As the saying goes “It’s a pretty sorry carpenter that blames his tools for a failed result”.
But, the opposite is also true. If we have a great result, it is not because of the “tools” that were used. Sure, great tools make getting that great result easier but great tools in the hands of an unskilled operator will not turn him or her into a savant.
The right file system for you will depend on your previous experience and the challenges you are encountering. If you are a beginner, you may want to choose a system that is easier to use. Maybe one that uses only one file to complete the entire procedure. If you are more experienced, you may want to choose a system that is more aggressive and can remove tissue more quickly.
But, do not let anyone tell you that the file system is the most important factor in a successful endodontic outcome. The most important factors are the operator’s knowledge, training, and experience.
That said, having the right file system can make endodontic therapy easier and more consistent.
So, how do you choose the right file system for you?
Over the years, there have been numerous improvements that are mixed and matched to achieve better results. None can be completely separated from the others.
At present there seem to be four major variables.
- Structural design: Structural design refers to all the tapers, variable tapers, flute designs and file cross sections.
- Manufacturing treatment: Variables here would be twisting wire, milling, electropolishing, etc.
- Metallurgical developments: This refers to heating and cooling metals to achieve stronger files with increased flexibility and resistance to fatigue (Gold and Blue files).
- Movements: This includes things like off-center rotation of the file as well as reciprocating and pure rotary filing.
So, let us look at just the last variable in this list: movements.
Reciprocating Filing Systems
Reciprocation systems are ones in which the file is not just going round and round.
Sometimes the motion is 180 degrees clockwise and 180 degrees counterclockwise. Other systems, cut 150 degrees counterclockwise and then 30 degrees clockwise to disengage the file.
Intuitively, reciprocating filing seems a little safer since the file is not moving in an unending circle. This probably played heavily into the decision most dental schools made to provide one of these systems for their students to learn on. Which is not to say it is a “beginner’s file system”. It just has a much easier learning curve. Final outcomes are stellar.
Rotary Filing Systems
Rotary files rotate in one direction, pretty much continuously.Some are more “crown down” while others finish different areas of the canal in sequence.Some have a variable taper in the same file, while other use a consistent taper within the file but a different taper between files.Rotary systems will tend to push less debris apically and typically allow the operator to finish instrumentation more quickly than with a reciprocating system.
If you are looking for a definitive answer to “What is the best file” or “Which system should I buy” I do not think it is a straight-forward evaluation and decision. A lot depends on your previous experience and what challenges you are encountering.
I encourage you to ask around, look at the claims and research regarding different systems and see what seems to make sense. Insist that the rep allow a reasonable demo period so that you can try it out on some extracted teeth. (Acrylic blocks do not give any insight on how the file will perform under clinical conditions.)Use what seems right and feels good when you are actually performing the procedure.
Do not be impressed by “proprietary” anything. We all think our stuff is best. As they say, “The proof is in the pudding”
If you have narrowed it down but still are not sure which system is right for you, hit me up inside of theEndo Simplified room and let us talk about it. Bottom line: do not be afraid to experiment with different file systems until you find one that you are comfortable with.
And remember doc, it’s not the files. You are the magic in your treatment.
Until Next Time,
Dr. Aaron Nicholas
DSN Endo Simplified Faculty
Owner Monday Morning Dentistry
P.S. Check out the upcoming hands-on and online courses from Dr. Aaron Nicholas. Registration is open for late August!