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34 I I opinion _ instruments _When you are competing against giants in a fieldthathasbecometremendouslylucrativeforthese giants, you could easily feel out of your depth and should beat a hasty retreat, lest you encounter their true wrath. It is undeniable that we are exposed to the all-encompassingmarketingpowerofthesegiants.We recognisetheirabilitytodominateendodonticeduca- tionintheschools(bothundergraduateandgraduate), commercialexhibitsandlecturesatallthemajormeet- ings,andthemajorityofthearticlespublishedintrade journals, all nicely capped off with an army of sales- people who make sophisticated pitches to dentists to buyoneoranotheroftheexpensiverotaryNiTisystems. We, however, have one over-riding advantage: we work with the simple but powerful idea that we have a safer, far more cost-effective and efficient way to perform endodontics that is so strongly based in commonsense that for those who expose themselves to these alternative concepts the acceptance rate will beextremelyhigh.Wedon’thavetoseemanypeopleto convince a small portion that they should adopt our approach,asthelogicandapplicationofourapproach is readily accepted by a large percentage of the far fewerdentistswecomeincontactwith. We have no other choice than to think this way, and it has done very well for us these past several years. We created an endodontic system that meets ourneedsbecausetheproductsthathadbeenheavily promoted in the marketplace did not. It is an absolute essential that the instruments not break. For us, there isnocompromiseonthispoint.Wedon’twanttoknow they won’t break if we only use them once, use them lightly with several iterations of recapitulation, not use them in highly curved, dilacerated, bifurcated or merged canals. Wewanttoknowthattheseinstrumentsusedinthe recommendedfashionwillnotbreak—period.Thiswas notarequirementbeforetheuseofrotaryNiTibecause while breakage occasionally occurred, it was a rarity. Once I had used rotary NiTi, I appreciated the greater tapered shaping, but this advantage did not outweigh the trepidation I had when using them. We came up withasystemthatincorporatedtheshapingassociated with NiTi—but without breakage as a worrying side effect.Iclearlyrememberpresentingalectureatafairly large dental meeting to introduce our concepts. After thelecture,oneofthedentistsIwasfriendlywithasked a younger dentist if he was interested in the system. Thedentistrespondedthathewasn’tinterestedinwhat I was talking about because it could not possibly be true.Ifitwere,everyonewouldbeusingit. The dentist’s response was an insight into human nature.WhatIgatheredfromthisremarkis: 1. If it sounds like it is too good to be true, then it is most likely not true. Having come to this conclusion, there is little follow-up to see if by chance it actually is true. It is more comforting to dismiss it. This reaction is even more likely if a dentist’s attention for new endo- donticsystemshasalreadybeencapturedbyoneofthe expensivesystemsofferedbythemajormanufacturers. Against my single endodontic lecture, the dentists attendingthelecturehadseenandheardaboutrotary NiTi systems at other lectures, in articles and testimo- nials, all by well-known opinion leaders and the ever- present salespeople who convince clinicians to buy theirlatestsystem.Itisdifficultnottogivecredenceto a flow of information that appears to be coming from diversesources,butinrealityisbeingcentrallychoreo- graphed. 2. Once an expensive system has been paid for, it is only natural the dentists would wish to defend their decisions, that they made the right choices to make theireffortsbetterandmoreproductive.Formanyden- tists,increasedusagefamiliarisesthemwiththerotary systems’ limitations and they thus begin to take the precautions that are necessary for safe usage. It is an unusual phenomenon of rotary NiTi that the more a dentist learns how to use these instruments, the more selectively they are employed. Case selection becomes animportantpartoftreatment. Case selection has become increasingly necessary simplybecausetherearemanysituationsthatcanlead to instrument separation. I cannot think of another innovation in dentistry for which the more a dentist roots1_2010 The perceptions of a David in a land of Goliaths Author_ Dr Barry Lee Musikant, USA