Twisted File: A New Paradigm in Endodontic Canal Preparation?

tf-175×175.jpgI stopped using rotary nickel titanium files a few years ago because of problems with files breaking. I did not break that many, but just enough to make me feel a bit insecure. I went back to using stainless steel files. Recently, though, I was reading about the next generation of rotary nickel titanium, the Twisted File from SybronEndo. According to Mounce – who I consider one of the greatest endodontists – these files are very resistant to breakage if they are used properly. Has anybody used these? How do these compare with other rotary nickel titanium instrumentation? Mounce says you may be able to do a whole endo with only one file. Thoughts?

Editor’s Note:
Richard E. Mounce, DDS published an article in Oral Health. May 2008, discussing the Twisted File. Below are some excerpts. The full article, as well as, other information about Twisted Files can be found at http://www.tfwithrphase.com.

The Twisted File (TF) is unsurpassed in its cutting efficiency, fracture resistance, tactile control, and the efficiencies gained from its use…A proprietary process of heating, cooling and twisting makes TF possible. TF is not ground against the material’s natural grain structure to create the cutting edges. Such grinding creates microcracks that can be future failure points due excessive to torsion and cyclic fatigue.

The heating and cooling process that the nickel titanium is subjected to optimizes its molecular phase structure that ultimately gives TF its qualities…many root anatomies will allow a single TF file to create the entire preparation. This is the first instrument ever that has possessed this flexibility and functionality…If used correctly (as described), TF will reduce instrument fracture dramatically, almost to zero…Reduced fracture rates translate to confidence, predictability, ultimately better clinical results and greater profitability…

Because TF cuts efficiently, the number of files needed to reach TWL (i.e. the minor constriction of the apical foramen) is reduced considerably…As a benefit of the heating, cooling and twisting of the metal, TF can negotiate virtually any curvature. It is very difficult to envision the clinical case that would require hand files to be preferred over TF in the apical third…The Twisted File is the first file that can be used Crown Down and/or as a Single File instrument in many cases and do so with unparalleled safety and cutting efficiency…

13 thoughts on “Twisted File: A New Paradigm in Endodontic Canal Preparation?

  1. Are you creating a glide path to a size #15 file. If not, perhaps that is why you were breaking the rotary files. It isn’t the file that’s breaking but the person using them who is breaking them.

  2. I have seen the literature and have worked with them on extracted teeth. My opinion is they are very very aggressive. I am sticking with my Tulsa endo files that I have had great success with.

  3. i am brazilian and endodontology. i would like to see some articles abouth fracture resistance of Twisted File.
    thanks.
    talita.

  4. Requirered RPM is 500. Feel is quite different from Protaper instruments. I tried them and they tend to grab very quickly-scary.

  5. TWISTED FILE OR GROUND FILE IT DOESN’T MATTER. THE SAFE WAY FOR ROTARY FILES IS A “PERFECT GLIDE PATH” PRIOR TO ROTARY FILING. I THINK IF WE SHORT CHANGE THIS CRITICAL STEP WE INCREASE THE RISK OF ROTARY FILE SEPARATION.

    TRY THE ENDOHANDLE TO GET A PERFECT GLIDE PATH PRIOR TO ROTARY INSTRUMENTATION. IT’S EASY AND VERY EFFECTIVE.

  6. Very few aticles written about it,
    Manufacturer claims it most effective, lowest time for rc shaping…
    I did more than 6 anterior and prem. using it, its very effective but nothing without limitations,
    I combine with it K3 to get the final apical width cause its size at tip is 25.
    BUT overall the principles of using rotary files should be followed or complications can happen.
    Also the agent of comp. in saudi Arabia doesn’t know exactly how many times can be used.

  7. Creating a proper glide path is crucial! I do a lot of molar endos with canals that have multiplanar curvatures. I commonly shape up to a 25 k-file using lubricant like FileRite or Slide. Also, files from 15 , 20 and 25 must be pre-curved to prevent ledging. Then I use Gates #2 and #3 to middle third, and peesos reamers #2 and #3 on coronal third only to establish straight line access. Then its rotary time with lots of irrigants. Never dry! Have fun.

  8. I’ve been using profile series for 5 years, with separation rate of 1/100. Currently using the Twisted files, just worked them gradually into my routine w/profile. Really speeds things up. I’m moving toward using TFs for 100% of each RCT.

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