September 1, 2004
by Ken Koch, DMD and Dennis Brave, DDS
One of the goals of Real World Endo is to have you perform not only efficient endodontics but safe procedures as well. There are multiple components and procedures that contribute to achieving this goal. In fact, one of the factors that has the ability to increase the safety margin of your procedures is the type engine you select to use with your rotary files.
As nickel titanium rotary instrument design developed through the nineties, so did engine technology. The initial quantum leap was going from hand instrumentation to a rotary file technique using an air motor. This initially worked in an adequate fashion but we then advanced to the arena of electric engines.
When compared to air turbines, electric engines are smoother, have a more consistent RPM. and produce less noise. Electric engines are strongly preferred because, as we like to say, “This is not just about how you do a root canal preparation, this is really about how you choose to do root canal therapy.” There are considerable differences in patient perception between a root canal done with an air turbine and one performed with an electric engine. In fact, very often when performing a root canal procedure with an electric engine and a bite block… the patient falls asleep! Think about it. What better marketing can you do for your practice than having a patient receive a “dreaded” root canal and they fall asleep.
Engine technology further progressed in the nineties to include torque control engines. The purpose of torque control is, in a word, safety. These engines can be programmed in such a manner that if a file is stressed to a certain pre-set torque limit, the file will reverse rather than unwind. This will help reduce separation. Torque control engines have particular application to the general dentist who is not continually performing root canal therapy. However, as the practitioner becomes more experienced, the need for torque control decreases. But the use of a torque control engine remains a safety benefit and is strongly recommended when first implementing a new rotary technique.
Another goal of Real World Endo is to remove as many rheostats as possible from the dental treatment room. Too often we find ourselves burdened by a number of rheostats on the floor underneath the patient. In addition to removing rheostats, we hope to develop as many portable components as possible. As a result of improved battery technology, we believe the world of portable equipment is coming to dentistry.
Consequently, Real World Endo, in concert with Brasseler USA and NSK Japan, is now able to offer a truly portable handpiece that will take your endodontic efficiency to the next level. But to totally appreciate this improvement in efficiency, we need to start by examining the unit itself (Fig. 1).
The EndoSequence handpiece employs advanced microchip and battery technology that provides everything required for “Big Time Endodontics.” This capability is a result of its unique design features and ease of use. Some of the unique features of the EndoSequence handpiece are the following:
Power and versatility
The Endo sequence handpiece with its unique 10:1 reduction head offers nine speed options (200-1000 rpm) that meets the demands of all greater taper rotary files. Additionally, the 10:1 head provides sufficient speed (1000 RPM) for gutta percha retreatment. Further versatility is offered through the selection of various contra angles that allow the unit to function as a prophy unit (2500 RPM) or as a slow speed hand piece (10,000 RPM).
Torque control and auto reverse
An enhanced 5 level torque control and auto reverse feature can be activated by the simple press of a button. Recommended torque control levels for clinical use of the EndoSequence rotary files are 4 and 5. This is equivalent to 1.8 to 2.4 N-cm (Newton centimeters). The maximum torque is 3.1 N-cm when the torque control is turned off.
Outstanding “feel” and control
Advanced endodontics is all about feel and predictability. The EndoSequence handpiece, with a weight of only 25 oz., offers superb tactile awareness. When combined with the EndoSequence rotary files, this handpiece transfers the fulcrum of instrumentation from the wrist to the fingertips. The net result is an enhanced “feel” for the procedure and more predictability in use (Fig. 2).
Easy to recharge
The EndoSequence handpiece comes with an exclusive (Real World Endo) wrench that makes it easy for your assistant to change the batteries, when needed. Under normal conditions, the batteries can be recharged 300 – 500 times before they need replacement. The batteries do not have to be totally drained before recharging. Furthermore, the handpiece automatically turns off when not operating for 10 minutes (Auto power-off function).
Because it is rheostat-free and cordless, the EndoSequence handpiece allows ergonomic unrestricted movement. This is particularly ideal for left-handed dentists working in various treatment rooms. Additionally, the portability achieved with this handpiece allows the clinician to perform “Have Endo will Travel” (Multiple offices).
We believe that when you examine this handpiece, you will find many advantages to the above listed features. However, after evaluating the features of this unit, we must ask ourselves, “What is the best way to use this?” Indeed, now is the best time to address this question.
We all want to perform our endodontics as efficiently as possible. This benefits both the dentist and patient alike. Furthermore, it is our opinion that the use of this handpiece will allow you, the clinician to take your endodontics to a new level of efficiency.
In the past, we used to employ multiple contra angles with our electric engines. By employing such a method, the assistant would change rotary files in the different heads and could pass along the next subsequent rotary file in a “ready-to-go” contra angle. The use of such multiple contra angles was one of the first modifications we adapted to rotary file techniques.
However, we made the technique even more efficient with the introduction of the EndoSequence handpiece. Instead of exchanging contra angles, we recommend having multiple handpieces. Simply have the units loaded with different files. The assistant now has the ability to activate the handpiece and pass it to the doctor with the appropriate file. Exchanging handpieces is faster and smoother than snapping off and changing contra angles. At first this may seem like too much work but when you see this technique in action, you will change your mind!
When you combine the efficiency of motion that is associated with portable handpieces, with the fact that the EndoSequence rotary files are used in the canal for only three seconds, the result is superb efficiency for the overall procedure. Routinely at our courses, we show a video of a clinical case that concentrates on four-handed dentistry. The attendees are always amazed at the speed and efficiency between the operator and the assistant. This is not magic but common sense. The combination of a portable handpiece and an efficient rotary system results in a truly synergistic procedure. Try it for yourself. We believe that you will agree that endodontics can be safe and efficient.
Dr. Kenneth Koch is the founder and past Director of the new program in Postdoctoral Endodontics at the Harvard School of Dental Medicine, and currently maintains a faculty position at Harvard. He is the author of numerous articles on endodontics.
Dr. Dennis Brave is a diplomate of the American Board of Endodontics, and was the senior managing partner of a group specialty practice for 27 years. Dr. Brave was voted “Baltimore’s Best” Endodontist by Baltimore Magazine. The holder of multiple patents, Dr. Brave has performed over 28,000 endodontic cases.
Oral Health welcomes this original article.