Asymmetrical Commentary in Endodontics

?One of the interesting observations I am making on linked in are some comments made by one individual in particular who doesn’t agree with my endodontic philosophy. There is absolutely nothing wrong with that and I welcome a collegial conversation on points where we differ. What motivates me to write this post is the evident freedom this individual feels in attacking my viewpoints as well as my character for holding such viewpoints with whatever evidence I offer from the literature as well as clinical examples and discussions detailing the clinical experiences also denigrated.?

?While an individual who actively is challenging viewpoints, research and clinical experience is free to do so, the very fact that he is making a challenge means he has alternate points of view and being the initiator in making those challenges does not take away from his responsibility to defend his point of view at least to the same degree he asks of others. His challenges include what he considers an artificial choice between the use of stainless steel K-files and the use of unrelieved and relieved stainless steel twisted reamers. He challenged me to offer evidence of the superior use of relieved K-reamers and I did so although he questioned the quality of the research, something he consistently does. Until now, I have not asked him to post research that either says K-files are superior or that the use of either is simply arbitrary. His providing his point of view with accompanying research articles and perhaps clinical examples would transform his approach from an asymmetrical exercise into a more balanced one.

?Along those lines, I have also been challenged regarding the non-distorted shaping that is produced when sequential unrelieved and relieved stainless steel reamer prepare highly curved canals. I have shown myriad examples of cases where these oscillating reamers have shaped highly curved canals without any obvious signs of distortion. He has not offered any corresponding ability of the K-files to perform this task without distortions. In reality, this is acceptable if he finds the use of K-files in larger dimensions incapable of maintaining canal integrity. If that is the case, however, he should note that non-distortion beyond a certain size in highly curved canals is a limitation that K-files cannot provide.

?He has also challenged the concept of 30o oscillation being capable of shaping canals in three-dimensions requiring vigorous application of the instruments against all the canal walls while being virtually immune to separation. He said that virtually is a copout, leaving room for the possibility of separation. In fact, I use the term virtually to define a miniscule possibility of separation that in all the years that I have been using them in 30o oscillation has failed to occur. I suppose there is no corresponding reply he can make if he does not employ the K-files in the oscillating handpiece beyond their thinner sizes, certainly not beyond a 20/02.

That leads to his active defense of rotary instrumentation that he states has allowed dental students to shape canals better and more predictably and that my enthusiasm for oscillating relieved reamers is a misdirection that is a barrier to improved instrumentation. If one looks at the studies where rotary has been introduced to the students, the comparison is not to oscillating reamers, but to the former manual use of K-files, a technique that I abandoned long ago. Now for a criticism that centers around “virtually” in regards to 30o oscillating stainless steel relieved reamers, I would not even challenge him to employ the same word to rotary instrumentation. An immense body of literature has clearly defined the vulnerabilities of rotary NiTi to separation. To avoid that possibility, they are routinely used with a light pecking motion with predominantly centered shaping that has been shown to not only leave pulp tissue in the buccal and lingual extensions, but impacts those spaces with dentinal debris generated mesio-distally that impedes the beneficial effects of NaOCl and EDTA.

I believe it is difficult to defend the three-dimensional cleansing capabilities of rotary NiTi??when a significant body of research has documented anywhere from 35% to 50% of the pulp tissue remains after rotary shapes complex anatomy. I leave it to him to supply the research that resolves this dilemma. I commented on the data regarding missed pulpal tissue and associated bacteria and his response was that it must not matter given the high success rate rotary delivers. I would challenge him to supply supporting data that confirms a higher success rate using rotary NiTi than that produced using oscillating stainless steel reamers that clearly have the ability to reach the extended recesses of pulpal anatomy.?

I have zero problem in his adopting any technique he pleases. He is skilled and will make the most of any technique he utilizes. What I object to is personal degradation. There is no place for it and certainly no need other than a peculiarity of human nature that seems for some to enjoy a forum where they can indulge themselves in this manner.

Regards, Barry