Dental Tribune U.S. Edition

By L. Stephen Buchanan, DDS, FICD, FACD Nickel-titanium rotary shaping files fundamentally changed every- thing in endodontics; conceptually, procedurally and economically. The efficiencies gained offset the costs, and dental companies were loved for making files that cost four times more than SS hand files but deliv- ered a tenfold improvement. Those seeds of success have grown into today’s endo market where we have come to expect another new file on the market every six months. Granted, it’s a quality problem, but while some of these new instruments have sig- nificant improvements in tip and blade geometry or were made with improved metallurgical and forming processes, some have offered little advancement over existing technol- ogy. Their introductions were just business moves proposed to benefit a dental company instead of dentists and their patients. So how do we sort through the list of new instruments and decide whether any of them truly offer clin- ical advantages commensurate with the high cost of purchasing new instrument inventories, new hand- pieces and the retraining needed to become competent in their use? To my mind, there are only a few reasons to change to a new rotary file system: 1) Improved safety and consis- tency of result. 2) Improved efficiency if the safe- ty and outcomes imperatives have been met or exceeded. 3) Improved procedural simplic- ity and/or cost of providing end- odontic services to patients. In that order! Any new instrument delivering improved efficiency at the cost of safety and predictability of outcome is a fool’s choice. So if we are choosing for excellence of out- come, we usually look at our failures and consider how we could elimi- nate those painful and expensive experiences from practice. However, deconstructing end- odontic failures can be nearly impos- sible, so it is imperative for dentists to choose for the right reasons. One of the greatest challenges to dentists making these decisions wisely is the difficulty of decon- structing endodontic failures — the prime example being failures due to apical damage caused by aggressive tip and flute geometries. Dentists who use rotary files have all suffered instrument separation when difficult anatomy is encoun- tered and rotary files are allowed to rotate for too long. This is why dentists interpret a new rotary file that cuts effortlessly to length in such positive light, despite the reali- ty that serious laceration will almost always result when aggressive tip and blade geometry intersects dif- ficult apical anatomy. The only evidence of the disas- trous shaping outcome is the inevi- table overfill that follows — a result AD Additions to the NiTi rotary file market What to bring in and what to leave out DENTAL TRIBUNE | September 2011 Industry News 19A g DT page 20A