Truth behind Short CUTs, SINGLE File Endodontics

I'm disappointed in Julian. He asks: Why can't endodontics be simple??...because it ISN'T !!! And HE of all people should understand that. Molar endo is NOT simple because molar anatomy is NOT simple. Mandibular premolar anatomy is NOT simple. Endodontics is NOT like operative Dentistry.

Then again, if there is sufficient monetary incentive, I suppose anyone can whore themselves out, spread their legs, close their eyes and pretend that it isn't happening. This is so disappointing....especially from someone involved with Endodontic Practice Magazine. I expected better. But I suppose everyone has their price.

The AAE says numbers of root canal treatments are decreasing. Endodontic incomes have flatlined or are tending downward. This forum has ever increasing Implant content masquerading as "Foundational Dentistry".( I used to think "ROOTS" was an endodontic forum, named for the structure we deal with. How many posts on ROOTS now deal with actual natural "Roots", as opposed to implants. With apologies to Kendo, I find the whole idea comically ironic. )

There is another challenge to us, coming from an area that we used to regard as our "friend"...the endodontic recall PA image. We used to use it to show us healing and supposedly to support our treatment results . Now we can't even trust that methodology anymore. cbCTs are showing more failures than we were able to see with conventional radiography. Being able to 3d image "through" cortical plates shows that we have less success than we thought. Rather than merely "retention rates" ( a gauge of implant success) true "Endo success" requires a much higher standard..... complete resolution of pathology and regeneration of a radiographically and histologically normal attachment apparatus. So cbCTs have become ammunition for the implant crowd. ( See Dr. fancy microscope Endodontist! Your endo is not NEARLY as successful as you though it was....now that you look at it with a cbCT!! Lets just go with an implant and screw the retreatment option. The comparisons between the two treatment mode success rates are unfair but which is "harder"?...doing a molar endo...or screwing in an implant? And if our goal is to make it "easy" ...is there really any choice?

Dr Julian Webber of Endowave Perhaps can answer a few questions:

(1) How much is he being paid to sell this system? (Royalties? %, salary, consultant fee?)
(2) Does he SERIOUSLY think one file can address the type of anatomy beautifully illustrated by the wonderful Versiani scans that were recently posted on here?
(3) Does Webber believe that when Endodontics is performed by the General Practitioner, it should be held to the same standards as Endodontist treatment. ( In many countries/states - THAT is the case ...legally.) If that is true, why should General Practitioners need "easier" methods...if they have similar "manual skills". They should be using the same techniques that specialists do....if they have the same "manual skills" that Julian claims that they have.
(4) If endo is "easy" why does he think that some US Endo practices consist almost entirely of retreatment?

Can we not be frank about the motivation for this system? Clinicians are used to paying a pittance for hand files. They are simply NOT willing to use Ni-Tis ( especially an entire SERIES!) a single time. That's a FACT. My survey results CLEARLY showed this. Whether you believe in the actual medical NEED for a mandated "single use file" rule ( there is MUCH debate...especially...research has NEVER shown a link between Endo contaminated files and a SINGLE case of (KJ) Mad Cow Disease ANYWHERE on earth.) in some parts of Canada and other countries, it is the law. The manufacturers SALIVATED at this opportunity and have done NOTHING but embrace it...to they point that some now mark "single use" on their packaging. ( Cha-Ching!!$$$)

The manufacturer's strategy is now :
(1) We have too many file sizes. Its too confusing, even for Endodontists ( tip size/taper etc.) never mind GPs. Endodontsts CAN keep these inventories because they can justify it by volume of cases. ( But Endodontists do NOT do the bulk of the Endo ...they are NOT the majority of our retail target!!) GPs doing only a few cases a week cannot justify having this amount of $ tied up in inventory. So they KEEP using the SAME FILES over and over again. That doesn't help manufacturers sell files !

(2) If GPs don't want to spend money for a 6 files that they resuse endlessly...lets give them the option to use ONE file that they WILL toss and WILL be compliant with single use rules.

(3) That will also make it MUCH easier for manufacturers to sell a cold ( or resin sealer based) single cone obturation technique that "matches" the shape created by the single wave one file. The next phase is the "drill a space to a predeterrmined size and fill it with a corresponding size filling" philosophy. The Phoenix of the silver cone method rises ashes of the discarded, outmoded, ignorant grave where it was buried.

Folks, this is NOT progress. This is delusional. It is the "dumbing down" of endodontics....for a fee. This strategy is NOT helping our specialty. THIS does NOT recognize the complex anatomy of the structures that we are called upon to treat. It does NOT recognize or acknowledge the need for hand files, the art of file bending and nuances of the specialty. It reduces it to the level of something "anyone can do".

The next step in the evolution of this process is what is now happening in California. Para-personnel ( Dental Assistants) can now legally place root canal fillings by law. If we make it simple enough, we will soon be able to "delegate" preparation of these canals with one simple wave one file that shapes ALL canals. We then can have our assistant put a single wave one file in the handpiece, drive it to the apex, fill with a "wave one cold cone" and we are done. We won't even need to be in the room. We will merely go to the bank to cash the patient's cheque. WE will become superfluous. We will now be a trade...an endodontic "spa". And when regulators and insurers realize that they don't have to pay DENTISTS to do this....we will be out of a job. We will have slit our own throat through the "simplification" of the specialty.

Then again, people like Julian and I don't have to worry about that. This will take time. We are 10 years from retirement and our practices are established enough that we don't have to worry ( or care) about that kind of fallout. We are just interested in getting our money NOW...the future of the specialty be damned. I've got MINE...the slow rot won't affect me. Screw em. Lets sell what we can now.

Credits- To Rob, of Endoexperience, who posted it on ROOTS forum