In my opinion, the time is long overdue for professional dental journals to publish articles that offer alternatives to rotary NiTi rather than limit the discussion to which one of these vulnerable expensive systems should be used.
Dr. Richard Mounce is an excellent practitioner without question. Also without question, he is ideologically committed to RNT in general and K3s in particular. While he states that K3s are the superior RNT system compared to other RNT systems, he then goes on to describe all the precautions that are an absolute necessity for their safe use. So concerned is he about safety that he repeats the precautions twice in one article. Once generally in the manner RNT should be used and then again under instrument sequence.
All the precautions required for RNT are virtually eliminated as requirements when 30 degree engine driven reciprocation replaces rotary and relieved reamers (both stainless steel and NiTi) are substituted for non-relieved K3s or any RNT system for that matter. Reciprocation virtually eliminates torsional stress and cyclic fatigue, the two main causes of instrument separation. Relieved reamers engage far less tooth structure along their entire length. The less the engagement, the less the resistance to apical negotiation. With the concern for separation eliminated, curved canals can be fully shaped with little need for recapitulation. Prebending stainless steel produces no canal distortion when manually placed into the canal to the initiation of even the most severely curved canals when they are correctly oriented, an easy step to learn and do. The tapered peeso part of the instrumentation sequence is ideally designed to straighten coronal curves making all subsequent shaping far less challenging.
While Dr. Mounce’s discussion offers a point of view that is enlightening, the more dentists can be exposed to safer and more effective techniques, the more they will benefit. At a minimum they should be given the opportunity to decide for themselves and your publication is in a unique position to offer it.
Barry Musikant, endodonist for 35 years, president, Essential Dental Systems S. Hackensack, NJ
