February 16, 2017
When you work with precision instruments in a technique-sensitive field such as endodontics, switching endodontic files is a big move – they are the tools that drive your work. From a clinical perspective, any new advancement you adopt should be rooted in science and research. From a business perspective, they should support your practice success and growth. Even if you consider yourself an “early adopter” of new technology and innovations outside of work, changing from the familiar in your daily work life requires energy. How do you know when switching is worth the effort?
Mark Haddad, DDS, and Matthew Haddad, DMD, are brothers and fellow clinicians who run Gulf Coast Endodontics, a thriving endodontic practice in the Houston, Texas, area. They advise looking beyond what’s simply new and different, to exploring what’s substantially better in your hands after performing no less than 10 cases.
“We have a big operation — six doctors and four offices. For us to go and switch the files we all use is a big deal,” said Dr. Matthew Haddad. “Therefore, it can’t just be a little different. It’s got to be better.”
The Canadian-born pair both received their specialty training from Boston University, where they were exposed to — and encouraged to try — several different endodontic file systems before adopting Dentsply Sirona’s ProTaper Universal when they started practicing endodontics together in 2010.
“It was the most efficient, for sure. Aggressive, but in the right hands, very efficient,” said Dr. Matthew Haddad. Though they continued to use ProTaper Universal for the next five years, their philosophy of staying up on what’s new never changed. “If you’re not trying what’s new, time’s going to pass you by.”
“We’re always paying attention. We tried a lot. We tried Kerr TF™ Twisted Files, imitation files, but nothing stuck,” said Dr. Mark Haddad.
Then in 2015, the brothers’ representative from Dentsply Sirona, Chris Bailey, provided samples to try of the next generation in the ProTaper family: ProTaper Gold rotary files.
The pair ordered 40 more ProTaper Gold packages to get a feel for the files over multiple patient cases. Here are five improvements they discovered that made switching endodontic files and converting their entire practice over to a new system worth the move.
1. Newfound Flexibility
“I admit, when I first tried ProTaper Gold, the flexibility made it feel flimsy,” said Dr. Mark Haddad. But that’s why he believes you should vet files over several cases. The improved flexibility soon gave him new confidence in getting around curves with less ledging and hand filing.
“I can tell you now, I do a lot less hand filing than I ever did before, especially with curved canals. Before, I would be very hesitant with the old ProTapers to go into curved canals. I would hand file to make sure it was opened to a .20 or .25, but now, I’m not worried at all. I do a lot less hand filing — and have a lot less shoulder pain,” he said.
Dr. Matthew Haddad agreed that having files that are not as rigid or stiff as ProTaper Universal is a real advantage.
“They’re a touch less efficient in a good way. They don’t cut quite as efficiently as the older ones, but this allows you to get around those corners with no ledges. It’s almost a perfect balance,” said Dr. Matthew Haddad.
2. Less File Separation
ProTaper Gold files are proven to offer twice the resistance to cyclic fatigue than their predecessor ProTaper Universal files – something the Haddad doctors noticed on their own firsthand. Research shows cyclic fatigue is the leading cause of file separation.
“The finishing files just aren’t going to break as often. That’s something you’re going to feel over time,” said Dr. Matthew Haddad. “I haven’t broken a Gold finishing file in probably 1,500 cases.”
They see this as a major benefit to their patients, their referring dentists and their practice.
“Breaking fewer files is just good for business,” said Dr. Mark Haddad.
3. Ability to Stay Centered in the Canal
Drs. Haddad said their experience with ProTaper Universal’s shape memory meant they had to take care to remain centered in the canal in order to evenly clean the canal walls and avoid ledging.
“The old ProTaper Universals are always fighting to straighten out, even if the canal is curved,” explained Dr. Matthew Haddad. “If you don’t remain centered, it significantly decreases the efficacy of your root canal treatment because you can clean too much on one side and leave tissue in other uncleaned areas.”
He also said when the canal is not smooth because of ledging, it’s difficult to get your gutta-percha all the way down.
Due to their metallurgy, ProTaper Gold files do not possess the same shape memory tendencies as ProTaper Universal.
“I just feel you can push these a little harder and stay on the true path of the canal,” he said.
Dr. Mark Haddad sees a second advantage to reduced shape memory: the ability to prebend ProTaper Gold files for easier access.
“Say you’re working on an upper second molar and the opening is not that big. When you can precurve the file, you can get into those tight areas more easily,” he said.
4. Dentin Preservation
Drs. Haddad said because ProTaper Universal files are more rigid, they exert more pressure on the coronal third and take out more dentin. ProTaper Gold, on the other hand, allows them to create conservative shapes.
“It’s common sense. Obviously the thinner you make something, the more susceptible it is to fracture,” said Dr. Mark Haddad. “With ProTaper Gold’s efficiency, it’s not taking quite as much tooth structure away,” he said.
“There’s simply going to be more gutta-percha in the tooth shaped with ProTaper Universal than with ProTaper Gold,” said Dr. Matthew Haddad.
5. Timesaving Efficiency
Dr. Mark Haddad said with ProTaper Gold, “everything is faster. I’m more confident, so I’m a little quicker.”
Dr. Matthew Haddad said from a practice management perspective, the switch to ProTaper Gold allows their practice to stay on schedule and deliver the exceptional patient experience their referring dentists have come to expect.
“Being a specialist, you get tough cases,” he said. “Gold has decreased the amount of times a treatment goes past its window due to difficulty of the case. It drastically decreases those cases that slow you down.”
That made switching endodontic files worth it. He said, “We always want to give our patients a great experience. ProTaper Gold was the first file that made us want to switch.”
Mark Haddad, DDS, is a graduate of University of Detroit Mercy. Matthew Haddad, DMD, is a graduate of Case Western. Both received their specialty training at Boston University. Their practice, Gulf Coast Endodontics, has south Texas locations in Houston, Pasadena, Cypress and Baytown.