6B Clinical ENDO TRIBUNE | February 2010 f ET page 5B entire length. The result is an instrument that engages far less, is significantly more flexible, cuts perceptibly better because of the incorporation of two columns of blades (where the flat meets the flutes) and produces superior better tactile perception. Furthermore, the flat transforms the K-reamer into an asymmetrical instrument that can differentiate between a round and oval canal, information that the dentist can use in determining the degree of shaping that a canal must attain to remove as much debris as possible. Please note, what might appear as a small change in design has produced a dramatically more effective instrument without compromising its complete safety1 (Fig 3). I believe I have made a strong case for the use of relieved reamers over K-files. If dentists appreciate these profound differences they will immediately improve in their ability to create an excellent glide path. As important as the differences between K-files and relieved reamers are, the incorporation of relieved reamers has greater implications than more effective glide path creation. Used either manually with a tight watch-winding motion or in a 30-degree reciprocating handpiece, relieved reamers do away with the insecurities of rotary NiTi breakage while shaping curved canals in an undistorted fashion2 to dimensions that those using rotary NiTi would not attempt out of fear of breakage. For those using rotary NiTi, this is a giant step in faith and one you might not be inclined to take. It is not necessary for you to take that step. Take the first step: replacing K-files with relieved reamers and determine for yourself if glide path creation is more predictably and efficiently produced. Only after you have convinced yourself that they are indeed much more effective, think about the extension of their usage for complete canal shaping. As major motivators, they are virtually free of breakage, can be used six to seven times before replacement, reducing the cost of these instruments compared to rotary NiTi by about 90 percent on a per-use basis. One definition of progress is the incorporation of equally or more effective techniques that are simpler and safer to use while costing far less. Relieved reamers fulfill that definition. ET AD Figs. 3, 4: The completed case. Fig. 3 References 1. Laurent Scherman, Patrick Sultan. Comparison of the canal wall states between a mechanized system and various rotary NiTi systems. Le Chirurgien Dentiste de FranceNo. 1411 du Novembre 2009. 2. Nagendrababu Venkateshbabu, Satish Emmanuel, Goud K.Santosh, and Deivanayagam Kandaswamy. Comparison of the canal centering ability of K3, Liberator and SafeSiders by using spiral computed tomography. Australian Endodontic Journal. Accepted for Publication, 2010. Fig. 5: Orascoptic Loupes, 4.8x HiRes Class IV (Orascoptic, Middleton, Wis.). Fig. 6: The surgical operating microscope (SOM) (Global Surgical, St. Louis, Mo.). Fig. 7: Twisted Files (.12/25, .10/25, .08/25, .06/25), (SybronEndo (Orange, Calif.). Fig. 8: Small Apical Assorted (25/.08/23mm, 30/.06/23mm, 35/.06/23mm) (Sybron Endo (Orange, Calif.). Fig. 9: The Skini Syringe and Navi tips (Ultradent, South Jordan, Utah). ET About the author Barry Lee Musikant, DMD, is the co-director of dental research and co-founder of Essential Dental S y s t e m s , Inc (EDS). The company’s roots stem from the desire for product improvements to the items of focus in lectures and daily practice. His research and business partner is Allan S. Deutsch, DMD. Musikant and Deutsch have combined 60-plus years of experience as leading lecturers and practicing endodontists in New York City. Contact them at info@edsdental.com. f ET page 3B syringe using Navi tips (Ultradent, South Jordan, Utah). The case could just have easily been obturated with RealSeal One Bonded Obturators (SybronEndo; Orange, Calif.)* an obturator version of master cone based RealSeal bonded obturation. RS1 has RealSeal obturators of .04 taper that are injection molded over polysulphone carriers in tip sizes 20-90. RealSeal has been shown both in vitro and in vivo studies to provide a statistically significant barrier to microleakage relative to gutta percha. Per the referring doctor’s request, a temporary was placed into the access. A layer of flowable composite was placed on the pulpal floor to protect the obturation in the form of Permaflo Purple (Ultradent, South Jordan, Utah) until the tooth could be permanently restored. After cone fit and obturation, a sealer puff resulted. This sealer puff is a sign that apical patency was maintained throughout the entire process. While it is not a sign of treatment superiority, it does signify the cleaning and shaping performed fulfilled the goals of canal shaping in that the apical foramen was kept at its original size and position and the original position of the canal was maintained. The clinical management of a calcified upper first bicuspid is detailed. Emphasis has been placed Fig. 10: RealSeal One Bonded Obturators (SybronEndo, Orange, Calif.). on preoperative treatment planning to avoid iatrogenic events. The tooth was shaped with Twisted Files to a master apical taper of .08 and a #40 master apical diameter using four files and approximately seven total insertions per canal. I welcome your feedback. ET ET About the author Dr. Richard E. Mounce is the author of the non-fiction book “Dead Stuck,” which offers “one man’s stories of adventure, p a r e n t i n g , and marriage told without heaping platitudes of political correctness” by Pacific Sky Publishing. For more information, see www.DeadStuck.com. Mounce lectures globally and is widely published. He is in private practice in endodontics in Vancouver, Wash.