Barry Musikant
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 OME
OF THE DENTISTS I speak to praise the nickel-titanium rotary crown-down
technique. They say that it eliminates the most significant problems
of traditional endodontics: there is no more hand fatigue, there are no
more distorted canals, and instrumentation sizes the canal to a tapered
gutta-percha point. The unpredictable flimsy fills of traditional
endodontics have given way to a standardized taper that allows the dentist
to place a much bigger gutta-percha point producing dramatically improved
radiographs.
Given this picture of progress, I have at times
felt like a Cassandra when I talk about the shortcomings of this highly
praised and highly advertised technique. My biggest concern regarding
rotary NiTi instrumentation is the increased potential for instrument fracture.
More often than not, dentists tell me that they used to fracture instruments
when they first began using the nickel-titanium rotary crown-down technique,
but since they have become more familiar with the techniques, fracture
is very infrequent and is further reduced by replacing the instruments
before they weaken to the point where fracture is likely. That response
might have ended further discussion, but thinking about my own emotions
when I was going through the NiTi rotary phase, I ask them whether they
worry about the possibility of fracture even though the instruments rarely
do fracture. And the response is always the same. They always
worry.
This consistent response from dentists, most of
them significantly younger than I am, made me think that perhaps there
are generational differences toward stress. Maybe the younger you
are, the more comfortable you are with stress. I don’t think so.
More likely, the dentists who accept this stress do so because they see
no alternative to doing excellent endodontics and, therefore, that is the
price they must pay. I believe I would have done the same except
that I had a crying need to produce excellent results in a simplified manner,
eliminating the stress that seemed as if it would lie ahead of me for the
rest of my professional life.
The result of my attempt to lessen that stress was
the development of the EZ-Fill bi-directional spiral, which coats the canals
thoroughly in a controlled manner, and a sequence of eight stainless steel
hand reamers and two NiTi hand files, which allow the dentist to perform
one-visit endodontics in less than an hour with results that are indistinguishable
from thermoplastic obturation techniques.
Most dentists react quite positively to these new
techniques even if they are doing rotary NiTi crown-down. The idea
of eliminating the fear of fracture while reducing overhead by at least
a factor of ten will generally gain someone’s attention. However,
some dentists actually take mild offense when shown an easier way, especially
when they have made a large investment in time and money to learn the so-called
modern techniques. The contemporary term for the anxiety that they
feel when they recognize the superiority of the new techniques but reject
the idea of adopting them is cognitive disonance. Like jealousy and
envy, cognitive dissonance does little to improve our ability to take in
new information.
We are in an irritating era for endodontics.
Every time we think we’ve got our act together, along comes new information
that unsettles the applecart, even if it doesn’t quite upset it.
Take heart. In these pages, over the next few months, we are going
to show you complete endodontic systems—simple in design, affordable, and
efficient—that will give you the ability to do endodontics as well as the
best endodontists.
January-February 2001
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When the length of a tooth
approaches the maximal depth of a 25-millimeter instrument, the interference
of tooth structure or a metallic restoration may make placing the probe
of the apex locator difficult. In such cases, it is easier to attain proper
measurement control using a 31-millimeter instrument rather than a 25-millimeter
instrument.
—Doug Kase
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