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Endodontic rotary vs. reciprocation: How do I choose?

John West, DDS, MSD

For more on this topic, go to www.dentaleconomics.com and search using the following key words: endodontic rotary reciprocation, WaveOne technique, John West, DDS.

What? another endodontic file? A single file reciprocating system? Let’s address these questions.

Context

New movements are emerging everywhere these days — in countries, quantum physics, technologies, even endodontics. However, this particular new movement is not ideological, political, or even a new technology. It is, instead, a root canal system shaping motion born out of timeless principles whose time has come. The reason its time has come is because of unique reciprocating movements, newer and safer proprietary DENTSPLY Tulsa Dental Specialties M-Wire, and an alternative way of thinking.

Introducing WaveOne single file system

The novel and patented WaveOne motion uses a large and efficient counter-rotating angle in the cutting direction, and a smaller angle in the opposite direction that resembles a safe reverse “balance force” manual motion. Three reciprocating cycles produce one complete rotation as the file gradually “follows” the canal and simultaneously carves the desired continuously tapering funnel shape required for consistent 3-D cleaning and 3-D obturation. The DENTSPLY concept is to build a file and develop a technique that could shape most root canal systems. The WaveOne primary file, with similar outline form to the world’s most popular endodontic cavity shape, the ProTaper F2 Finishing file preparation, has the capacity to produce a similar radicular preparation while giving the clinician a sense of simplicity and efficiency.

WaveOne science

Using micro-focus CT scanning technology in clinical testing, eight highly respected endodontic teachers/clinicians, in conjunction with Nova Southeastern University College of Dental Medicine, conducted extensive research. Four reproducible and sustainable results are noteworthy to any doctor using nickel titanium technology for preparing root canal shapes that can be predictably designed to create the endodontic seal: 1) Canal centering ability of WaveOne 2) Remaining canal wall thickness after shaping with WaveOne 3) Final shape versus original shape of the canal with WaveOne 4) Canal wall cleanliness with WaveOne.

WaveOne technique

WaveOne is more than a single reciprocating file. It is a file, technique, thought process, attitude, and philosophy. It is also a special and specifically designed motor. The e3 torque control motor features preprogrammed settings that have been researched to determine the fixed speed and angle parameters that have been minutely optimized for safety and efficiency.

WaveOne small, primary, and large shaping files allow the clinician to choose the appropriate preparation file based on the radiograph and glide path size.

WaveOne single use file selection:

1. If a #010 K-file is very resistant to movement, select WaveOne small file. Clinicians should focus on manually preparing adequate Glidepath for WaveOne primary file.

2. If a Glidepath can be confirmed by a “super loose” #010 K-file, select WaveOne primary file.

3. If a #020 K-file or larger easily follows to length, select WaveOne large file.

Shaping technique

1. Once Glidepath is confirmed using super loose #010 K-file, “ride” WaveOne primary down the Glidepath canal and continue as long as the file progresses. Short of maximum resistance, remove, clean, and follow again until desired depth.

2. If WaveOne primary does not easily progress, remove, clean flutes, irrigate with sodium hypochlorite, confirm patency, and begin next wave of shaping until desired depth.

3. If flutes show evidence of dentin shavings at length or foramen size is confirmed with a snug #025 K-file, preparation is complete. If not, proceed with larger WaveOne file.

Is single file reciprocation the wave of the future?

Excellent endodontic clinicians know where, how, and what instruments to use when. WaveOne may become a standalone technique or may be part of a technique. The question of rotary vs. reciprocation may ultimately be rotary and reciprocation. The truth of the marketplace will decide. In the meantime, test drive WaveOne side by side with your current rotary system and decide for yourself. If you are afraid of rotary, break too many files, or want to simplify your endodontic inventory, WaveOne is worth the test drive.

John West, DDS, MSD, is the founder and director of the Center for Endodontics in Tacoma, Wash., and is recognized as a premier endodontic clinician, educator, and author. He is the immediate past president of the Academy of Microscope Enhanced Dentistry. Reach him at johnwest@centerforendodontics.com.

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DE Magazine
November 2014
Volume 104, Issue 11
1411DE_C1