For me, probably yes, despite the high cost and unpredictable fracture of many systems. However, I believe that dental practitioners and endodontists are now ocean swimmers in a huge number of hand/rotary NiTi systems with different sizes/tapers/cross sections/file tip angle and morphology/even the alloy itself may vary. Numerous comparative studies with conflicting findings, then some practitioners (including me) have concluded that not using a single system is the best way. You can create your own system by selecting a number of NiTi and SS files. This probably indicates that we are still at the very beginning of the right way to the root apex.
I think that rotary NiTi files are much more useful than hand ones. The simplest system is the best. Now in the market you can find wave-one and reciproc. They are not the besr solution but I believe that they constitue the light at the end of the tunnel.
as you both I would not recommend and prefer one system over others. Depending on the situation we see, different systems will do a good job. For endodontists this is not really a question. They will be trained with many systems and get the information choosing the best system for the situation. But for GP it is a question we would asked many times. So rotaries are a perfect choice in easy cases. Reciprocating files (WaveOne, Reciproc or Adaptive) I will choose in retreatment cases, ledges. In sharply curved canals I would recommend high flexible files and really curved also HandInstrumnets better than rotaries. As a summary: For GP most systems on the market will work very easy and safe. The most difficult work for them is to know when to stop treating...
Many thanks Holger for your comment. I totally agree with your statement,and indeed, rotary files have shortened the distance between Endodontists and GPs and a well-trained GP can now provide a predictablle RCT. Despite this competition, I believe that both are in the same trench - Recent NiTi systems are expensive (Self adjusting file is about 3 times the price of ProTaper), and this overhead would definitely increase the treatment fees, and both will face a similar patient attitude towards RCT using this innovation!..
SAF is neither a rotary nor Hand instrumentation system. It is very special and should not be used for GP in treating typical cases.
I gave SAF as an example of recent NiTi systems showing elevated price. Despite this, its beneficial application for oval and curved canals should not limit its use for Endodontists, in my opinion.
The beneficial impact of rotary NiTi versus hand files is actually well established. In any case, whatever the system, the most important is to respect the purposes of the root canal preparation. Each practitioner must choose a system according to his own point of view depending on several parameters: flexibility, respect of the anatomy, taper, cutting effciency, debris removal, cost... In fact, generally, when you try to enhance a NiTi instrument's property, unfortunatelly, it leads to a disadvantage regarding an other point. Thus, it is important to understand how do the instruments act within the root canal. Finally, there is no ideal system and this is why endodontists often use different systems according to the clinical case they have to perform. Having said that, general practitioners should choose one or two systems maximum in order to manage most the situations. Just one exemple to open the debate: i'm convinced that the new reciprocating files (Wave One or Reciproc) are very interesting for most initial root canal therapy especially because you can save time to shape the root canal and this time saving must be used to irrigate more after the root canal preparation and to activate and renew the different irrigants (in terms of fluid mechanics, the irrigation efficiency is better when the canal has been enlarged).
Much agreed, Frederic, and thanks for raising this very important point. Reducing the time should never be at the expense of irrigation, especially in necrotic cases. We may finish the mechanical instrumentation in few minutes; but still we have to give the time for NaOCl to do its crucial job in the complex internal root anatomy given that our RCT is a chemo-mechanical procedure.
- I also have tried the SafeSiders system. The side relief of SS files together with reciprocation is interesting, and I can feel the difference in performance between it and conventional hand SS K-files. Generally, I believe that the idea of reciprocation is novel, and it has solved critical issues faced with rotary files. Probably one day we hear people using SS hand and NiTi rotary files in reciprocating hand pieces!!.
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