Accusations Without Evidence

The critic has repeatedly taken on the roll of divining my intent in the posts I place on linkedin, concluding that my sole motivation is to maximize my profits. In that quest he says I have misinformed and lied in two ways, making the shortcomings of rotary NiTi worse than they are and making 30o oscillations of relieved stainless steel twisted reamers better than they are. What does he offer as proof of lying and deceitfulness in reaching that goal?

As an assessment of my character, his conclusions cannot be based on anything other than his gut feelings, a process devoid of actual evidence. Perhaps, he believes that anyone running a business is solely interested in maximizing profits and the only way to do that is by lying and being deceitful. If that is the case, he should be applying that cautious attitude with everyone he has a business relationship with. As a director of a post-graduate endodontic program that would include numerous relationships with manufacturers and their representatives. In reality, his negative assessments of the character of business owners is limited to me. What do I do that merits such attention? I write posts that offer the dentists data and examples of rotary NiTi weaknesses and the strength of 30o oscillating stainless steel relieved twisted reamers.

Since he has already stated his opinion of my character, it is a natural sequence of one possessed of such a mentality to deny any veracity to the data and clinical examples I offer. The problem he has here is that the vast amount of data I offer is thoroughly documented in the literature. Let’s take some examples both those negative regarding the use of rotary NiTi and the positive for the use of 30o oscillating relieved stainless steel reamers.

The data regarding rotary NiTi’s potential to separate as canal anatomy becomes more complex. There are literally several hundred studies that attest to this fact. His response to this data is for the most part no response at all or stating succinctly it is a rare event. That is a lot of documentation for what he describes as a rare event as well as the invention of several techniques to remove the fragments left in the tooth from this rare event. On a fairly routine basis, here on linkedin, dentists post cases regarding the removal of fractured segments. From my own communications with dentists at our workshops, instrument separation is not the rare event he claims it to be nor is it one that is not a major concern of the dentists employing rotary NiTi.

A great deal of data has been documented regarding the inadequate debridement of oval canals and thin isthmuses when using rotary NiTi, the result of the need to stay centered to avoid instrument separation. Here, the critic uses a different tactic. He never refers to those myriad studies. Rather, he points to studies all over 10 years old that in comparing rotary against 30o oscillations, rotary’s results were superior in terms of degree of debridement and in the amount of distortions produced during the instrumentation process. It is entirely fair for him to reference these studies. It is also entirely fair for me to dispute the value of these studies for the following reasons:

. These studies from 10 or more years ago used a series of stiff NiTi instruments designed with the horizontally oriented flutes of a file, a configuration that not only tends to straighten curved canals to the outer wall, but tends to impact debris apically with loss of length, effects that as developers of this alternative system, we realized were counterproductive abandoning their use as part of the system. Today and for the past several years, they are no longer part of the system. By removing these instruments we removed their potential to distort curved canals. As of today, there is no published literature that I am aware of that has made comparative studies that this problem still exists. To constantly quote literature that includes the instruments that have long since been abandoned does not reflect the way things are done today. For a person well-versed in the several generations of evolution that rotary NiTi has gone through, it should be understood by the critic that what counts today is the way things are done today.

. While the removal of NiTi instruments designed as stiff files no longer causes straightening of curved canals to the outer wall, why would rotary NiTi which must stay centered produce superior debridement than a system that can be vigorously applied to all the canal walls, regardless of the complexity of the pulpal configurations? This can come about through design of the testing protocol. If the protocol calls for centered shaping for all the systems tested, the protocol is not addressing the main advantage that 30o oscillations have over rotary, their complete immunity against separation that gives the dentists the freedom to apply them vigorously against all the canal walls. If the protocol is limited to canals round in cross-section, the protocol lacks the more complex anatomy that compromises the use of rotary, but not 30o oscillations.

Given the impact of design of the protocols, it is important for researchers to be aware of how each system is used to their maximum advantage. Without this knowledge researchers can inadvertently produce results that don’t reflect clinical reality. An unbiased reading of the literature should make these observations clear. There are, however, more nefarious causes of research that favors one system over another, namely corporate sponsorship, a factor that has an unknown degree of impact on producing predetermined results. Supporting that thesis is the documented fact that 80% of endodontic academics, including those doing the research receive industrial payments. The fact that research is often supported by corporate sponsorship and the researchers, themselves, may be part of the 80% that receive industrial payments must be another factor to be considered in assessing the quality of the research to date.

The critic to date has made no comments on this study, but he supports the results of outdated research and protocols that coincidentally support rotary NiTi assuming without question that all is above board. Given the 80% recipients of industrial payments this is a Pollyannaish attitude that suggests where his bias lies.

. To display the non-distorting potential of the 30o oscillations of relieved stainless steel twisted reamers I have posted many cases with highly curved canals that I believe make the point convincingly. The French study also showed superior debridement using the oscillating reamers along the entire length of the canals compared to three rotary systems. Regarding the posted x-rays of highly curved cases, the critic responds by noting in one case the he describes as excessive amounts of dentin removed coronally ignoring the right angle bends that were successfully instrumented without any apparent distortions in mb and mb2 and subsequently obturated in the apical 2/3 of the canal. He then makes generalized remarks about distortions without pointing to examples in the cases I posted. On the other hand, when I pointed out a similar excessive widening in a case he posted he took umbrage at the fact that apically this particular case was spectacular, another example of selective criticism.

Today laser irrigation systems are being touted as the solution to the inadequacies of rotary instrumentation, inadequacies that have been reported on over their long use as the most advanced of instrumentation systems. This is an extremely expensive adjunct that has not been shown to date to increase successful outcomes and has been shown in the research to induce dentinal defects. When I posted this research it resulted in the critic’s anger to me. There was nothing personal in the literature I posted and certainly did not call for such a response bringing up the question of why such a response, the reason becoming increasingly obvious without stating it. The process of debate minus personally degrading remarks is the best method of arriving at contemporary truths. These truths will change over time. It is called progress and exists most healthily when mutual respect and an open mind are part of our basic principles.

Regards, Barry