Barry Musikant

Improvements Brought Complication and Expense
    While these innovations are improvements, many of the instruments and techniques used to achieve them are complicated and expensive. The introduction of Ni-Ti files of different designs to achieve a wider taper requires the implementation of a crown-down technique because of their metallurgic characteristics. Although Ni-Ti has super elasticity to negotiate curved canals without distorting them, it has little tolerance for deformation without fracturing. 
     To minimize instrument distortion, the crown-down technique requires the use of thicker files first with thinner ones used sequentially in a crown-down direction. This technique is delicate, requiring keen tactile sense and patience. In the process of switching from stainless steel to Ni-Ti, the cost of the average instrument increased from $1 to over $6! This, without any promise that the Ni-Ti instruments would last even as long as stainless steel ones. The increased use of Ni-Ti that must be replaced frequently to achieve the continuously tapered canal shape is common to most of the techniques employing crown-down preparations. 
    Replacing lateral condensation with various thermoplastic techniques also produced a major increase in the cost of obturation. $6 thermoplastic points replaced $.07 gutta-percha points. Heating systems costing thousands of dollars replaced Bunsen burners and lateral condensation. One method of thermoplastic obturation requires placing a red-hot spreader within 5 mm of the apex, releasing the heat ring, and further advancing it another 3 mm over a matter of seconds,
reheating the spreader, and releasing it from the gutta-percha followed by further obturation with a gutta-percha glue gun. 
    Are the improved results justification for the increase complexity and expense? I do not believe so. 

Simple and Economical Alternatives
Read the accompanying article on this site entitled “How to Instrument and Obturate Canals Superbly and Economically” for alternative methods that are simple and economical. 
    We have employed them in our office for ten months with immense success, characterized by reduced flare-ups, excellent radiographic results and ease of operation. The techniques described in this article are in full conformity with the latest research in endodontics. The sealing ability was at least the equal of thermoplastic and lateral condensation techniques. These techniques have reduced cost and time. 
    The increase in complexity and expense to achieve superior results has proved not to be inevitable after all; it has been short-circuited by a little creativity and common sense.