Optimizing Root Canal Shaping: Efficiency and Safety with RootFlex

Another very important point here is how to use the files, okay? Most of the endodontics, they love to brush, brush the walls. We don't have to brush. I just go up and down, up and down, up and down, following the root canal direction. So by the end of the root canal preparation, I still have a lot of walls and the middle and cervical portions because I don't have to brush. It's very important for the endodontics nowadays because we are preserved a lot of denting there. Welcome to the Phil Klein Dental Podcast. Today, we're diving into a real game changer in endodontics, the RootFlex file system by Merida. This system, according to our speaker, was built for speed and efficiency, letting you shape canals with as little as two files. And here's the kicker. According to our speaker, the ultra-sharp tip not only cuts faster, it stays sharp longer. So in many cases, you can shape the canal with just one file. That's a big deal. Our guest today is Dr. Henrique Bassi. He is a world-respected endodontist from Brazil who developed one of the first heat-treated NITI instruments that resulted in a method that is not only safer, but extremely fast, making the entire endodontic procedure easier for the patient. and more pleasurable for the doctor. According to him, there's no need to brush canal walls with the endophile. RootFlex does the cutting for you, and it does it quickly, safely, while preserving dentin. And when run at higher RPMs, he says that it can instrument a molar canal in under 10 seconds. So for all those listeners doing endo in your practice, stay tuned for this episode. Dr. Bassey will be sharing clinical tips and real-world advice that can help you work faster, smarter, with more predictable endodontic results. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases, and our entire production team will really appreciate it. Dr. Bassey, it's a pleasure to have you on the show. Thank you so much. It's a great honor to be here. And I will do my best to make the things clear about the system. Yeah. And I do want to tell our audience that we're interviewing not only an endodontist, but also a star volleyball player from a country that has many good volleyball players. But Dr. Bassi was on the Brazilian national volleyball team. He was actually captain. You brought the team to world number one. number one position at World Cup tournament in 1985. So very, very impressive. And if your endodontics is as good as your volleyball shot, then I think we're in really good shape here. So, you know, I'm an endodontist. So it's very interesting that we're talking about this. Endodontics has gone through an evolution where when I went to endo school, we were very much focused on doing whatever we had to do for straight line access to the apex, which means if we had to remove tooth structure and steer away from conservative dentistry, so be it as long as we get to the apex, let the restorative dentists worry about the rest. But today, we're not doing that as much. Now we're much more aware of maintaining tooth structure because that's all we got. You know, these teeth don't grow after they're fully formed. So you are a big proponent of a root canal file system that actually meets those conservative goals. So if you would, to begin this podcast episode, tell us about these files and how you're using them. Most of our procedures, all over the world, everybody wants to remove a lot of structure in order to reach the apex portion, the April 3rd. So doing this, we are removing most of the structure that supports the teeth life. So in other words, if we reduce the structure, we are reducing the teeth longevity. So what we did... is to use the concepts of anatomy, the knowledge about anatomy, and we know through the textbooks that the root canals are normally O2 tapers. If we use O2 taper files inside the O2 taper canals, we have a lot of engagement. So what we did, we developed a 0-1 taper file. So when we use a 0-1 taper file inside the 0-2 taper canal in average, In some ways, we are going to pass over the circle and middle portion of the root and reach the apex very easy. So doing this, we don't have to use orifice shapers. We don't have to pre-enlarge something, some kind of procedures, unless it's really necessary. So the concept nowadays for medium invasive endodontics is to preserve as much as possible. Now you talked about the glide path. Let's just explain to the audience, for those of us who may not be completely familiar with the numerical designation of how a file is designated, a 0.01 taper means that every millimeter away from the apex of the instrument, the diameter of the file increases by one hundredth of a millimeter, right? That's right. That's right. The 0.2 is going to be two millimeters and so on. Yeah, two hundredths of a millimeter. Yeah. So every millimeter away from the end of the file, the taper increases by two hundredths of a millimeter with the typical 0.02. And that was what our standard files were when I was in endo school. Everything was, you know, a 20 file. Right. A 20 file was a 0.02 taper, which, like you said, causes a lot of engagement along the entire file system. And that's where. we get the hang-ups, and it's also more time-consuming, and it's more strenuous to instrument the canal, more instrument breakage, etc. So in this episode, Dr. Bassi, we're going to be focusing on the Merida root flex system. Let's begin with the glide path file and how you use that clinically and then move on to the other files. Yes. First, I would like to be very clear that We are talking average size, okay? In terms of average size, the foramen for molars is around 25, 22 to 25. There's no reason for us to start with 0.15 millimeter diameter, 0.20, since the foramen average is bigger than this. So the biggest advantage of this to start with 25 is because 25 is stronger, more resistant than... tip 15 so since we are going to use 0.25 tip zero one taper so the file will go all the way down until the apex and niche the framing if the framing size is average so we are going to be able to establish the patents establish the glide path after that we are going to use other other types of files with a different design to shape the root canal. But mainly, it's very important for us to do the glide path and establish the patterns. Many doctors love to use 10K to do these procedures. I have no problem with that. But in my concepts, one of the biggest advantages for rotary, no matter what kind of rotary you're using, their files are rotating and the files are able to remove the debris from inside to outside the root canal. Since we have the benefit of... rotary. I prefer to start my root canals with rotary instead of use 10K. Doing this, I have much less chance to block with poop tissue. So you're not a fan of using a manual glide path instrument like a 10K file, number 10K file. You're going to go straight to rotary with your glide path system. Yes. I'm not saying that I'm not a fan. I'm saying that it's better to use a rotary prior than use a 10K. if your hands no no no matter no no no matter your ability no matter your skills and what's the reason for that what is your reason for that to to avoid some block to block the root canals okay for regular motors it's very easy everything is going to work perfect doing rotary doing k 10k no better but with 15 of the motors they are really complicated they have some arrows they have calcifications they have a lot of difficult things to bypass start with the 2501 taper I am able to reach my apex for molars. I'm talking about molars, not about incisors. It makes sense. And the key thing here for our audience to understand is that 0.01 taper. Because that 0.01 taper is less than half the average diameter of a typical molar apical foramen area. Correct? That's right. And we must be aware that the technology that we have nowadays for nickels I-10 is too high. The heat treatment we are talking about, the heat treatment that we are talking about, cause a huge effect over the fire's resistance. No matter if it's a zero-one taper, which is a very thin... piece of metal a very a very thin piece of nickel titanium it's really resistant it's very difficult to break this this file why is that you're saying because the way it's treated with heat yes when we finish to grind the files with nickel titanium all the companies most of maybe 100 of the companies they are submitting the nickel titanium inside the oven for certain temperature to change the austenite phase to martensite phase. When we do that, we expand the capacity of the files a lot. We can even use the files in 950 RPMs with a very safety margin. When we use a higher RPMs... we increase the efficiency, the file's efficiency a lot. It's unbelievable what those files can do in 950. So that's why I prefer to try to test, to check my root canal with a 2501, because if I present, I will be there at the apex, pick up my apex locator, take my root canal left, and that's all. But if we are not able to go with a 2501, then I would think about to use my 10K hand file. Okay. That's an inversion of the patient. And again, I just want everybody to know we're talking about the Merida RootFlex system, which is a nickel titanium endodontic file system. And within this system, the files are available in two different tapers. So tell us about the two different tapers and their clinical applications. Well, basically what we are doing now is to offer two sets of files. One is 0-3 taper, the other one is 0-5 taper. When we check our CBCT exam or radiography, no matter what kind of instrument we are going to use to check how the root canal looks like, so we are going to define which sketch we are going to use. And the procedure is going to be the same all the time. I'm using the 2501. to the apex. If this file is not there, that's okay. My root canal is 25, so I use a 2503 or a 2505 according to the anatomy. If the root canal is wide enough, I use a 2505. If the canal is very narrow or very curved, I use a 2503. So according to the foraming size, I use the shaping file to match the foraming size, okay? So that's basically what is the procedure. The idea of the system is to minimize the number of files to use. This is another very important point here. Since the reciprocation files were introduced around 2010, the single file systems call a lot of attention of the market. So the doctors love to use less and less files. The docs would love if we do not use files anymore, but we still have to use that. So the idea is to use one or two files to prepare the entire root canal, since the glide path to the shape. So in our system, if you want, you can use most of the case. two files, one for GlidePath and establish the patents. The second file is going to be the shape file. If you want it, you can put one file in the middle to avoid big skips from 01 to 05. For example, people can say, oh my God, it's a lot of work for a 05 over a 01 taper. So if you want it, you can pass a 03 taper in the middle, but I don't think it's really necessary. The root flex, they are extremely efficient. So we are not only cutting the debris, the denting, but we also remove everything outside. So what about the sharpness of the root flex files? Apparently there's an exceptional sharpness to this material, this nitide. Is that different than other files on the market? Or what is so special about the sharpness? The sharpness is a very important point here to discuss. In order for us to use less files during the root canal preparation, we need to have a file that is very efficient. Instead of using three or four files, we use only one that makes the job for four files. So those files are extremely resistant and efficient, very sharp. The way we grind our files is a little bit different than the others. In order to keep the sharpness, it's very common when you see in the market nowadays, Gold colors, blue colors. The files have different colors because they do the heat treatment over by the end of the process. When they do the heat treatment, they put the grind parts inside the oven. They create oxide layer over the file that reduce the sharpness. So we don't do it this way. I do the heat treatment on the first stage of my grinding parts. And then at the end, I have a very sharp file anyway. So our files is by far sharper than the others because we invert the grinding process. In order to do that, we had to change our machines to develop tools to hold the more flexible blank. Because the nickel titanium is very flexible. When you heat treat the black, it's become more flexible. So it's very difficult to grind a very flexible black. So you have to develop some tools to hold the blacks in the right position to grind. So it's a different way to process. What does this do for the clinician as far as... saving chairside time because it seems to me having a file that stays really sharp that continues to cut it's very easy to work with just two files or three files which which is extremely efficient. Well, we have two different steps here. The first is the glide path and patency, and then we have the shaping itself, okay? If we use only two files for both procedures, we are going to save a lot of time, a lot of time. And the files, the files we are talking about, the cyclic fatigue is huge. Comparing if another brand's in the market, we sometimes 10 times more resistance in terms of cyclic fatigue. And we all know that cyclic fatigue is very important to stay longer inside the root canal. That's why I can even use our files, the root flex, in the 350, it's going to be good. But I can increase to 600, 950. Can you imagine using 950 RPMs for shaping files? But you can do that because we have cyclic fatigue enough to support such stress. Now, what about ledging? With a very sharp file and you got a rotation speed of 950, aren't you likely to have more ledges developed in your instrumentation? No. Unfortunately, I think they can check at Morita's website. They will have some pictures about our tip. We use a very round tip, completely round. We don't have transition angle. Another point that avoids the latches is the heat treatment because the file is much more flexible than the original ones. So even inside the root canals, the files keep... keeps the flexibility. There's another very important point here. The root flex temperature transformation from martensite to austenite is very high, close to 51 degrees centigrade. It's very far from the body temperature. When we put the file inside the root canal, the body temperature is around 36 and a half. Many files in the market, they are temperature transformation. is very low, close to the body temperature. So when those files are inside the root canal, they start to become stiffer, different than root flex, because the root flex temperature transformation is very high, close to 51 degrees centigrade. So even inside, if we stay working inside a very curved canal, the file keeps very flexible and do not transport internally, we do not cause internal transportation or even latch. What is your RPM that you recommend with first the glide path files? What's your RPM on that? We recommend the beginners to start to check the root canal. Start with 350, 400, okay? Once the guy becomes very familiar with the file's behavior, they must increase the temperature, the RPM to 500, 600. They will notice the efficiency of the file becomes up, up, and up. So the ideal, I recommend to use 950, but I suggest those guys to start with 350, 400. And when they feel comfortable, they will notice that it's possible to run 950 RPMs very easy. With a very safe way. What about the compatibility with different handpieces? Do they have to use a Morita handpiece for the root flex files? No, they don't have it necessarily to use Morita handpiece for. to use a Morita's file. It's not true. All the files in the market, they are under ISO standards. So all the files in the market probably match all the hand pieces and vice versa, okay? You know, when a dentist looks to buy a NITI system, they compare prices, they compare characteristics of the file. How would you differentiate RootFlex from your competitors? What's the key? outstanding feature that our listeners should be aware of when it comes to buying a NITI file system? Well, you know, I will be very honest. Our files, the root flex, have a very, very sharp edge. So in order to use one file to shape the entire root canal, we have to be very efficient. And I repeat again, efficiency in this case is not only cut, because you can cut and you have enough space to promote the removal. The root flex, they have a lot of space for the ships come outside. So we are very efficient in remove and cut the denting. Doing this, when we go to irrigate, we have cleaner walls. I would say that we have cleaner walls. walls for our irrigation systems, ultrasonics, lasers, and etc. Is it your recommendation, Dr. Bassi, to discard the file after a single use? Well, it's a good discussion in my country, especially in my country. Normally, the doctors like to say that they would like to use more than once, maybe two patients, two, three patients. Okay, this is a risk, okay? No, I don't believe, no company, will prepare a file to a single use because we need to create a safety margin for something that happens during the procedure, etc. So in our case, Morita's file, the root flex have a very, very big safety margin. But I never, as a manufacturer, I don't know. what kind of root canal you're going to do in your office. Probably you can have a very simple case and the files will be very, very new after this use. But I don't know, probably in another situation, you can have a very difficult case, 85 years old guy to do a second molar. So the file will be very stressed after the use. So we never know. The companies never know that. So that's why you make a safety margin. But we recommend for you to discard the file after the first use. Very well explained. Very well explained. I mean, what you're leaving it up to is the operator, the dentist, to say... You know, I barely use these files and I'm already done instrumenting the canal. I can get another use out of them. That's up to the operator. That's up to the dentist. How complex were the root canals? Very curved canals, very difficult, very calcified. So my concern is how you control this way. So it's difficult to control. That's why the companies recommend to... threw it away after the first use. Yeah. What are you guys using in Brazil for an irrigant? I assume you're using sodium hypochlorite to decontaminate the canal and break up the proteins? Yes, yes. I would say that 98% of Brazilian endodontists, they are using sodium hypochlorite. 6%, 5.2%, 6%, most of them. No, 8% is not popular here, as in the U.S., but 6% is really popular here. 6%? Sodium hypochlorite and 94% water mixed in there. Yes, yes, yes. The dilution rate you're talking about. Okay. What about EDTA? Do you use EDTA as a chelating agent? I think most of them, they are still using the EDTA to, I don't know the right word in English. Yeah, to chelate. To chelate, yes, to chelate the walls, yeah. Yeah, the walls of the canal. So you communicate a lot, Dr. Bassi, with your friends in Europe and your friends in the US. And I'm talking about your dentist. friends and endodontist friends in both these areas of the world. And what you found was that most of the files, or if not all, that are sold in Europe are sharper than the endodontic files sold in the United States. So I'm just wondering if you think that when a US dentist begins using the root flex system, they'll immediately notice the sharpness of that file. I know I have a lot of friends in the United States, a lot of endodontic friends. So I have the opportunity also to have friends in Europe. And the difference between files in Europe and the United States is very significant. So in Europe, the files, I would say they are sharper than U.S. files. Historically, that's what we can see. So the difference those guys will notice for root flags. is the sharpness the efficiency you you're gonna you're gonna shape your root canal in a matter of five five seconds eight seconds no longer than this once you have the patency to go to come with a uh 2505 paper it's gonna be three or four strokes and you are there at the apis because the files are really efficient the files the the ads do not brush the the walls they really cut Another very important point here is how to use the files, okay? Most of the endodontics, they love to brush, brush the walls. We don't have to brush. The only reason we are brushing the walls is just because of a lack of files efficient. We brush to open this coronal aspect and go down. Brush coronal, go down. We don't have to do this with root flex. That's why I save a lot of denting. I just go up and down, up and down, up and down, following the root canal direction. So by the end of the root canal preparation, I still have a lot of walls and the middle and cervical portions because I don't have to brush. It's very important for the endodontics nowadays because we preserve a lot of denting there. So why you can't do that? Because the file is efficient. Otherwise, we have to brush like any other files in the market that I know. It's a very good point. And regarding obturation, what is the typical obturation that you guys use over there? You know what? I'm a shoulder fan. The old way is the steel. what we have the best. Yeah, no, I don't disagree. Listen, Dr. Bassey, it's been a pleasure having you on the show. As an endodontist, it was very refreshing to hear the way you think. And a lot has changed in the last 10 years in endodontics. And I think you're right. I think an endodontist or a general dentist who does a lot of root canal, especially on calcified cases, will appreciate the sharpness. and the safety of these files, because that's ultimately what we need to do when we're instrumenting. We need to make a pathway to the pulp where we can get this tissue out, and your system that you developed or helped to develop allows the exit of all this debris along with the instrumentation and shaping of the canal, and it does it in an efficient time, and it maintains its sharpness, so you don't need a ton of files to keep changing. You could rely on the same two files. to do the job very very good stuff i hope you keep up your volleyball because uh it'll keep you young yeah i don't know if endodontics is endodontics may not keep you young but volleyball will you know what i i two years ago i made a prosthesis because it's a volleyball consequence for years of volleyball so nowadays i cannot practice anymore. I cannot jump anymore. I go skiing every year, so it's enough for me right now. You watch the volleyball tournaments. Just go and enjoy them. Stay healthy. Thank you very much. Thank you to Marita for all the innovation and R&D, research and development, and participating in our program. I think our listeners will be very interested in learning more about the RootFlex system from Marita. Thank you, Phil. Have a good day.