If you look at typical endodontist/dentist reviews, notice the main theme: painless, fast and nice. Let me emphasize again: painless! None of the reviews are about having “sealer puffs” or “0.5mm from radiographic apex” or “used laser/gentlewave for thorough disinfection”.

If you want to operate a successful practice, pain management is one of, if not the most important factor when managing patients. There are numerous ways to reduce pain management during the procedure and more importantly post-op pain.

One of the biggest culprit of post-op pain/swelling is reciprocating file due to the way it operates:

As shown from the video, reciprocating files are pushing out the infected dentin outside of the root canal space. What does this do? Well, you’re pushing infected dentin that contains bacteria that caused infection in the first place and an extraradicular infection and also flare-ups. If this happens, not only the patient will have more post op pain but now the infection is difficult to manage with non-surgical root canals (because the infection is now outside of the root canal space).

Another point I want to make is that no canals are perfect circle (although if it was then it would make everyone’s lives easier but we all cannot get what we want). As you can see, infected dentin debris are getting packed to the side of the canals when you instrument. Reciprocating file motions are packing dentin apically so you’re really decreasing the success rate of your root canals. In a separate article, I will also mention why finishing apical sizes any less than 30 (unless the canal is extremely curved)

If/when patient develops pain afterwards, it is never a fun conversation for a general dentist to tell the patient “well the previous root canal failed so we need to drill through the crown we put on and have to redo the root canal and also possibly need a new crown” So obviously we should do everything we can to prevent from this happening by any means.

Endodontists can manage this with Root End Surgery (aka Apicoectomy) but it’s best if we can avoid it (duh). There’s even an article from Journal of Endodontics about this topic:

As you can see from this article, post op pain is more intense with patients treated with reciprocating file system compared to continuous file system.

Another problem with reciprocating file is the microcracks that intensify tooth pain and more importantly causing tooth fracture. Tooth fracture is one of the hardest symptoms to diagnose because its not really visible from radiographs. So you’re making patients have persistent discomfort or pain long term which can make both the nonspecialist and specialist look bad.

I’m attaching another article about dentinal defects comparing reciprocating vs rotary file system:

These are the reasons why I use continuous file systems!