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16 Comments Jan 7, 2011 | Business USA

Specialists quarrel over 'single file endo'

Post a comment by Daniel Zimmermann, DTI

NEW YORK, USA/LEIPZIG, Germany: Endodontic procedures that only require one rotary instrument are causing controversy among specialists worldwide. In internet forums, endodontists are currently discussing the Pros and Cons of the new procedure. So-called single reciprocating file systems have been launched by several dental manufacturers over the last few months.

Developed by Canadian-Libanese scientists, the single file endo concept is said to require only one reciprocating file and no glide path or initial instrumentation for the majority of root canals. According to the manufacturers, the technique is supposed to cut working time and lower cross-contamination between patients, a common problem associated with the use of multiple files.

However, specialists are not so sure. "This current trend in file design and philosophy is the equivalent of doing brain surgery with a hammer and chisel. Anyone, who truly believes that Hess type anatomy can be dealt with by using one rotary file, is delusional," a specialist in an US-based endo forum said.

"The technique requires a new motor, which will turn off many dentists who are already working with conventional rotary NiTi instruments," a German internet blogger commented. "The bottom line is that the system has to offer considerable advantages or it will be rejected by the market despite its clinical potential."

In a recent Dental Economics article, Manhattan-based dentist Dr Barry Musikant said that the technique could create a new standard for intrument use in endodontics. "Common sense says that single usage is a rationalisation to compensate for the weaknesses of rotary NiTi."

Most reciprocating systems are already available in major markets.

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16 Comments
  • jeremy magruder, USA May 1, 2012 | 7:01:11 PM

    I have attended two different continuing education courses in which the waveone system was presented. Using only one file does sound like a scam on the surface until you learn the research that the waveone technology is based upon. There are a few auxiliary components that can be used like a single glide path file and a single hand file( to confirm canal patency between irrigating) . Also, there are 3 available files but usually only one of the files is needed per canal. In my opinion based on research presented, it is a very good system. The canal is prepared conservatively and with precision. Also, research indicated that the file will only rarely separate. Sceptics of the waveone system should take a look at the research before judging.

  • p.d. fox, split, croatia Feb 10, 2012 | 5:08:28 AM

    Here they go again, discussions about pro's and con's concerning endodontics are like searching for a non existing root canal. Preparation of the root canal, after opening and creating a glide path, mainly serves the possibility to reach the apex. There and only there shape and size do matter, the rest of the canal could as well be prepared using a banana, if it would fit. Cleaning and disinfecting the walls of the infected root canal can only be completed by using chemical/medical agents. Any discussion about turning, twisting or wiggling is a waste of time, better spent on the golf yard. Compliments to Christian Diegritz, who shows common sense. And to those who wish to discus this matter with me (not in any way involved in dentistry anymore), mail me at pimdevosXgmail.com. Wishing you all predictable results, Pim

  • Dr.Mathew India Feb 8, 2012 | 7:11:05 PM

    Here in India, Dentsply came with protaper and anthogyr, since the nitti files started breaking, they came out with x-S-mart, which do was a fialure, now the reciprocation, that concept is good, but a single file to perform root canal cant take it much, since root morphology keeps on variying, and not constant. Last eight months back i started using EDS reciprocating system, which is much better than all the systems, in BMP as well as flexibility and fracture resistance. Regards Mathew

  • Mohamed Salman Jan 3, 2012 | 9:02:19 PM

    Totally agree with Cohen "Full circle endodontic treatment", single file instumentation achieves the mechanical objectives only, what about the biological objectives??go to the next step in the the cycle.....cleaning... take additional 2-3 minutes for active irrigation and here is a study I will present in the next PAN ARAB ENDODONTICS in Dubai next week. SEM evaluation of root canal debridement after single file F2 ProTaper and EndoActivator irrigation Various single file techniques have recently been introduced to the endodontic market. The purpose of this study was to determine the efficacy of single file F2 ProTaper instrumentation in a reciprocating hand piece and EndoActivator irrigation for root canal cleaning. Fourty extracted single rooted human maxillary and mandibular teeth were shaped with F2 ProTaper (#25 .08) only in a reciprocating handpiece of an ATR motor following the suggestion of Yared (2008). The canals were then treated as follows (n = 10 canals per group); group I (control) irrigated with 5.25 NaOCl using 27 gauge needle, groups II, III and IV received additional one, two or three minutes activation by the EndoActivator with the tip #20 .02 respectively. Roots were split and examined with SEM. The presence or absence of debris and smear layer on coronal, middle and apical thirds was evaluated by using a 5-grade scoring system at x200 and x1000 magnification, respectively. Data were analyzed with the Kruskal-Wallis and Mann-Whitney tests. Activation of 5.25% NaOCl for either two or three minutes significantly reduced debris and smear layer scores compared to control and one minute activation (P < 0.05).There were no significant difference between two or three minutes activation. One minute EndoActivator irrigation did not enhance debris or smear layer removal. Conclusion: Under the conditions of this study two minutes EndoActivator irrigation is required after single file F2 ProTaper in a reciprocating handpiece to improve root canal debridement. Do not always believe radiograph and company marketing brochures as well

  • Chirag shukla(mum)India. Dec 29, 2011 | 6:34:45 AM

    In the ever growing and evolving field of human sciences the horizon for Endodontics and complete endodontic treatment seems far fetched and something of profound imagination, and the idea around the globe that we may just have achived it through systems like receproc,SAF,Wave one are really absurd.How can we really forget the concepts and principles Endodontics.A single file for a root cannal treatment aren't we forgetting that files shape and irrigating solutions clean the systems, we achieve the shaping with these instruments in 15 mins max but what about cleaning the systems .this is where we need to focus look back at the past mistakes and teach and train our colleagues and students about the importance of the most vital aspect of endodontics, that is cleaning,we need to understand the fact ourselves that files shape and irrigating solutions clean.Every new thing that is introduced recieves it's share of criticism and SAF receproc and Waveone are no different.All these instruments are good in their own limits but are we going to be sure that we have thouroughly disinfected the system before obturation.Truly if the answer is NO then we need to be critical of the use of such instruments.A 15min endo really should'nt be our aim while we sit to perform an endodontic treatment,But complete Endodontics should be our aim,Agian coming back to the point I personally don't feel that wave really does anything different than its previous version of pro-tapers,in true sense it is not a reciprocating file the principle is loose based on a kown concept of reciprocation by rooane,and it can be more agrressive if not used with caution.

  • raef sherif, Alexandria, Egypt Oct 28, 2011 | 1:10:10 AM

    No matter it's one file shaping or many files shaping , the idea of canal preparation is to open a convenient pathway for effective irrigation. Single file canal prep will save more time for irrigation and cleaning , which is waht we have to do and focus on. finally it's up to the endodontist to add his signature on his preparation with any instruments he like. Wave one and reciproc will surely open a new way for a new generation of NiTi files , and a new instrument needs a good mind to use it in the best way.

  • Barry Musikant, NY/USA Jun 22, 2011 | 7:52:05 PM

    I call a reciprocating single file instrument system a rationalization for NiTi's weaknesses because pure rotation too often is accompanied by the anxiety of separating an instrument. There are those who deny this reality, but having used rotary systems myself in the past, having taught thousands of dentists who voice the same concerns and a perusal of the thousands of articles that discuss the breakage of rotary NiTi instruments, it a reality that we have had to cope with. The very fact that these systems have been developed is testament to the concerns stated above. Their answer, however, imo,is inadequate. The literature clearly states that minimum apical preparations to a 35 are recommended. This is not accomplished. the research also points out that 08 tapers do not increase the effectiveness of irrigation when the apical preparation is less than 35, yet at the same time can undermine the thin roots of oval canals in the walls constituting the minor diameter. NiTi is a metal that always wants to rebound to the straight position making it increasingly likely to selectively shape to the outside wall of curved canals. By minimizing the tip size of these instruments the manufacturers reduce the effect of this property, but they do it at the expense of thorough cleansing. Most important, this is not a truly reciprocating system. It is a hybrid one that will still result in 200 full rotations per minute. While the 30º counterclockwise motion employed in this system will reduce the torsional stress generated by the handpiece, it does nothing to prevent cyclic fatigue leaving the instruments vulnerable to separation even though they are meant for single use only. 30º reciprocation, unlike the hybrid system used with the systems above, virtually eliminates all torsional stress and cyclic fatigue. Used with vertically oriented relieved flutes, these alternative instruments accomplish full shaping to 35 and beyond without any concern for separation. Their ability to adapt to canal shapes either by recording the curve as they negotiate thru the length of the canal or by prebending and manually negotiating the most severe curves gives these instruments the ability to fully cleanse canals without fear of instrument separation. My own personal opinion is that the various iterations of NiTi would never have occured if we had used relieved stainless steel reamers, rather than K-files, from the start. All that has happened with NiTi is a constant evolution for the dollars to keep flowing to the major manufactuers as they attempt to come up with ways to use these expensive instruments without separation and limiting the costs at least enough so they will be bearable to the dentists who are being asked to purchase them.

  • Claudio Farnararo Jun 9, 2011 | 12:52:28 PM

    This new system it's incredible, I started using it since it came out and the primary results are amazing. Of course I must said that it's impossible to think in the complexity of root canal system of a single file endo. But really the 21.06 goes in most canals, and the I believe that all the Endodontic system in future will convert to this new movement. But if I shape a single molar with just that instrument and in few seconds, and then usa a couple of more hand instruments to fnish my preparation...what's wrong with that? Like Julian webber said I never heard an opinion leader saying : single endo file. It will depends a lot from the phylosopy of treatment, with the next exit of finally a thermafil without carrier i say that it coincide with this new technology. I strongly believe that when we will have a system of obturation that allow us to have warm guttapercha (soon the guttacore) there will be no more need and reason of brushing movemnet.... the only actual reason it's to make space for plugger ( we could also discuss of the last millemeter of guttapercha whatever warm system you use..) it's a nonsense from my point of view.

  • Ian Kerr/UK Feb 9, 2011 | 11:58:41 PM

    As a general dentist with a passion for endodontics I am excited by each new development in endodontic training and equipment, especially when these are driven by a desire to improve outcome for our patients. Where developments are driven primarily by a desire to speed up the process I have less interest. "One file systems" may make shaping marginally quicker but if they do not offer greater canal wall contact or if they distort the canal anatomy more than previous systems then we have gained little more than a couple of minutes of working time. If a guide path is still required along with coronal flaring then just how much time we have saved is questionable. Any system that enhances our ability to irrigate a canal system more fully is likely to improve outcome and is worth considering no matter how many files are required. Endodontic training needs to emphasis the comprehensive nature of planning (both endodontic and restorative) and the biological nature of the condition. Understanding the 3D aspect of the canal anatomy is essential and should be an important part of training. Predictable endodontic outcomes are achievable by all dentists with appropriate training and adequate time in practice. Any new system that assists this goal should be applauded.

  • Esteban Ulate-- Costa Rica Feb 3, 2011 | 6:13:05 AM

    FIRST OF ALL I WANT TO MENTION I REALLY SUPPORT ONE FILE SYSTEMS AS THEY STAND FOR NEW IDEAS AND THE INTRODUCTION OF NEW TECHNOLOGY BUT.. THE TRUTH ABOUT ONE FILE SYSTEMS IS THAT THEY ARE REALLY NOT ONE FILE SYSTEMS. AS JULIA MENTIONS YOU NEED AT LEAST A GLIDE PATH AND A 2/3 CORONAL PREPARATION (WHICH CAN BE ACHIEVED WITH ADDITIONAL ROTARY FILES). I MENTION THIS NOT TO CRITICISE THE SYSTEM, (ANY CRITICAL BUYER WITH GENERAL KNOWLEDGE IN ENDODONTICS SHOULD KNOW THIS) BUT TO POINT OUT HOW FUTILE THIS DISCUSSION REALLY IS. WHEN A NEW SYSTEM IS INTRODUCED, WE AS ENDODONTISTS SHOULD CONCENTRATE ON MORE IMPORTANT CHARACTERISTICS OF NITI FILES . FOR INSTANCE; ADVANTAGES AND DISADVANTAGES OF RECIPROCATING SYSTEMS, FILE SEPARATION, FILE CAPACITY TO SUCCESFULLY PREPARE ALL CANAL WALLS AND THE LAST ISSUE SHOULD BE HOW QUICK THE TREATMENT WILL BECOME. OUR RESPONSABILITY IS TO TELL GENERAL DENTISTS OUR CONCLUSSIONS AND ROOT FOR THE BEST SYSTEM. FINALLY, IS REALLY SHAMEFUL FOR ME AS AN ENDODONTIST TO READ HOW IMPORTANT THE TOPIC OF SINGLE PREPARATION FILE HAS BECOME. THERE ARE MORE IMPORTANT THINGS TO FOCUS!! BEST REGARDS

  • Matt Swenson Jan 24, 2011 | 5:49:19 AM

    Excellent individual points by all—The endodontic importance of canal shaping, fidelity, cleaning, disinfecting, patient care, final outcome, etc. But, many of these points only represent a single point in a much more complex treatment. In my opinion these and many other similar endodontic arguments miss the mark by not looking at "full circle" endodontic treatment (treatment planning; long term prognosis; access; shaping; cleaning; and obturation). With the above in mind, shouldn't the real question be, "can single file endodontic systems, such as SAF and WaveOne, work as part of full circle endodontic care?" If yes then the next question to consider amy be, "is that treatment approach providing the best, most effective care for the patient?" Thanks! -Matt Swenson/Your Dental Edge

  • Stephen Cohen Jan 20, 2011 | 5:41:57 PM

    Posted by: Christian Diegritz, Germany — Jan 12, 2011 1:27:03 PM Dr. Diegritz posted very thoughtful and cogent comments. Readers should follow Dr. Diegritz's advice.

  • Julian Webber, UK Jan 12, 2011 | 2:41:44 PM

    I am on the WaveOne development team and read this article and the comments with interest. Reciproc and WaveOne have a slightly different sizing. WaveOne is 21:06, 25:08 and 40:08. Reciproc advises the file is chosen after an appraisal of the radiograph and radiographic dimensions. In addition, they feel the Reciproc file can be taken to length without any prior glide path management. WaveOne advocates a glide path, albeit it minimum 1. if 8/10 are tight then use WaveOne Small (21:06) 2. if 10 can easily be taken to length then use WaveOne Primary (25:08) 3. if 20 or bigger then use WaveOne Large (40:08) WaveOne Primary will be the main work horse. Gauging foramen diameter at the end of the shaping procedure may indicate the need to go the next size shaping file. It is mainly a single file technique but there are occasions when two files are used. Of course we all appreciate that they are single use. The plastic on the handle will expand on placement into the sterilizer so cannot be inserted into the handpiece. The motor reciprocates in reverse. The files have a reverse flute design. The motor can be set up for continuous rotation CW and CCW. You can brush with the files just like ProTaper for increased coronal enlargement. Usually the first 2/3 can be prepared, the working length reconfirmed and then the WaveOne is taken to length. Yes, it is simple and yes it is quick. It is up to us as teachers to emphasise the importance of irrigation. Remember, files shape and irrigants clean. This concept is the same for all preparation techniques. How anyone can knock reciprocating systems because they are too quick and cynically one file is beyond me. And yes, a single file technique will excite the generalists because of costs (far cheaper than SAF) and because of speed. The speed issue is of course concerning because whilst we can hammer home the message on the importance of irrigation, sadly many will miss the point and go straight to fill with a great possibility for failure. That is the problem with every file system. All current systems are quick and no emphasis on irrigation so why "knock" WaveOne and Reciproc. They are no different.

  • Christian Diegritz, Germany Jan 12, 2011 | 1:27:03 PM

    No Canal is round! Looking at MicroCT images—no matter if you take a look at Brown & Herbranson, Ove Peters or Frank Paqué—when do we FINALLY come to the conclusion and accept that: 1. We will NEVER be able to clean all canal walls with a machine driven instrument no matter of the design of it. 2. AP is about KILLING BUGS. When do we finally change our perspectives from a machinist to a medical professional? Ah yes, I forgot, there is no money behind it and microbiology books and Siqueira papers are “boring”. It is a DISEASE we are fighting against every single day and not a beautiful looking fine white line in the X-ray. HEALING SHOULD BE OUR GOAL. FIGHT THE BIOFILM and RESPECT THE ANATOMY. In my opinion, we should stop bashing about these new systems. No one reading this will ever use just one file trying to clean and shape and believe all the “propaganda”. The real problem I have with this system is that it reduces the amount of irrigation and disinfection, which is why I am more impressed with the SAF System. We should all try it out if it may help us in our protocol. Because everyone is talking about the file and not the idea of reciprocation. Be open minded. With regards, Christian

  • Bojidar Kafelov, Bulgaria Jan 10, 2011 | 11:11:57 AM

    Here in Bulgaria we also have problems with refferal! Few GP reffer patients to endodontic specialists. Other GP simply say that the tooth was inevetably damaged and has to be extracted and they place an implant! I don't understand why do we search the most simple ways to handle such complex problem such as endodontic treatment - it's never about one file or one guttapercha point! Every tooth, every canal even is different from the previous...Then how to clean and shape those differences with one file, even with the "breakthrogh" design of Wave One File or Reciproc? I hope that endodontists around the world have enough brains to decide where the truth lies! Best regards to all, Bojidar Kafelov, DDS

  • dr sameer jadhav,india Jan 7, 2011 | 5:55:19 PM

    its good system only thing is the cost of the file,reusability, and new motor ,are the only points to cosider otherwise reciprocating files sounds promissing

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