Tuesday, September 1, 2009

Twisted Files by Sybron Endo - A True Case Story

Twisted Files from Sybron Endo have been on the market for about 18 months and are enjoying good sales and a high degree of confidence from users. They are rotary endo files designed to make cleaning and shaping the root canal system faster, easier, and with less stress for the both the patient and the doctor.

I've been using TF's since before they were available to the buying public at large and I'm very happy/impressed with the way they handle and do their job. I use a hybrid technique that employs different file systems for different cases, but TF's are almost always part of the regimen.

What makes Twisted Files different is in their manufacture. For years endodontic files have been manufactured by machining/cutting a wire to create the lands and flutes. While this is efficient it also creates stresses in the files and can create microscopic weaknesses that can cause them to break during treatment. While this does happen from time to time during a procedure and is in no way a reflection on the care provided, it is stressful for both the patient and the doctor.

Twisted Files are made by twisting the nickel titanium wire to create the working surface instead of the aforementioned cutting. This process makes the files more flexible and less likely to break. Instead, the files have a tendency to "unwind" as seen in the picture above. Whenever a file is removed, the operator should carefully inspect it for unwinding and discard it if unwinding is present.

The file in the photos above was from a clinical case done yesterday. It was a 2 appointment molar with CaOH in the roots to facilitate healing. When negotiating the distal canal, there was some type of obstruction, probably a small crumb from the temporary filling or a small piece of tooth debris. I re-obtained working length to a 25 hand file and then went in with the TF .08. I was anticipating a smooth glide path, but in the area where the blockage had been the file grabbed at something. Never force a file - is great advice so I removed the file to inspect it and to do more work with hand files. Upon inspection, I saw what you see above... a nice unwinding right at the tip. The file did exactly what it was designed to do; unwinding instead of fracturing. The area where this occurred was about 3/4 of the way to the apex so it would have been a difficult retrieval.

This is one of the reasons I'm a big fan of Sybron and the Twisted Files in particular. If you'd like to know my whole endodontic routine/procedure check out one of my lectures on "Digital Dentistry in the Operatory of the Future".

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