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Endo tips    Better Endo    Endo abstracts    Endo discussions

Lightspeed (LS2 and LSX) cases


The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Dan - www.rxroots.com

From: dan
To: ROOTS
Sent: Friday, June 03, 2005 11:03 PM
Subject: [roots] Lightspeed (LS2 and LSX) cases

These files are now the safest file on the market of any metal
or any design.  I have been trying to break one for at least
75 canals (the directions are to push) and have concluded that
you just can't leave one in the canal.

These cases are all done with the new Lightspeed files and
Resilon Simplifils. - DanS

exactly.  you can break them (up high)----you just can't leave 
them in the canal.

what I don't like is that my Taskal handpiece doesn't have enough 
torque or speed to get the feel I want.  LS folks are
aware of this and will provide a recommended solution in the near 
future.  Yesterday I just put them in a regular hand
piece to finish a case and they were much smoother. cool cases 
- Kendel

hi dans, you did it all the whole procedure with lightspeeds-  
give me the sequence..   awesome - Holger
Holger, 15 k file loose at the apex, apex up with lightspeed.
Correction to my previous post, 75 cases, not canals.- DanS

Dan, do you have the feeling when you are using the LS that you're 
pushing dentin debri towards the foramen, rather than getting it out? 
Specially since there's no flutes to get the debris onto, I mean.
Do you have problems (or how do you avoid them) of blocking yourself 
out of the apical thrid? - JL

Has this been your experience?
No and no.  If I gain patency, I don't lose it because of the lightspeed.  I
like to recapitulate with pre-curved stainless steel files, which have
flutes.  Simplifil plugs fit to the largest diameter of the apical prep and
don't tend to puff as much as with other techniques, so the fills are often
short of the "RT".  Do we really want to debate length again? - DanS

No please.... Carlos Murgel
PS.  Dan I note some puffs on your last cases, why do you think 
that happenning?

maybe because he cleaned the entire canal! - JL

gracias, Dan
I was not asking because I thought your cases were short, but because 
that was my oncern about LS which, other than that, make much sense to me.
now that you mention it: do you try to instrument and fill to the PPDLL 
(paper point dry longest length)? ;-))) - JL

I don't use the paperpoint length on every case, but when I have a wide open
foramen I do.
I like the length I get from my EIE AFA foramen locator - DanS

Here you go again Dan  ;-))

Here are some LS cases from the archives, one or two are with the original 
LS, most of them done with LS prototypes (now LSX).

The second to last case (2005-03-28) is a necrotic case and somewhat 
interesting in that the palatal didn't get treated with LS.  I don't remember 
why I made the decision---perhaps that's  what the anatomy felt like at the 
time, or I was lazy.  Also, the MB root had four orifices prior to 
instrumentation.  Eventually the MB1/2 merged and the MB3/4 merged.
I searched for DB2 but have to assume I missed it-no joy.  It provides an 
interesting visual contrast.

The very last case is one from just the other day( 2005-06-03) with thinner 
apical preps.  Quite a difference.

Maybe I'm writing this mostly to myself, since I really feel we need to get 
the apical preps larger and yet I'm guilty of convincing myself at times 
that the smaller sizes are adequate as long as there is adequate taper..

Also I should say that it is about the Prep, not the instrument, there are 
any number of ways to accomplish this, LS just works for me.

But I will say this about the LS files that is unique in my limited experience.  
When using these files, you will often feel a mid root constriction, or other 
anatomical irregularities, say 5 mm or so from the apex.  After passing through
this point with the file, you will feel the instrument just drop and spin freely, 
obviously not yet an adequate size to touch the walls.  Feeling is believing, 
and this is not an isolated occurrence, it happens quite often.  And it is
consistent with the evidence we saw in Monterrey.

Having said all that I'm the first to admit I don't know what I don't know.  
I'm just the student.

Enough of this rambling   ;-) - Kendel

Kendel: Beautiful work as is your custom, but as was presented in monterrey in a way that is difficult to refute, larger apical sizes are necessary regardless of taper. See my crude attached diagram In any asymmetric apical exit, we must obliterate the maximum diameter. Anything less leaves debris, does not provide an apical seal, and case can go to hell.- gary Gary, That picture certainly makes you question the entire theory of apical gauging! - Frank Allen Gary, Great diagram, what do you suspect will be the impact on the current philosophy of apical gauging as a sign of finished cleaning? - Frank Allen Agreed ......seeing Kendel become such an outstanding endodontic clinician is one of the reasons that makes me come back to ROOTS. He is a prime example on how the bar is being raised. It makes it worth my time having to use the Delete key so often with other posts. Do not get offended about this "delete" scenario of mine. I will never disclose my delete "list". ;-) And I am sure I am definitely in the "delete" list of many ROOTERS also. With all due respect an admiration for my tocayo's (same name in Spanish) Benjamin Briseno magnificent anatomy work, and of Steve Senia's (one of the people our specialty is very proud off) review of BB's and others apex size findings. I am not completely convinced of the need to take our preps to such big sizes. Yes Anatomy is destiny......but there is no "best evidence" (level I and II) that their "anatomy" research and attaining bigger apical sizes leads to better outcomes. Extrapolation of "anatomic" findings to healing or outcome finding without controls is something we've always used in this field of ours I plead guilty..myself of doing it. So I am not criticizing Benjamin's and or my good friend Steve Senia's ideas I am just expressing my view an doubts...and I emphasize again WITH ALL DUE RESPECT. - Benjamin Schien Ben, you remind me of Dr Trope here: he keeps asking us "how does this or that affect the outcome of out treatments?" (you see: you are not in my "delete" list, but I understand i am most probably in yours ;-) - JL If you do not take the apical preparation to at least the dimension of the long side of an oblong exit, then how can you ever be sure you have removed all of the contaminants and secondly, how can you ever obturate that preparation and have any hope of attaining an apical seal? Weíve quoted a lot of sources in recent times on roots that have come to the same conclusion, that our apical preparations need to be larger. All briseno and senia did in Monterrey was to provide further evidence of the need to enlarge. I realize that the Buchananís and others donít do this. But how does one avoid placing a round peg in a square hole surrounded by debris if we do not? And to reiterate your sentiments, I ask this with all do respect for your knowledge and contributions. Iím trying to understand the opposite side of the argument and the rational for it - gary Gary, Do an apico or an extractionÖthatís the only way youíll be pretty sure youí've removed all the contaminants. J Otherwise, with most preparation approaches, youíre not getting things perfectly clean. Taking a 20/.08 GT a mm long will give you a nice preparation in a lot of roots not enough in other roots. Taking that GT file long is my goal in all canals to start with. Then gauging comes into play in determining whether or not to go larger. I keep a selection of .02, .04 & .06 taper k3 files for that gauging process. (I keep sizes 30-60 in those various tapers). I do a lot of my gauging with these k3 files nowadays rather than with hand files. (Mostly because Iím a bit lazy about the hand files when the rotaries do such a nice job) I take the rotary file that I think is appropriate (on mb and ml in a lot of lower molars for instance, this is a 30 or 35/.04, on the palatal of an upper molar of distal of a lower molar, it is frequently a 40/.06), and then look at two things: how easily does it progress to length(if at all), and are the last couple mmís of flutes loaded and clean looking when evaluated under the scope. Based on the answer to these two questions, Iím finished with my shaping, or may choose another file, either smaller of larger. The thing I donít like about these larger parallel preps is Iím afraid they result in over enlargement which could present a difficulty for re-treatment. Whatís going to happen when you try to enlarge those already large canals in the future when that unknown % of those cases end up failing as some of all our cases do? - Mark I am 52 years old and have only grappled with this argument for the past 3 years, during which time I have significantly increased my apical sizes and have seen a significant increase in clinical healing with lack of apical radioluscencies radiographically as a result. Intuitively, as an evidence based person of science, I have difficulty with any concept of apical finish that will not attempt to completely remove all apical tissue. I try to do this by gauging the apex and then going larger. Microbiologically, that is the only concept that makes sense to me. Any other finish of smaller diameter is counting on entombment, in my mind a less predictable concept. Therefore, I suspect we shall need to agree to disagree on this concept. The larger apical size, as you eloquently stated in one of your slides, minimizes one of the variables that can cause endodontic case adversity, provides an understanding of the level of treatment necessary to bring about a good result, and allows that level to be reached on a constant basis - gary Ben, it is the reason I keep coming back is to see the Sashis, Marks , Kendels , heck even the Kauffmans and Guys of DT. I have seen some remarkable transformations from GPs to endogods, all because people like yourself care to share. That is the key TO CARE TO SHARE. its a rarity in the specialties and something I am proud of from this forum and the endo specialty in general - Glenn Dan very good, Do you see this new file as an subistitute for the traditional LS?? Do you miss the half sizes? - Carlos Murgel Hi again dan, Many of the preparations appear pretty parallel from about mid-root down. Does this concern you? Recalling the original "pecker" instructions of the original LS instruments, I would have expected that shape. Are you shooting for an essentially parallel preparation, or are you trying to create taper? Are you still a pecker? or a reverse pecker? :-) The simplifill technique requires a parallel apical 4 mm and a step back to larger sizes from there. It is tapered with the goal of a tight fitting plug at the apical 4 mm. I can often soften this plug with a touch and heat and further condense it. Pecking is out, pushing is in. This is the only file you are directed to push on. The instruments are stamped. The number of instruments depends on the "working width" of the canal. I re-use these to the max. they have not broken in the canal, but I have had a few "twist up" such that they are permanently deformed. I have had several separate from the handle. When I stop abusing the files, I anticipate both of these events will decrease. I am keeping track of usage. I used the initial prototype on at least 50 cases. The file names are a pitiful attempt to protect patient privacy - DanS I see this as essentially a centered condensation technique ala Thermafil, or System B. Is this your take? Have you played with this parallel apical preparation in a plastic block to see how the hydraulics work? I do not find Thermafil, or SystemB work well in parallel apical preparations. Especially SystemB, which reliies on a conefit--i.e. how would you appropriately fit a cone in a parallel prep... Thank you for the reply Dan. Alot of endodontist could learn from you--me being one of them.- John A Khademi John, Surely you jest. I am doing all the learning. This is essentially a one cone lateral condensation technique that can be augmented by any number of warm techniques. I have not played with the block as you described, but it would be interesting. Many times what you think is happening down there has no basis in reality. This was really driven home by the fabulous apical anatomy presentations in Monterrey.- DanS John K, if by hydraulics you mean the cone pushing sealer into any remote anatomic pulp space, my question is why would a tapered cone accurately matching a tapered prep exert more/better hydraulics than a parallel cone accurately matching a parallel prep; I certainly cannot see why, but I would like to know the explanation; - JL The simplifill plugs actually have an 02 taper. When pushing them to place it often takes a bit of force. If it doesn't fit snugly it may not disengage the handle - Ken These are the stamped instruments correct? How many individual instruments were used to create a typical molar shape? Do you re-use them? And what the hell do your filenames mean? :-))) - John A Khademy John: Iím not dan, but I would actually classify the classic simplifil technique more as a cut off single cone technique. What dan is doing with the touch and heat secondarily is considered optional or elective, as is lateral condensation. Backfill can nearly be any way you want. - gary Nicely done cases. and I like the shape Dan. As somone not familiar with LS2 can you please tell me" 1. What the sequence is for the new lightspeeds 2. What makes them the safest files from a mechanical standpoint. Well done , nicely flowing cases - Glenn Glen, Sequence is as I described to Holgar; get a 15 K file loose at the apex and go apex up with the LSX sizes #20, 25, ect. They are the safest file because they are not ground at all. The cutting head is stamped into a nickel-titanium wire - DanS Thanks for the information on the LS cases. I like the apical area, my own preference is more of a taper higher up but who can argue with your great results. Thanks Dano, I appreciate you taking the time to show the cases.- Glenn
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