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
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
maybe because he cleaned the entire canal! - JL
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
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
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
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
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
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
Thanks Dano, I appreciate you taking the time to show the cases.- Glenn