In the fourth year of university, in 2003, during the course of conservative and endodontic department, students were asked to deal with three canals.

 

I was assigned 3 monocanals.

 

I remember that because of the thousands of protocols and all the documents for rx that were requested added to the inexperience, we needed at least two appointments for each tooth.And, during the second, I still remember that we were quite scared of the ROOT CANAL OBTURATION WITH THE OBTURA SYRINGE! A highly technological device that you had to request, after filling out forms and ensuring that you would have repaid with your poor student pockets the delicate 30 gauge needles if you accidentally lost or broke them. The department had a single syringe back then, which you received packed in a box with all the pieces laid out with manic care due to its high economic value!

 

 

When it was time to perform, after having gone to a great deal of trouble to document the case, you would start managing the delicate root canal treatment starting with the downpack with Touch’n Heat and pluggers with the Schilder technique, and eventually completing the backpacking with the Obtura syringe .

 

While hesitantly doing the maneuvers, without even realizing what you were doing, as you worked without goggles, you could already feel the anxiety for the moment of the final x-ray. After filling out another dozen forms to access the x-ray and the holder you would go to the printer … look at the x-ray hoping the liquids were not exhausted … you would go to the diaphanoscope … and … A SHITTY CLOSURE FULL OF GAPS !?

 

Three crappy closures out of three! 100%! Clear round!

 

 

I must confess that after this experience I kind of started to hate endodontics.

 

The following year, in the prosthesis department, the syringe Obtura and Touch’n’heat were unavailable, so, after learning the previous year that the cold condensation technique sucks, the next year you had to put it into practice while managing prosthetic cases. When they say “practice what you preach”…? With the conceit of who has already used the best technique on the planet, I reluctantly approached this primordial and primitive technique… though the x-ray were much more beautiful! Even if I knew that closure was probably going to be less successful than the one performed with heat the previous year, I restarted feeling passionate about endodontics.

 

In the meantime, while attending some endodontic courses I discovered this technique I could not figure out: THERMAFIL. I was wondering how to be sure to compact the gutta percha with that simple gesture … Where were all those measurements of the apex, the cone, the choice of the plugger, etc.? Too easy to work properly.

 

However, shortly before graduating, I had the chance to work for free in a center where they treated immigrants without residence permit and poor people. I bought a detector, rotating tools, endo motor, endodontic holder and then I decided to use Thermafil because the stove was easier to carry than the Obtura syringe and System-B or the Touch’n Heat, it cost less and it could fit into my padded endodontic killer-style briefcase…

 

 

Without clear criteria on how to select the Thermafil diameters and how to handle the work lenght, because the University had elegantly skipped this technique, I guessed the first thermafil 25 (definitely under-sized as I had a gauging of 25… ) and stunned by its simplicity I looked at the x-ray skeptical… sure of having restarted the series of negative results begun in the endodontics department. I was amazed by my first root canal treatment with small puffs. And it was a premolar, not a monocanal! No kidding!

 

From that moment on, I knew I became a great endodontist!In fact, I understood only a few years later that my level was still extremely pitiful, but that experience made me passionate about endodontics.

 

I owe everything to Thermafil and I will never deny it.

 

But in the following years, I began hearing some endodontists saying that Thermafil was good only for a few cases or even not good at all. And that a cool endodontist had to use the Continuous Wave of Condensation technique by Buchanan. Actually I’m not sure that Buchanan developed this technique because it sounds more like one of the martial arts techniques that Kenshiro used in the Hokuto school in the 1980s…. Are Japanese always on the go with technology…

 

However, the four judgments, which are also the 4 GREAT LIES we refer to on the title of the post, were:

1- “Hm, but if you have to retreat the Thermafil you’re fucked up … ”

2 – “Hm, what if the carrier is denuded touching the canal?”

3 – “Hm, the problem is that with Thermafil you struggle to put the post, and anyway you can’t put them during the same session of the canal closure.”

4 – ” Hm, but with Thermafil you can’t close difficult anatomies like bifurcations, IV Weine classes, confluent canals … you have no apical control!”

When you’ve just graduated the judgments of the masters of endodontics are dogmas, especially if preceded by the exclamation “hm!”  As a self-styled top level endodontist, if I only used Thermafil I was bound to be labeled as a geek and incomplete endodontist. And I did not want to be neither geek nor incomplete, so I bought the Obturation Unit by Sybron Endo. I used it 3 times.I made 3 shitty closures without any control, (and my hand had become more sensitive anyway…).

And to avoid leaving endodontics to Federico, who in the meantime had his hands full while denying the dogmas of the master surgeons, who often start with an even longer exclamation, such as “Hhhhhhmmmm”, I sold the magnificent Obturation Unit.

 

But since then I have been working more and more… you know, I don’t like days off… and I worked 6 days a week…

In one year I was doing 400 canals… then 600… then 800…

And you know what… after figuring out how to do it with Thermafil, I could put posts… and the carrier did not come out and the posts didn’t break off… at the beginning I cooled the gutta with the crio spray, then I realized that it’s enough to condense it with a plugger before cutting the carrier with a Dentsply Post Space Bur… even if I know this is not possible, so the carrier will grow again or all the posts will come off in a few months… See a post space completely clean like this is definitely a deception…

And when I bought the microscope I started to find loads of absurd anatomies… And I could only close them with the Thermafil… although I actually thought I could do it because it was impossible. Look at this first inferior premolar I have retreated about a month ago… a furcation 5 mm from the bottom of the tooth… practically a IV Weine class… What do you think I have closed it with?

I had denuded without even realizing a few thousands of Thermafil… and even if my treatments hardly fail, they will probably be back in the next few years, because we know that if Thermafil is denuded, the treatment fails because of obscene act in endodontic place…I have retreated hundreds of Thermafil… but certainly even if the result was “puff” I actually created a canal parallel to the previous one, which was impossible to retreat.See how difficult it is to retreat the  Thermafil and overcome the carrier wall…

Surely I was just lucky or incompetent. Or maybe not? Or maybe the truth is that you always have to play it cool and support the most complicated techniques to still feel a proper endodontist? Anyway the endodontic specialist in the past was undoubtedly a badass.  But when in a few years rotating instruments, apex locators and fast canalar obturation techniques enter the market and the endodontics is available to anyone, what do you speak about during once-crowded and now declining courses? “Guys, the closure is a piece of cake, put a stick in the canal and it’s done!”?

 

No, you have to create anxiety and sense of inferiority and inadequacy in the learners … You have to make it clear that simplifying is not good. And so for years when I go to some course or public a case on fb I hear the usual spiel. When you talk about Thermafil, everyone feels entitled to tell you that Thermafil is not to be used… they get naked, you can’t retreat them and the pivots are in serious trouble, etc. But come on, have you ever used Thermafil?!?!?! Or do you speak only based on hearsay? Only if you work and see what you’re doing you can make these kinds of statements. Otherwise you’d rather shut up.

 

Let’s be clear, when some high skilled endodontist shows me significant scientific examples I listen to them, I make my objections and we discuss… But it is much harder and longer for anyone to close with the continuous wave of condensation than with Thermafil.That’s why in the end, many make use of more exotic techniques, from the Gutta Condensor to the McSpadden in order to close with hot gutta and to escape the difficult method (the wave of condensation) or the fake one (the Thermafil). Actually, with the continuous wave of condensation or with the classic Schilder technique, the level of criticality is higher. So much so that, with this technique, I was able to successfully perform not a single closure neither as a student nor when I had an experience of thousands of treated canals. I have the utmost respect for those who know how to use it fastly and flawlessly. It’s certainly my fault, I’m probably and incapable and dummy… but in the meantime I won a Lavagnoli Prize (an agreement of the SIE-Società Italiana di Endodonzia), I have a publication on the Journal of Endodontics and managed cases where I found 6 canals in a molar. And I work with the best microscope in the world. And the cases don’t come back. In endodontics as in the rest of dentistry, you need to select the least operator-dependent effective techniques as possible. Then it can happen to have that single case out of 50-100 in which another technique would have been the best solution enabling you to save 5 minutes, that’s ok you will accept it with light heart. The 100% success will always be an utopia. And anyway, in those sporadic cases where Thermafil creates some complications, you can still be successful. I think we will be able to prepare some online courses on Thermafil. Believe me, it’s a great technique! I’ve nothing against Mr.Kenshiro and his continuous condensation Technique, but I trust more the technique invented by Ben Johnson… that even if doped, he holds a real world record and knows what speed is about.

 

 

Moreover, I am a Silver Member of Style Italiano and I believe in the group’s motto: Feasable, Teachable, Repeatable. We need to teach things that work, simple and less operator-dependent. Let’s not invent complications and theories to make easy and effective things difficult. Such as Thermafil. If I wanted to learn how to use them but you do not know where to start I suggest you an interesting article by Enrico Cassai on the blog of our friends of Style Italiano about how to use them! Click here to take a look! Stay tuned!

Stefano

 

P.S. I apologize to Steve Buchanan and Ben Johnson, two great world- famous masters of endodontics! I took the liberty of joking a little … No intention of offending!