The Proof Is In The Pudding

Anyone who has been reading the commentary on some of my recent posts has read that x-rays don’t tell us whether or not the canals have been distorted. Nor do they tell us if the canals have undergone adequate debridement. The only thing we should base our judgements on are some studies that showed rotary instruments produced less distortions than the 30o oscillating reamers while also debriding the canals more thoroughly. So, if you see highly curved canals that appear to be well-instrumented without any signs of distortion, it is merely an optical illusion without any merit if they were the result of 30o oscillating instrumentation.

As with many areas of research on endodontic instrumentation, there are conflicting results. I published one study that contradicts those results favoring rotary NiTi. I also posted a study published in the International Endodontic Journal stating the likely irrelevance of all these types of studies given the dearth of data supporting their impact on outcomes. In short, they are more marketing tools than sources of insight.

So, in that light, I will continue to post some of the cases we have done over the years that emphasize the ability of the 30o oscillating stainless steel relieved reamers to shape canals without any apparent signs of distortion and with dense fillings that suggest the three-dimensional cleansing that results from the use of a system that can be vigorously applied to all the canal walls. In short, what I am saying is that part of our education is clinical experience, something we do personally that may support the research we may have read or contradict what has been published. Sometimes, you just have to trust what you see and not believe what opponents of this form of instrumentation would call your lying eyes.

In the cases below, you see a variety of examples employing the 30o oscillating reamers that appear to faithfully follow the original canal anatomy. In the final 2 x-rays you see significant periapical healing using this means of instrumentation. These are the types of results that are also routinely posted by those displaying their rotary accomplishments.

Certainly, rotary works, but it comes with drawbacks that are not associated with the 30o oscillations we employ, most prominently, the complete elimination of instrument separation. With the assurance that separations are eliminated as an iatrogenic event, the dentist now has the freedom to apply them vigorously against all the canal walls, rather than limiting them to the centered position that is recommended when instrumenting canals with rotary NiTi.

So, at worst we accomplish comparable results without fear of instrument separation. We use the instruments multiple times because they are virtually unbreakable given the way they are employed yielding great cost savings and being engine-driven from the start, they eliminate hand fatigue throughout the entire instrumentation process while dramatically shortening the procedural time requirements making the dentist more productive.

In the next few posts, I will be placing a good representation of the cases we have done over the years including many where periapical healing is present. This is a technique that we have been using for many years. It has weathered the test of time and unlike rotary it is adaptable to all pulpal configurations regardless of their complexity.

Regards, Barry