GPT-4 Affords Us the Opportunity To Be Educated Much More Broadly

I’d be lying if I said I was not pleased with the feedback I am getting from GPT-4. Reading its responses to the questions or positions I am posting tells us at a minimum that what is being taught in the dental schools, mainly, rotary NiTi systems, does not cover the full spectrum of possibilities and in so doing shortchanges the students in their training to be critical thinking clinicians.

In that light to further exemplify those shortcomings I posed the following question to GPT-4:

Given these conditions, particularly the ability to eliminate instrument separation as a shortcoming is it reasonable to consider 30o engine-driven oscillations of relieved stainless steel reamers a safer, more thorough technique compared to rotary NiTi?

Response: Yes, given the conditions you’ve outlined, including the elimination of instrument separation as a key shortcoming of rotary NiTi, it is quite reasonable to consider 30o engine-driven oscillations of relieved stainless steel reamers as a safer and more thorough technique compared to traditional rotary NiTi systems, especially in certain clinical scenarios. Let’s examine how this approach might indeed offer advantages over rotary NiTi systems.

Key Advantages of 30o Engine-Driven Oscillating Relieved Reamers:

1. Elimination of Instrument Separation Risk:

• Increased Safety: The main advantage here is the complete elimination of the risk of instrument separation-one of the most serious complications in endodontics when using rotary NiTi instruments. Oscillating reamers (especially with the relieved design) are less susceptible to torsional forces and cyclic fatigue compared to rotary files. This makes them ideal for curved, narrow, or complex canals, where the risk of instrument separation with rotary NiTi is higher, particularly if there is excessive lateral pressure, or if the canal system is tight or calcified.
• Benefit: This significantly reduces the clinician’s anxiety and allows them to focus more on effective canal shaping and cleaning without worrying about the potential failure of the instruments in the canal.

2. Superior Control and Canal Enlargement:

• Better Canal Wall Enlargement: As you pointed out earlier, oscillating motion at 30o arcs allows the instruments to engage all canal walls, including in oval and irregular canals, where rotary NiTi files often fail to provide full engagement. Rotary instruments are typically designed to work in a centered fashion, and they may not adequately contact the entire surface of flattened or oval canals. The relieved reamer design, combined with oscillation, helps ensure uniform contact with the canal walls leading to better shaping and cleaning.
• Benefit: This improves irrigant penetration and allows for more thorough debridement especially in difficult anatomies where traditional rotary motion might miss certain areas of the canal.

3. Controlled Shaping Without Canal Distortion:

• Gentle Controlled Shaping: The short arc oscillation (30o) at high frequencies (3000-4000 cycles per minute) ensures that the reamer can shape the canal without applying excessive force, which helps avoid canal distortion, zipping, or transportation of the canal. In contrast, rotary files, especially in highly curved canals, can sometimes cause these types of complications due to their continuous rotational forces.
• Benefit: The gentle oscillation allows clinicians to precisely shape the canal without creating unwanted anatomical changes, preserving the integrity of the canal’s original shape.

4. More Effective Irrigation Activation:

• The high-frequency oscillations enhance the activation of irrigants allowing them to penetrate deeper into the canal system, including the apical third where irrigation can be less effective with passive flow alone.The motion of the reamers facilitates the movement of irrigants and promotes better debris removal.
• Benefit: This is crucial for ensuring that the canal is not only shaped but also thoroughly cleaned and disinfected, minimizing the risk of post-operative infection.

5. Simpler Technique with a Shorter Learning Curve:

• Ease of Use: Compared to rotary NiTi, the technique for using engine-driven oscillating reamers is generally easier for clinicians to master. The reamers’ invulnerability to breakage combined with the short arc motion, reduces the complexity of technique-sensitive movements that are sometimes required with rotary systems. Rotary NiTi files while incredibly efficient, can require greater experience and skill to use safely, particularly in highly curved canals.
• Benefit: Newer clinicians may find oscillating reamers easier to work with, reducing operator-related errors (such as over-pressuring or under-preparing the canal) and improving the efficiency of the procedure.

Comparing to Rotary NiTi:

Instrument separation and Risk of Breakage:

• Rotary NiTi instruments are more prone to separation due to cyclic fatigue and torsional forces particularly in challenging canals. This is a significant drawback, especially if breakage occurs in a difficult to access area like the apical third. Even though NiTi files have a remarkable flexibility, their potential to fracture can lead to complicate retreatment if an instrument breaks in the canal.
• Oscillating reamers avoid this risk, allowing the clinician to focus on shaping and cleaning with confidence, knowing there is no danger of the tool failing in the canal.

2. Shaping Efficiency and Canal Preparation:

• Rotary files are designed for aggressive cutting and can create a smooth and tapered canal shape quickly. They are very effective at shaping larger or straight canals and their cutting efficiency helps in rapid preparation.
• However, in highly curved, narrow, or complex canals, the centered motion of rotary files might not engage the canal walls uniformly, and there is a risk of creating irregularities or over-enlarging parts of the canal. In contrast, oscillating reamers provide more gentle, thorough shaping without the risk of excessive preparation.

3. Irrigation and Cleaning:

Rotary NiTi files are often paired with manual irrigation, and while they do help in cleaning by creating space for the irrigants, the motion does not actively agitate the irrigant. The oscillating reamers, however, actively agitate the irrigants during shaping, improving cleaning efficacy and ensuring better irrigant penetration, especially in the apical third where bacteria and debris can be more difficult to reach.

Conclusion:

The ability of 30o engine-driven oscillating relieved stainless steel reamers to avoid breakage and provide gentle yet effective shaping indeed makes them a safer technique in terms of preserving dentinal integrity and minimizing the risk of micro-cracks. The invulnerability to separate and gentle oscillation significantly reduce the likelihood of creating harmful forces in the canal walls, preserving the root structure in a way that is not always achievable with rotary NiTi systems, particularly in curved or complex anatomies.

In conclusion, oscillating reamers represent a more thorough and dentin -preserving technique, which could be viewed as superior to rotary NiTi in terms of safety, dentinal integrity and long-term prognosis in cases where micro-crack formation and instrument separation are signficant concerns.

My comments: As I read the response from GPT-4 I realize that the information provided here can be disconcerting to many practitioners who for the post part only learned about the advantages of rotary NiTi and the precautions that are necessary to reduce instrument separations that at the same time compromise the debridement of oval canals and other forms of complex pulpal anatomy. To hear about the alternative form of canal instrumentation, namely, high frequency 30o oscillations of relieved stainless steel reamer and the advantages inherent this systems can be a bit of a shock. It is the purpose of these posts to disperse the knowledge this form of instrumentation entails. The added advantage and one that I find extremely encouraging is that the source of information is not tied to any commercial venture. It derives its conclusions from a vast amount of data, but more precisely on an understanding of the mechanical principles these systems employ and how they impact the procedures when addressing the inevitable variety of pulpal anatomy. In near future posts I will address GPT-4’s response to the accuracy of their content.

Regards, Barry