Dr. Nick Barker looks at advancements in endodontic file systems, and why all endodontists should embrace the change
It’s natural for dental professionals to strive to keep their costs down and, as file systems have advanced, it is worth considering how the number of files used during treatment can play a significant role in improving clinical efficiency and safety while reducing both time and money in practice.
We have seen an expansion in the choice of endodontic rotary file systems in the last few years. This change is largely due to major develop- ments in their design and the materials used in their construction to reduce the risk of file and instrument fracture, allowing safer and faster treatment for patients. Despite understanding the benefits of converting to a simpler system, many dental professionals question whether it is worth upgrading from a tried and trusted system. In my opinion, if it’s going to have a significant impact on clinical efficiency, practice profitability, and arguably, patient satisfaction — it is worth the change!
When considering system upgrades or changing from another manufacturer, it is important to take into account the following:
Fewer files plus one torque and speed setting can result in shorter treatment time. Dentists spend less time changing files, and cutting efficiency is higher, so shaping time is reduced. The time saved is valuable and can be used for other procedures, particularly effective irrigation of the entire root canal system.
Technological advancements and safety
Consider the file’s swaggering effects and material choice; do they decrease the risk of file breakage?
Is the file flexible enough to cater to straightforward, advanced, and more complex cases?
Setup and cost
It’s also important to consider setup and ongoing maintenance costs. When you’re comparing costs of rotary systems against hand files, for example, the rotary will always work out to be more expensive. However, it should not just be looked at in these terms; there is a need to think about clinical time in the long-term. While hand files will always have a place in endodontics, regularly using predominantly hand files means procedures may take significantly longer than using a modern rotary file and can cause greater discomfort to the user. A highly effective cutting system using fewer files will significantly reduce the amount of clinical time spent as procedures become less complicated.
What this ultimately means is that you are not stepping out of a Mini into a Rolls-Royce, nor is it about taking a massive leap of faith to a completely different or alien system. The reality is that we are just moving forward with the technological advancements to a system that has been overhauled and improved, just like upgrading to the latest version of your computer system or upgrading your phone.
The convenience of using only two or three files means there is no longer a need to remember a complex sequence of files. With older systems, you could be regularly using up to six files in any one operation — over twice as many and at more than double the cost. As sequences are reduced with systems like ProTaper Next® (Dentsply Tulsa Dental Specialties), with fewer files and changes, it makes treatment quicker and far more comfortable for the patient.
When tackling more complex cases, the ProTaper Next file system benefits from major technological advancements when compared to its predecessor. Comprising five instruments, all with a shortened 11 mm handle for improved access, and constructed of M-wire nickel titanium (NiTi), the system simplifies an already trusted preparation process. The M-Wire NiTi system boasts flexibility and strength, offering a greater resistance to cyclic fatigue, thus decreasing the potential for file separation. The flexibility of M-Wire has allowed for further development within the ProTaper Next system, which gives the file an individual, snakelike “swaggering” movement as it moves through the canal, effectively creating a larger space to remove any debris while contacting a greater surface area of the canal wall.
At any one point along the length of the file there are four points, but due to its off-center rotation, only two points are in contact with the wall of the canal at any one time. This creates a large void to allow transportation of the debris up and out of the canal, minimizing blockages. It also reduces the likelihood of binding around the file, therefore reducing the risk of file breakage.
The first file in the system, X1, effectively replaces the S1+2 and F1 files in the ProTaper® Universal system. It has a tip size of 0.17 mm and a 4% taper, offers excellent flexibility, and enhances shaping of the canal very early in the process, as the majority of the shaping is carried out with this instrument. Following this with the X2 finishing file (0.25 mm tip and 6% taper) can, in many cases, allow completion of mechanical cleaning and shaping with just two instruments.
Making the switch
Many dental professionals find a level of comfort with particular instruments, materials, and even suppliers, and there is an understandable reluctance to change. As the saying goes: “If it ain’t broke, don’t fix it.”
However, sometimes a complete system comes along that is worthy of consideration, and dentists should remember that taking a step forward to something new is not as difficult as it may seem — in fact, it could save you time, money, and stress in the long-term!
In my opinion, ProTaper Next is the next generation rotary system for endodontic specialists and for general practitioners looking to upgrade to a simpler, more effective, and efficient endodontic solution.