Analyzing the Actions of My Critic Regarding Endodontic Discussions

From my perspective, he embodies the action of projection. He projects onto his target unsavory acts that he himself commits. For example: He says I make statements that are not backed up by research, such as 30o oscillating reamers producing superior debridement of the canals compared to rotary NiTi. He states that the data I offer to support this claim is inadequate in making that point valid. He does not state why the data I offer is invalid. It is enough for him to simply state it as so. What he does not address is a large body of data clearly indicating rotary’s incapacity to cleanse oval canals and thin isthmuses. So while I show data that supports my claims, he ignores the data that documents rotary’s inadequacies in debridement altogether. I would claim that given this particular example it is he who is projecting his misdirections onto me.

One may not agree that one set of data fully supports my claim of superior debridement. To overcome the doubts that might be assigned to a single data point, I offer a combination of data points including cross-sectional studies showing full debridement and obturation of oval canals. I add to that data video showing the complete debridement of the mesio-buccal and mesio-lingual canals of a mandibular molar as well as the complete debridement and obturation of the isthmus connecting the two, a pulpal configuration that rotary has been shown in micro-ct scans not to touch leaving the tissue and bacteria in place. I add to that data the French study that I have previously posted comparing the cleansing of the canal walls using rotary systems to the oscillating reamers that documents that the full removal of the smear layer and opening of the dentinal tubules along the entire length of the canals was only accomplished with the oscillating reamers.

For my critic this data is still not enough to support my claims. That’s fine, but given his critical appraisal?of the data I offer, I would expect a much higher standard of response from him that contradicts?the well-documented evidence of rotary’s inadequate debridement of oval canals and thin isthmuses. Rather than offering any ameliorating data he offers nothing to contradict those studies. Evidently, he believes no response is the best response regarding this issue. This strategy to degrade a competitive technique as well as its advocate does not in my opinion represent the essential exercise of critical thinking. Rather, it is a strategy that recognizing the validity of the data challenging rotary’s claim of superiority simply ignores it and aggressively and indiscriminately attacks the opposition. In short, it is a strategy counting on indoctrination and stimulating emotions rather than relying on a combination of data, common sense and clinical experience.?

As the endodontist who completed my root canal therapy on my mandibular second molar said, to work the canals laterally for better debridement he utilizes stainless steel hand reamers to avoid a higher incidence of rotary instrument separation. What he has concluded via years of clinical experience is that given rotary’s predilection to separate when applied laterally particularly in curved canals it is best limited to centered shaping with the extensions of oval spaces and isthmuses more safely attended to with hand instruments used with pull strokes and manually applied short arcs of motion. Engine-driven 30o arcs of motion are simply a safer and more efficient way to apply these short arcs of motion.?

So, I imagine his tactics will continue with no sense of irony. He will insist that I present data to support my claims followed by stating the data is irrelevant, inaccurate and false combined with the further tactic of never addressing the issues of breakage and inadequate cleansing that have compromised rotary’s usage since its inception. As I now routinely state in many of my posts, the best way to evaluate the merits of both systems is to compare the usage of the oscillating relieved twisted reamers to any of the rotary?systems that the majority of dentists have learned first in dental school and then reinforced by intensive marketing over the years. In that regard, we offer our endodontic workshops where the dentists can reach their own conclusions regarding what they believe works best for them.

Some further thoughts on the responses my critic employs regarding my data points: I present data in the form of photographs and video that clearly show the three dimensional cleansing of oval canals and thin isthmuses. They are readily available for anyone to view them. Because the cross-sections have not been published in research journals it is my critic’s contention that they are not valid evidence, what anyone can plainly see is not real. According to that same reasoning whatever is published represents the truth. Yet, the abundant amount of published research regarding instrument separation and the inadequate debridement of oval canals and thin isthmuses is ignored by my critic.?

I don’t believe that I am too far off base in calling this dichotomous?viewpoint a reasonably good example of biased reasoning. He would be so much more consistent if he simply said that in his hands and the hands of his students he feels more comfortable with the rotary systems and sees no reason to teach or learn any other approaches. Obviously, he is not limited to that particular narrow preference. His greater goal is to undermine the approach we use and to turn an old Bing Crosby song on its head, to accentuate the negative, eliminate the positive, latch onto the critical and don’t mess with mister in between. Balance and broader viewpoints are out the window when alternatives offering solutions make their appearance.

Fron a strictly unbiased perspective, why would anyone not see the value in the fact that stainless steel relieved twisted reamers confined to short arcs of motion virtually eliminate instrument separation? Is it such a quantum leap in insight to realize that once instruments are immune to breakage they can be used far more aggressively against all the canal walls whether or not the canals are highly curved? Does he not see from the cases I have posted over the years using the 30o oscillating technique that short arcs of motion also prevent distortions and the transportation of canals even in highly curved cases? A more open mentality would be more consistent with his contention that unbiased education is his main goal.

Finally, lets address the reasons for the aggressive confrontation of my critic regarding the alternative instrumentation techniques we advocate.

• My posts don’t encourage the expanded use of rotary NiTi.
• My posts clarify the vulnerabilities of rotary NiTi
• For each rotary weakness, 30o oscillating reamers offer a solution
• After all the academics are accounted for, the bottom line for the manufacturers is increased sales, profits and market penetration
• A well-run marketing effort is always on the lookout for potential competitors particularly when the competitors accentuate the shortcomings of the dominant systems
• Rotary wishes to monopolize the major opinion leaders. To have an opinion leader with a decidedly different message is damaging to the branding concept of rotary in general and?more specifically?to the individual products. When an opinion leader is wayward it is best to diminish his impact as thoroughly as possible, but one must be careful in doing this lest it?backfire and further hurt the brand.
• Create distance between the acts of degradation and the company that implements the tactics. In that situation the person doing the degrading may not even realize his job of doing the unsavory work that the manufacturers don’t want to be identified with.

Regards, Barry