Richard Mounce, DDS
In a now classic rock album, "Frampton Comes Alive," Peter Frampton asked the question, "Do you feel like we do?" This sentiment has relevance for how we choose the endodontic materials and methods we use. Advocates and manufacturers certainly can ask us to feel like they do. In this column, we will examine how we make choices about the materials and methods we use, and we'll make some suggestions on how to potentially view our choices from a different and new perspective.
The recommendations that follow clearly represent my empirical opinions and biases. That said, following these recommendations might give clinicians (both specialists and general dentists) a new perspective from which to make the most informed choices possible.
1) Get samples, borrow loaner equipment, and try the materials at convention booths. Many manufacturers have loaner equipment and giveaway samples, so you can try out equipment and materials before they become part of your armamentarium. For example, SybronEndo (Orange, Calif.) has introduced RealSeal. RealSeal is a bonded obturation material based on Resilon technology from Pentron (Wallingford, Conn.). It literally bonds a resin-based material, made in the shape of gutta percha points, into the dentinal tubules in a monoblock. The monoblock of obturating material is contiguous from the tags present in the dentinal tubules, through the sealer, to the core filling material. Trying RealSeal at the booth at a national meeting and purchasing a small quantity will allow you to try it out and see if the manufacturer's claims match your clinical reality. This avoids the potential for making a purchase that either ends up on the shelf or is discarded later.
2) Ask for both sides of the argument. Never accept a manufacturer's position without getting the other side of the story or trying all of the various products at your disposal. Trying a variety of rotary nickel titanium files would be an example of a material to investigate before making a final selection that becomes your clinical reality for the long term. If you are not getting the clinical result that is being represented, either the material is not being used as recommended or the material does not work as claimed. Trying a new material while learning a new skill at the same time is difficult and requires a lot of patience. For example, attaining proficiency in learning to use rotary files can be a challenge. Watching demonstrations by sales representatives or clinicians at continuing-education courses and conventions has great value.
Ask questions and expect hard answers based on more than opinion. For example, numerous brands of rotary files are available with little, if any, literature about the product. In some cases, the literature that does exist can be hard to interpret. Simply taking the word of a salesman that a certain file is optimal for your needs is to perhaps deny a better alternative because you didn't make the extra effort to constantly try new products. Obtaining loaner equipment and free samples can go a long way toward taking this step. In addition, many salespeople are more than willing to make an in-office stop to demonstrate the manufacturer's recommended use of the product. Call specialists who are considered opinion leaders in your community and ask them what they use, why, and how. Find out if the clinical experience of the specialist is similar to what the sales staff is claiming.
3) Read the literature ... and read beyond the abstract. Just because an article says that a given rotary system causes less canal transportation in the given study is meaningless in the context of its broadest application. For example, an article may claim that one file transports less than some other file, but this says nothing about its fracture resistance, cutting ability, its optimal rotational speed, debris removal, and other characteristics. In addition, some studies do not utilize the files per the manufacturer's recommendations, nor do they compare files in a like manner (i.e., the various files were not used in a comparable fashion). Because of this, the conclusions in the literature may bear no resemblance to the clinical reality, nor do they provide a true comparison. Simply reading a sound bite from an article can be very misleading, so be cautious about accepting such conclusions.
To summarize, before deciding on an endodontic product, material, or method, obtain samples, consider clinical trials, ask hard questions, investigate the literature beyond the abstracts, and compare it to other options. The journey and the learning achieved is similar to having your endodontics "come alive," and will certainly enhance your satisfaction and profitability, and most importantly, benefit your patients.
Dr. Richard Mounce is in private endodontic practice in Portland, Ore. He lectures worldwide and is a widely published author. Contact Dr. Mounce via email at lineker @aol.com. Visit his Web site at www.MounceEndo.com.
