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Endodontics:

Procedures That Finally Make Sense

Consequences of the present way endodontics is being taught

Rotating NiTi: continuous and interrupted

1. Increased chance of instrument separation

1. Increased chance of instrument separation2. Increased degree of torsional stress to the

instruments and the tooth.

Aggravated by the narrow mesio-distal dimensions of the canal and the greater taper of the rotating

NiTi instruments


instruments and the tooth.3. Requires crown-down preparations and straight

line access.



line access.4. Both procedures remove excess tooth structure

in the mesio-distal plane.

The role of mechanical instrumentation in the cleaning or root canals. Zvi Metzger, Michael Solomonov, Anda Kfir. Endodontic Topics 2013;29:87-109.


instruments and the tooth.3. Requires crown-down preparations and straight line

access.4. Both procedures remove excess tooth structure in

the mesio-distal plane.5. Not effective in cleansing in the bucco-lingual

plane.



line access.4. Both procedures remove excess tooth structure in

the mesio-distal plane.5. Not effective in cleansing in the bucco-lingual

plane.6. Produces dentinal micro-cracks.



line access.4. Both remove excess tooth structure in the mesio-

distal plane.5. Not effective in cleansing in the bucco-lingual

plane.6. Produces dentinal micro-cracks.7. With a non cutting tip and flutes that drive the

instrument apically, increased amounts of debris are driven apically.

The same rotating fluted design that draws the instrument beyond the apex will also drive the debris

in front of the tip beyond the confines of the root.

8. Reduces resistance to vertical fractures.

When tooth structure is excessively removed in the mesio-distal plane in teeth where the pulp is very thin in that plane, the roots become weaker.

8. Reduces resistance to vertical fractures.9. Gives the canal a shape that increases the

masticatory stresses.

Again, a result of excessive removal of tooth structure in the thinner mesio-distal plane.


masticatory stresses.10. Only for single usage.


masticatory stresses.10. Only for single usage.11. Very expensive.


masticatory stresses.10. Only for single usage.11. Very expensive.12. Increases procedural stress.

When the dentist must be constantly conscious of the impact of the procedures on the integrity of the instrument rather than the integrity of the

root, it underlines the fact that he/she is using a poorly conceived product.


masticatory stresses.10. Only for single usage.11. Very expensive.12. Increases procedural stress.13. Still dependent upon the K-file for the glide

path.

K-files are used manually for the creation of the glide path producing hand fatigue and tend to

impact debris apically in curved canals resulting in loss of length before rotary NiTi is employed.

And that brings us to a far safer, more efficient, less expensive approach to endodontic instrumentation

that virtually eliminates hand fatigue and separation while preserving far more tooth

structure.

Now let us consider 30º reciprocation of modified reamers oscillating at 3000-4000 cycles per

minute.

1. Use of modified reamers rather than K-files thatencounter less resistance making the shapingprocedure faster.

K-File

Relieved Reamer

Relieved Vertically Fluted Instrument

K-File

We use these instruments rather than k-files.

Comparing relieved vertically fluted instruments to k-files we observe the following:

1. Fewer flutes on the 16 mm of working length of a relieved vertically flutedinstrument than on a k-fileapproximately 16 flutes versus 30.

Consequences of fewer flutes:

1. There is less engagement along length.

2. Relieved vertically fluted instruments are more flexible than files because they are less work hardened and thinner in crosssection.

3. The flutes are more vertically oriented.K-File



K- File

Consequences of less engagement:1. Less resistance along the shank as we

negotiate apically.

Consequences of greater flexibility:1. Able to negotiate curved canals with

less chance of distortion.

Consequences of more vertically orientedflutes:1. Able to cut dentin along canal length

when the motion of the instrument iseither horizontal rotation or reciprocation.

Taken together, the consequences of greater flexibility, lessengagement and more efficient cutting along length produce

a superior tactile perception along length and at the tip of the instrument.

The consequences of superior tactile perception:1. Allows the safe incorporation of a cutting tip.

The consequences of a cutting tip:1. The ability to pierce pulpal tissue rather than

impact it apically.

2. The ability to distinguish between a tight canal and hitting a wall when used in awatchwinding motion or a reciprocatinghandpiece.

The incorporation of the reciprocatinghandpiece allows a 30º arc of motionoscillating at 3000-4000 cpm.

A 30º arc of motion represents 1/12 of a circle or 5 minutes on the face of aclock.

The motion is so limited it virtually eliminates the 2 major factors that cause rotary NiTi files to break and unwind,namely, torsional stress and cyclic fatigue.


2. No hand fatigue after the initial instrument goesto the apex.


2. No hand fatigue after the initial instrument goesto the apex.

3. Virtually no chance of instrument separationduring the full shaping of the canal.

A 30º arc of motion virtually eliminates torsional stress and cyclic fatigue in turn eliminating

instrument separation and dentinal micro-cracks.

1. Use of reamers rather than K-files thatencounter less resistance making the shapingprocedure faster.

2. No hand fatigue after the initial instrumentgoes to the apex.


4. Far less tooth structure sacrificed in the mesio-distal plane.

Rarely, if ever, do we exceed an 04 taper, thus preserving dentin in the mesio-distal plane while removing more tissue in the bucco-lingual plane.

Nor is straight-line access necessary.





5. Greater debris removal in the bucco-lingualplane.





5. Greater debris removal in the bucco-lingualplane.

6. No dentinal micro-cracks.

7. Less reduction in resistance to vertical fracture.

7. Less reduction in resistance to verticalfracture.

8. Lesser tapered preparations making thetooth more resistant to masticatory forces.



9. Used multiple times.



9. Used multiple times.10. Relatively inexpensive.



9. Used multiple times.10. Relatively inexpensive.11. Far less procedural stress.



9. Used multiple times.10. Relatively inexpensive.11. Far less procedural stress.12. Faithfully follows the glidepath created by

the most flexible 02 tapered stainless steelreamers.





13. Pushes far less debris over the apex becauseof a cutting tip and not being drawn into the

depths of the canal.





13. Pushes far less debris over the apexbecause of a cutting tip and not beingdrawn into the depths of the canal.

14. Superior measurement control.

Simple predictable sequencing

(includes both the glide path and full canal shaping as part of the system)

30/04

30/02

You have been presented with a detailed rationale for modified reamers over K-files, 30º reciprocation

oscillating at 3000-4000 cycles per minute rather than continuous or interrupted rotations and the

predominant use of stainless steel 02 tapered instruments rather than greater tapered NiTi that will

increase the quantity and quality of the remaining dentin while increasing the speed and safety of your

procedures.

The relieved reamers combined with the 30º reciprocating handpiece are commercially known as

the SafeSider Instruments and oscillate in the handpiece called the Endo-Express.

For further information on learning these techniques call the offices of Dr. Barry Musikant.

The office number is 212-582-8161 and the address is 119 West 57th Street NYC, NY.

Our E-mail address is [email protected]

For those interested in reviewing supportingresearch it is available on request.

mailto:[email protected]

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