A Discussion On The Incentives Perhaps Motivating One Individual

The critic has repeatedly claimed that my sole interest is in selling the products we developed to maximize my profits, that those products are inferior to those he favors and that I know it, but due to my greed I will lie to attain those profits. He offers no explanation of how he knows my motivations. Rather, he evidently deduces it from the fact that I am part owner of a company that develops endodontic instruments and offer data that conflicts with studies that describe NiTi’s superiority.

So, let’s discuss incentives and motivations. As an endodontist for over 50 years and still in full-time practice, something he ignores in his characterization of me as a “peddler”, just like any dentist or endodontist, I want my procedures to be safe, effective and efficient. Early on, I bought into rotary NiTi and experienced the fairly rare occurrence of instrument separation. Unlike separating a stainless steel instrument that was pretty much avoidable by making sure they were used with short arcs of motion, rotary NiTi would occasionally separate without warning no matter how carefully I thought I had employed them.

For me such unpredictability was intolerable and its avoidance became a strong incentive to create a system that would not subject the instruments to the stresses that produce these separations as well as relieving me of the psychological insecurities that accompany the use of what I consider an unpredictable system. That motivation had nothing to do with maximizing profits. I wanted increased security in my practice without decreasing effectiveness and efficiency.

Without question, employing received stainless steel reamers in a handpiece limited to 30o arcs of motion virtually eliminated instrument separation affording me the freedom to apply these instruments vigorously against all the canal walls. This ability overcame the necessity of rotary NiTi to stay centered in canals even when highly oval to reduce the incidence of instrument separation resulting in the many studies that document inadequate debridement of complex pulpal anatomy. So, compared to rotary NiTi, the 30o oscillating relieved stainless steel reamers give me the ability to perform superior debridement.

My presentation of such data is described by the critic as lies and disinformation, but it is only common sense that superior debridement would result from a system that is vigorously applied to all the canal walls. While he offers data that challenges that assertion, he also ignores the data that I reference in supporting that claim and is in line with common sense observations. As a practicing endodontist, having the ability to more thoroughly cleanse canals without any concern for instrument separation was a major improvement doing away with the insecurities and limitations in canal instrumentation that rotary imposes.

In the process of testing the 30o oscillating relieved stainless steel reamers on extracted teeth often with highly curved canals, we also found consistent with the balanced force technique that confined to short arcs of motion, the reamers stayed true to the original canal anatomy. That is another area the critic challenges me on despite the large number of cases I posted with highly curved canals that show no apparent signs of distortion.

So, I am describing incentives and motivations that have nothing to do with profits. The excitement was about developing an alternative instrumentation system that did away with instrument separation as a cause of concern, consequently, freeing up the dentist and endodontist to apply the instruments vigorously against all the canal walls with the added feature of staying true to the original canal anatomy.

Now having developed the system and testing it extensively in our own practice we thought the advantages this approach introduced in the face of rotary NiTi’s drawbacks would be attractive to dentists who likely had the same concerns regarding rotary NiTi that we had. There were never any lies or misdirection. There are descriptions of the way we use them, why we use them in this fashion and the data accumulated that supports their usage. If the critic condemns information that comes from a profit making corporation, to be consistent he has to condemn just about all innovation that has come about in this country. It is simply not a reasonable position to take. Certainly, he has every right to question the data supporting various positions, but he is also subject to the same scrutiny. When one accepts honorariums, something he has done throughout his career, he has at least a partial incentive to please those sponsoring him.

In a way, lecturing for the honorarium sponsored manufacturing corporations is a bit like the rating agencies the investment houses use to attain ratings on the mortgage backed securities they sell. A good portion of those securities attained the triple A rating equal to federal government securities with the exception of higher interest bearing rates. In the 2008-2009 great recession we know where they went. The problem was that the investment houses selling the securities were those paying the rating agencies. The rating agencies were not going to get more business if they applied less than the most positive ratings on those securities. The investment houses would simply switch to one that would be more cooperative.

You tend to please those who pay you, so you can continue in this mutually rewarding relationship. Now the sponsored lecturer may, indeed, be excited about what he is talking, but he/she cannot deny the obvious incentive that is present in honorariums. I have no idea what the combination of incentives add up to and to make character assessments based on unsubstantiated opinions is reckless and destructive. I would hope he would follow the same form.

In that same light, our initial motivation in developing what we believe is a safe, more efficient and effective way to instrument canals had little do with thoughts of profits. We had solved problems in our own practice adopting techniques we developed. To condemn us because we brought these innovations to market and interpret our actions as one of pure greed is reckless and leaves no room for the joy and satisfaction of developing products that are genuine solutions to existing problems.

People are far more complicated than the critic wishes to recognize. At the same time we are far simpler. Most of us attempt to live by principles we grew up with, honesty being one of them. For most of us, we equate honesty with good. I don’t think I am going to far off the beaten path stating that most of us feel good when we do good things. Lincoln said precisely that. The critic will say what he says, but for me it doesn’t detract from my beliefs that we are attempting to expand the endodontic education so the decisions one makes are based on a broader amount of data than was formerly available. If that is a character flaw in his eyes, so be it.

Regards, Barry.