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Inside Dentistry
August 2023
Volume 19, Issue 8

Optimal Flexibility to Deliver a “White-Glove” Endodontic Treatment

Coltene’s HyFlex® EDM files expand the possibilities in challenging root canal cases

Sam Alborz, DDS

Sam Alborz, DDS, became hooked on endodontics when he attended his first endodontics lecture while in dental school. "I was so impressed," he says. "I could not stop talking about it." Alborz—who now maintains a private endodontic practice in Knoxville, Tennessee—had not planned to specialize, but his mentor convinced him that he would not be truly happy unless he pursued this interest.

Still, Alborz practiced general dentistry for 2 years after dental school before he entered his endodontic residency. This provided him with experience that he feels shaped him as an endodontist. "I got to restore a lot of teeth, which prepared me for the restorative work that I do as an endodontist," he says. "I restore every case; I will remove all the caries, re-build up the tooth, perform a gingivectomy, and more so that the tooth is restorable when it gets back to the general dentist." Alborz refers to these services as "white-glove delivery of the tooth." He says some endodontists simply perform a root canal and put in a temporary filling, only for the tooth to not be restorable by the general dentist because the decay was too deep.

Part of what achieves this white-glove treatment is the use of a microscope for the entirety of every procedure, which Alborz has done for 17 years. "You can see things with magnification and illumination that you otherwise could not," he says. "In my opinion, to practice endodontics today without the use of a dental operating microscope is below the standard of care."

The other essential tool in Alborz's practice is Coltene's HyFlex® EDM, a file that is manufactured from nickel-titanium (NiTi) alloy with controlled memory (CM) heat treatment to allow for regeneration and reuse. Due to an innovative manufacturing process using electric discharge machining, HyFlex EDM files have a unique surface and stand out for their durability and high fracture resistance.

Alborz compares the flexibility of HyFlex EDM files to copper wire because they do not recoil when bent. Although this made him skeptical when he was first introduced to them approximately 9 years ago, they are now the only files he uses. "These are the most flexible files on the market because of the way that the metal is treated, so they are far less likely to break and separate inside the canal, which makes more effective treatments possible," he says. "I would not use anything else."

The ability to pre-bend the HyFlex EDM files allows Alborz to treat, for example, tooth No. 18 of an elderly patient who can barely open her mouth. "With traditional NiTi files, we would not be able to reach that far back, but we can pre-bend the HyFlex EDM files to reach," he says. "If not for these files, I would need to send many more cases for extraction simply because of the inadequacy of the interocclusal space." The flexibility also allows the dentist to better maintain the true anatomy of the canal. "HyFlex EDM files respect the canal anatomy that Mother Nature created," Alborz says. "Stiff NiTi files want to straighten curvatures, so they transport the canal, ledge it, etc. They are simply not flexible enough to take the curvature. These files are."

With the HyFlex EDM Finishing set, apical enlargements can be performed with ease. "We are able to apically enlarge the canal at the very tip without removing tooth structure at the other parts of the canal," Alborz explains. "We are being very conservative at the top of the canal while still opening that apex. That is a unique capability with this file. Apical enlargement is so important when a canal is very infected with a large lesion." Of course, enlarging the apex improves cleanliness and, subsequently, healing. "I can perform a beautiful endodontic procedure and good restorative care, but if the case does not heal, I have not achieved anything," Alborz notes. "A traditional NiTi file with a very small tip of the apex will not clean that canal, so those challenging cases would be extraction cases without HyFlex EDM files."

The flexibility of the HyFlex EDM files also puts less stress on teeth. "When you have a stiff file with no give," Alborz says, "the dentin gives, which creates more microcracks. A flexible file, meanwhile, absorbs that energy, which decreases the number of microcracks that are created inside the tooth. So, we are conserving the longevity of the tooth." That flexibility lends itself to the file being more durable, as well. "If you push this file beyond its modulus of elasticity and it struggles when pressed to the canal, it will unwind a bit because it is so flexible," Alborz explains. "Traditionally, when a NiTi file unwinds, it must be discarded. With these, however, you can put it back in the autoclave, and it recoils to its original shape so it can be used again."

Alborz also uses the HySolate family of rubber dams from Coltene. "They are highly flexible and powder-free, and they come in various colors, which is important when using a microscope," he says. "They also come in different thicknesses and sizes. I cannot understand anyone using any other rubber dam."

Furthermore, most Coltene products come with a 2-year warranty, which Alborz says is indicative of what a strong partner the company is. "They provide excellent customer service," he says. "Their representatives are knowledgeable and always there for you. They are good human beings and do not have that corporate feeling. They have created a great culture and offer the best customer support I have seen in the dental field."

Coltene's customer support could almost be considered "white-glove." Their premium products certainly help Alborz provide his white-glove services to referring dentists. "HyFlex EDM files are completely different from other files," Alborz says. "They allow me to provide such a higher level of treatment than I ever could without them."

Key Points

HyFlex EDM files feature high fracture resistance and flexibility.

Regeneration and visual monitoring allow for multiple safe uses.

HyFlex EDM files allow fast preparation with high cutting efficiency and a reduced number of files used.

Suitable for almost all clinical cases.


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