgar Schäfer, who said: “If you’ve never broken a file, you’re not doing much endodontics.” So yes, with 350–400 fully treated molars a year, it happens to me too, but fortunately it’s very rare. Unfortunately, no motor can prevent this 100%.

In your experience, which factors play the most significant role in ensuring clinically successful treatment during mechanical preparation?

The endomotor is certainly important, but to be honest, manual techniques play at least as significant a role in terms of control, tactile feedback, and safety—especially when dealing with complex anatomical conditions. Nevertheless, the motor must have good torque and a reasonable torque limit so that I can prepare the canal safely. The workflow is also important. I want to be able to set different modes so I can work in both reciprocating and fully rotating modes. The Tri Auto ZX2+ endomotor allows for this and also offers reverse rotation. I really like this programmability of the device. And the measurement capability available simultaneously with preparation provides me with a simple aid.

How do you use the preset memory programs in the Tri Auto ZX2+—in other words, what does your workflow look like?

There is a total of nine preset memory programs from MORITA. You can use them as they are, or—as I do—assign and program them individually. For example, I always start glide path preparation in OGP2 mode. I assign that to M1. Then I continue in continuous rotation and set the MANI file on M2. In difficult cases, I like to switch back to OGP2 or use OTR mode.

The Tri Auto ZX2+ features an optimized apex stop. Is that helpful? 

I have to admit that I don’t use this feature because I prefer a different workflow. I always measure the canal beforehand using the Apex Locator Root ZX mini and hand files. For an optimal, reproducible measurement, the canal should only be slightly moist; however, for preparation, I prefer to completely flood it with sodium hypochlorite. Ultimately, it’s a matter of personal preference. Many dentists measure simultaneously, while others do so prior to preparation. I belong to the latter group.

Dr. Zupanc, there are sometimes complex cases—hidden and curved root canals, for example. How do you prepare for such cases?

First, we always take a 2D image or receive one from the referring dentist. This often allows us to assess the complexity, and in individual cases we additionally take a 3D image with a small field of view. This allows to identify the canal anatomy and potential difficulties very precisely. Then we decide on the appropriate file system and set the endodontic motor accordingly.

Do the X-ray images from the referring practice meet your requirements as an endodontist?

It can become challenging when patients come to us having already had a 3D CT image. Often, these 3D images have been taken with a volume that is far too large and, consequently, an incorrect resolution. In the worst-case scenario, such images provide me with no additional information for treatment planning compared to a 2D X-ray. We are then faced with the dilemma of either forgoing treatment-relevant information from the 3D image or having to take a new image, which means not only additional costs for the patient but also an increased radiation dose.

For endodontic cases, I therefore prefer to take the CBCT image ourselves. The Veraview X800 combined X-ray unit features a high-resolution endo mode with a small field of view. This allows me to obtain exactly the information I need for my treatment with minimal radiation exposure.
 

You use different filing systems depending on the case, including MANI—what has been your experience with MANI? Is there anything unique about it?

We use MANI’s rotating, radially landed JIZAI files—files that, thanks to fewer cutting points, prevent excessive twisting and thus minimize the risk of breakage. In my opinion, these differ significantly from other file systems on the market. MANI endodontic files offer excellent flexibility without twisting in the root canal. With the radially landed MANI file, I can very reliably maintain the natural course of the root canal. While this isn’t quite as fast as with other file systems, the question is whether I really want that level of aggressiveness in the canal. In simple cases, you can reach the goal quickly with them. But if you have an apical curvature, as is typically the case at the distal root of the lower 6th or 7th tooth, using a file that’s too aggressive can quickly damage the natural structure and create a step. You can handle something like that much more smoothly with the MANI files.

How user-friendly is the Tri Auto ZX2+, especially regarding changing files?

In my workflow, one special feature is that I use two devices. That way, my assistant can already set up the next file, and I only need to switch devices. Sometimes I use six to seven files for instrumentation, so a quick change makes sense. The great thing is that I can change programs with one hand, without looking away from the microscope. The major advantage of the Tri Auto ZX2+ endodontic motor is that there are no cables and no foot pedal, and everything can be adjusted directly on the unit. I can also place it wherever there is space.

You already mentioned the Root ZX Mini. What has your experience with this apex locator been like?

When we took over the practice in 2025, new equipment was purchased. In Bonn, I had already worked with the Root ZX apex locator for the past seven to eight years. I know the device and how to interpret the readings. That made the decision relatively easy, so I chose the Root ZX Mini. It’s fast, simple, small, and handy. The Japanese ability to fit a lot of technology into a small space is also an important factor — the device takes up very little room on the delivery cart. Measurement works in different environments, and I don’t need to calibrate the device. MORITA’s innovations have long been pioneers — especially when it comes to reliability.

Finally, looking ahead: from an endodontist’s perspective, what innovation still needs to be invented?

It would be really great if we were a bit more digitally advanced with microscopes. Ideally, I would like the radiograph and the apex locator display to be projected into my small working field so that I would have to look away from the microscope even less. Other than that, we are already very well equipped.
 

Dr. Zupanc, thank you very much for this interesting conversation.