Well, I don’t know if I’m going to help you improve the speed of your preparations, but I do want to make some comments about some files that I’ve recently had the opportunity to try (they may not be new to everyone, I work in China and things take a little longer to become available here). I’d like to make the point now that I’m not tied in any way to these files or the companies that sell them. In general, debates over what file system is best usually leave me a little bored and I’m not here to promote a particular brand or system. Everyone has their own favourite system and when you have experience with one type of file, then that is probably the one that will provide the best results for you. I also think it’s often quite difficult to take to a new file system as they all have a learning curve, a different feel within the canal and certainly different tolerances when it comes to fracture resistance.
Anyway… The Pathfile NiTi files are only designed to prepare the glide path through the canal, and then you can use whatever system you prefer to complete the preparation. Want to know what I think is the key to quality rotary NiTi preparations? You guessed it, it’s the glide path. Most rotary Ni Ti files are designed to follow a path, not create one. It’s quite well accepted that if you can resist the temptation to pick up your initial NiTi file until your glide path is well and truly established, then you’ll find preparations are easier, smoother and probably faster. So, a rotary file system designed to create a glide path is a novel concept which challenges the assertion I just made.
There’s not much research around regarding these files other than an article that showed novice users could produce smoother glide paths in plastic blocks than endodontists can with stainless steel hand files. (Berutti et al, 2009) Sounds promising right? Well, I must admit to being a little hesitant when I first saw these files, because they are really narrow and well, you’re not creating a proper glide path before you put them in the canal. In my head, this meant susceptibility to breakage.
There are three files. A #13 (Purple), #16 (white) and #19 (yellow). The files are 2% taper, so they really are quite narrow, but I guess that’s what makes them useful for preparing glide paths. The idea is to use a #10 stainless steel hand file to scout the canal (and confirm initial working length with EAL if possible), then use the #13, #16 and #19 to create the glide path. Working length is confirmed after this step. In practice, I found that they do a really good job of preparing the glide path, especially in narrow and curved canals e.g. MB2. The glide path that is produced is generally very smooth and makes the subsequent cleaning and shaping procedure easier and dare I say it faster. I don’t think you necessarily need to use all three files in all canals. Overall, you’re probably not going to prepare the canals any faster as you are now adding additional files to the process, and there is obviously going to be an increase in cost. But, if you are new to rotary NiTi, or looking to improve the consistency with which you can create a smooth tapered prep all the way to the apical foramen, then it might be worth giving these files a try. To be honest, these are the first products I’ve tried in some time that have had any sort of “wow” factor for me.
Using these files won’t be for everyone and more experienced practitioners probably have less need for them, but The Endospot is all about sharing information and helping others to improve their endodontics, so when I find something that I think might be worth discussing, then it will appear in your inbox. So, if you feel inclined to do so, get your friendly local rep (I think will be Dentsply in most places around the world) to drop a few samples off to you and grab some extracted teeth to get the feel of the file before diving into a live case. And remember to be gentle, these files are thin and going into narrow canals. If you do a search for Pathfile on youtube, you’ll find a couple of videos worth watching as well. If any readers have experience with these files and want to contribute some tips, then please leave a comment below.
BERUTTI E, CANTATORE G, CASTELUCCI A, CHIANDUSSI G, PERA F, MIGLIARETTI G, PASQUALINI D. 2009. Use of nickel-titanium rotary pathfile to create the glide path: comparison with manual pre-flaring in simulated root canals. J Endod, 35, 408-412