Rotation vs. Reciprocation: Why Choose, When You Can Have Both?

Rotation vs. Reciprocation: Why Choose, When You Can Have Both?

Brasseler’s innovative approach to root canal therapy combines the safety of reciprocation with the efficiency of rotation to preserve more dentin and save time during procedures

For endodontists, root canal therapy treatment plans have typically fallen into one of two approaches. Rotary file systems, in which the file rotates down the canal to the apex uninterrupted, tend to be favored by experienced endodontists for their greater efficiency, while reciprocating file systems, where the file cuts in a back-and-forth, washing-machine motion, tend to be preferred by newer clinicians due to their increased safety and simplicity.

Now, thanks to a new file system from Brasseler USA, you can have the best of both worlds.

The ESR (EndoSequence Reciprocating) CM file system, combined with the Endo Sync Plus handpiece, allows the file to rotate down the canal until it meets resistance, and then automatically switches to reciprocation to ease through the tight spots. Endodontist and educator Allen Ali Nasseh, DDS, MMSc, says that this technique pays off 3 big ways:

1. 1. Greater efficiency when the going is easy, and greater safety when the canal is tighter
2. 2. A more conservative preparation that preserves dentin coronally
3. 3. The ability to combine reciprocating-motion canal prep with hydraulic condensation obturation

The ESR CM, part of Brasseler’s robust EndoSequence family, incorporates small improvements that add up to a big difference, according to Dr. Nasseh. “This combines the advantage of the safety of reciprocation with the efficiency of rotation, and as a result, you do not have to do so much dentin removal as is typical with conventional reciprocating files,” he explained. “This gives us the ability to marry hydraulic condensation obturation with reciprocation.”

Here’s how the ESR CM stacks up against competitors’ reciprocating files:

• • A proprietary heat-treatment process allows for maximum flexibility to respect the natural anatomy of the canal. The ESR CM is up to 3.3 times more flexible than competing systems and has up to 3.6 times more resistance to cyclic fatigue.
• • A thinner file core size diminishes the risk of excessive dentin removal coronally. That improves tooth structure, reduces fracture stress during RCT, and prepares the way for obturation via hydraulic condensation.
• • With a reverse-cutting flute, modified triangular cross-section, rounded safety tip, and constant-taper shape, the file is optimized for reciprocation and accommodates rotation, too.

The ESR CM system comes in 5 sizes:

• • #15 (03) scout file
• • #25 (06) triage file
• • #30, #40 and #50 (04) finishing files

“Typically, I use the scout file to find working length, and then I use the triage file to determine the complexity of the case,” said Dr. Nasseh, who has completed over 26,000 root canal therapy cases over the course of his 30-year career. “If it reaches the apex easily, I can finish with the #30. If not, I may have to finish with the #40 or occasionally the #50.”

Using the EndoSync Plus with Optimum Torque Reverse (OTR) technology, clinicians can adjust the torque threshold from a low of 0.2 Ncm to a high of 1.0 Ncm. When torque hits the threshold, Dr. Nasseh said, the handpiece automatically switches from rotary to reciprocating motion. “This gives you a happy medium between rotation and reciprocation, which you can adjust depending on your preference and the needs of each case,” he concluded.