The Times Are Changing

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The Times Are Changing

Postby BarryMusikant on Wed Jun 24, 2015 1:38 pm

The Times Are Changing

Something unusual is happening in the field of endodontics. While new products are continuously being introduced by the major manufacturers they are still sticking to themes that were espoused over 25 years ago, namely greater tapered instruments used in either continuous or interrupted rotation. The preparations these instruments make are being challenged in the literature as weakening the roots by literally taking too much dentin away during canal preparation and producing dentinal microcracks that under the forces of obturation, post placement and function can propagate into full blown vertical root fractures. Many of the designs introduced and accepted by the major opinion leaders in endodontics are being rejected because of their documented detrimental effects. Endodontists who at an earlier time praised the greater tapered shaping now look at these preparations as being excessive.

Into this void of rejection have stepped advocates of minimally invasive endodontics with access holes as small as possible and canal preparations that look barely larger than a 10. Given what was originally advocated, this response is dramatic. It remains to be seen how this minimalist approach will impact success rates. The fact that there is a thinking opposition to the marketing agenda of the major manufacturers is healthy. The major manufacturers may still dominate teaching of their techniques due to the financial rewards universities receive from them, but the monolithic acceptance of their marketing efforts is being undermined by recent research and a host of endodontists who clinically see the detrimental effects that have occurred since the introduction of greater shaped rotary instrumentation.

Today we know the following:
1. Greater tapered shaping weakens roots
2. Instruments generating full rotations continuously or interrupted are producing dentinal defects that can later propagate into full blown vertical root fractures.
3. The potential for dentinal microcracks is increased when rotation and greater tapered instruments are simultaneously employed.
4. Greater tapered rotary instruments are not cleaning the extensions of oval isthmus-like anatomy

Combine these insights coming from documented research with the clinical awareness of their vulnerability to separation and we have a system that is not only vulnerable in its own right, but yields a tooth weaker than it need be after endodontic treatment.

This environment is a great incentive to encourage dentists to try other approaches that preserve tooth structure, preserve the quality of that tooth structure and are virtually invulnerable to breakage.

Regards, Barry
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Re: The Times Are Changing

Postby jogl on Tue Sep 19, 2017 6:37 pm

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Joined: Sun Mar 01, 2009 8:39 am

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