SAF System presentation - July 2014

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Presentation of the Self-Adjusting File (SAF) System - a revolutionary innovative system for root canal (endodontic) treatment, that adapts to the anatomy of the root canal in a minimally invasive way, without excessively removing dentin or causing micro-fractures, and at the same time includes simultaneous continuous irrigation (with Sodium Hypochlorite or other irrigants). This enables the dentist to carry an efficient cleaning-shaping-irrigation endodontic procedure with a higher success rate.

Transcript of SAF System presentation - July 2014

1Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive

EndodonticsDr Alon Amit July 2014

2Dr Alon Amit Minimally Invasive Endodontics

Comfort Zone

3Dr Alon Amit Minimally Invasive Endodontics

The mind is like a parachute ndashIt works better when itrsquos open

4Dr Alon Amit Minimally Invasive Endodontics

Letrsquos start with a short question

5Dr Alon Amit Minimally Invasive Endodontics

Rate the following factors according to their importance when choosing an endodontic file system

1Preserves more sound dentin2Easy to use3Low chance for file separation4Cheap price5Reduces treatment time6Provides better cleaning

Letrsquos start with a short question

6Dr Alon Amit Minimally Invasive Endodontics

What are we going to discuss today

Requirements of RCT Current technologies New technology

7Dr Alon Amit Minimally Invasive Endodontics

Shaping

Disinfection Obturation

Healing

The ldquoHoly Trinityrdquo of Endodontics

Clea

ning

amp

Cleaning The removal of tissue remnants

harboring bacteria and preventing proper seal

Shaping The removal of infected Inner layer of dentin

to facilitate effective irrigation and obturation

Disinfection The use of irrigants

to remove biofilm from the canal

Obturation Preventing re-infection

of the clean root canals

8Dr Alon Amit Minimally Invasive Endodontics

Root Canal Treatment success rate

Absence of Apical Periodontitis as seen in X-ray photosbull Orstavik 1996 Int J Endod 29150-155 85

bull Hoskinson et al 2002 OOOOE 93 705-715 74

bull Orstavik et al 2004 Europ J Oral Science 112 224-230

79

bull Kojima et al 2004 OOOOE 9795-9 79-83

bull de Chevinggy et al 2008 J Endod 34 258-263 82

bull Siqueira et al 2008 OOOOE 106 757-762 76

By Specialists

~80 bull De moor (Belgium) 2000 Int J Endod 33 113-120 40

bull Dugas Friedman (Canada) 2003 Int J Endod 36 181-192

49-56

bull Jimenez-Pinzon (Spain) 2004 Int J Endod 37 167-173

36

bull Tsuneishi (Japan) 2005 OOOOE 100(5) 631-5 60

bull Georgopoulou (Greece) 2005 Int J Endod 38 105-111

40

bull Kirkevanget (Denmark) 2006 Int J Endod 39 100-107

40

In general~50

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

2Dr Alon Amit Minimally Invasive Endodontics

Comfort Zone

3Dr Alon Amit Minimally Invasive Endodontics

The mind is like a parachute ndashIt works better when itrsquos open

4Dr Alon Amit Minimally Invasive Endodontics

Letrsquos start with a short question

5Dr Alon Amit Minimally Invasive Endodontics

Rate the following factors according to their importance when choosing an endodontic file system

1Preserves more sound dentin2Easy to use3Low chance for file separation4Cheap price5Reduces treatment time6Provides better cleaning

Letrsquos start with a short question

6Dr Alon Amit Minimally Invasive Endodontics

What are we going to discuss today

Requirements of RCT Current technologies New technology

7Dr Alon Amit Minimally Invasive Endodontics

Shaping

Disinfection Obturation

Healing

The ldquoHoly Trinityrdquo of Endodontics

Clea

ning

amp

Cleaning The removal of tissue remnants

harboring bacteria and preventing proper seal

Shaping The removal of infected Inner layer of dentin

to facilitate effective irrigation and obturation

Disinfection The use of irrigants

to remove biofilm from the canal

Obturation Preventing re-infection

of the clean root canals

8Dr Alon Amit Minimally Invasive Endodontics

Root Canal Treatment success rate

Absence of Apical Periodontitis as seen in X-ray photosbull Orstavik 1996 Int J Endod 29150-155 85

bull Hoskinson et al 2002 OOOOE 93 705-715 74

bull Orstavik et al 2004 Europ J Oral Science 112 224-230

79

bull Kojima et al 2004 OOOOE 9795-9 79-83

bull de Chevinggy et al 2008 J Endod 34 258-263 82

bull Siqueira et al 2008 OOOOE 106 757-762 76

By Specialists

~80 bull De moor (Belgium) 2000 Int J Endod 33 113-120 40

bull Dugas Friedman (Canada) 2003 Int J Endod 36 181-192

49-56

bull Jimenez-Pinzon (Spain) 2004 Int J Endod 37 167-173

36

bull Tsuneishi (Japan) 2005 OOOOE 100(5) 631-5 60

bull Georgopoulou (Greece) 2005 Int J Endod 38 105-111

40

bull Kirkevanget (Denmark) 2006 Int J Endod 39 100-107

40

In general~50

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

3Dr Alon Amit Minimally Invasive Endodontics

The mind is like a parachute ndashIt works better when itrsquos open

4Dr Alon Amit Minimally Invasive Endodontics

Letrsquos start with a short question

5Dr Alon Amit Minimally Invasive Endodontics

Rate the following factors according to their importance when choosing an endodontic file system

1Preserves more sound dentin2Easy to use3Low chance for file separation4Cheap price5Reduces treatment time6Provides better cleaning

Letrsquos start with a short question

6Dr Alon Amit Minimally Invasive Endodontics

What are we going to discuss today

Requirements of RCT Current technologies New technology

7Dr Alon Amit Minimally Invasive Endodontics

Shaping

Disinfection Obturation

Healing

The ldquoHoly Trinityrdquo of Endodontics

Clea

ning

amp

Cleaning The removal of tissue remnants

harboring bacteria and preventing proper seal

Shaping The removal of infected Inner layer of dentin

to facilitate effective irrigation and obturation

Disinfection The use of irrigants

to remove biofilm from the canal

Obturation Preventing re-infection

of the clean root canals

8Dr Alon Amit Minimally Invasive Endodontics

Root Canal Treatment success rate

Absence of Apical Periodontitis as seen in X-ray photosbull Orstavik 1996 Int J Endod 29150-155 85

bull Hoskinson et al 2002 OOOOE 93 705-715 74

bull Orstavik et al 2004 Europ J Oral Science 112 224-230

79

bull Kojima et al 2004 OOOOE 9795-9 79-83

bull de Chevinggy et al 2008 J Endod 34 258-263 82

bull Siqueira et al 2008 OOOOE 106 757-762 76

By Specialists

~80 bull De moor (Belgium) 2000 Int J Endod 33 113-120 40

bull Dugas Friedman (Canada) 2003 Int J Endod 36 181-192

49-56

bull Jimenez-Pinzon (Spain) 2004 Int J Endod 37 167-173

36

bull Tsuneishi (Japan) 2005 OOOOE 100(5) 631-5 60

bull Georgopoulou (Greece) 2005 Int J Endod 38 105-111

40

bull Kirkevanget (Denmark) 2006 Int J Endod 39 100-107

40

In general~50

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

4Dr Alon Amit Minimally Invasive Endodontics

Letrsquos start with a short question

5Dr Alon Amit Minimally Invasive Endodontics

Rate the following factors according to their importance when choosing an endodontic file system

1Preserves more sound dentin2Easy to use3Low chance for file separation4Cheap price5Reduces treatment time6Provides better cleaning

Letrsquos start with a short question

6Dr Alon Amit Minimally Invasive Endodontics

What are we going to discuss today

Requirements of RCT Current technologies New technology

7Dr Alon Amit Minimally Invasive Endodontics

Shaping

Disinfection Obturation

Healing

The ldquoHoly Trinityrdquo of Endodontics

Clea

ning

amp

Cleaning The removal of tissue remnants

harboring bacteria and preventing proper seal

Shaping The removal of infected Inner layer of dentin

to facilitate effective irrigation and obturation

Disinfection The use of irrigants

to remove biofilm from the canal

Obturation Preventing re-infection

of the clean root canals

8Dr Alon Amit Minimally Invasive Endodontics

Root Canal Treatment success rate

Absence of Apical Periodontitis as seen in X-ray photosbull Orstavik 1996 Int J Endod 29150-155 85

bull Hoskinson et al 2002 OOOOE 93 705-715 74

bull Orstavik et al 2004 Europ J Oral Science 112 224-230

79

bull Kojima et al 2004 OOOOE 9795-9 79-83

bull de Chevinggy et al 2008 J Endod 34 258-263 82

bull Siqueira et al 2008 OOOOE 106 757-762 76

By Specialists

~80 bull De moor (Belgium) 2000 Int J Endod 33 113-120 40

bull Dugas Friedman (Canada) 2003 Int J Endod 36 181-192

49-56

bull Jimenez-Pinzon (Spain) 2004 Int J Endod 37 167-173

36

bull Tsuneishi (Japan) 2005 OOOOE 100(5) 631-5 60

bull Georgopoulou (Greece) 2005 Int J Endod 38 105-111

40

bull Kirkevanget (Denmark) 2006 Int J Endod 39 100-107

40

In general~50

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

5Dr Alon Amit Minimally Invasive Endodontics

Rate the following factors according to their importance when choosing an endodontic file system

1Preserves more sound dentin2Easy to use3Low chance for file separation4Cheap price5Reduces treatment time6Provides better cleaning

Letrsquos start with a short question

6Dr Alon Amit Minimally Invasive Endodontics

What are we going to discuss today

Requirements of RCT Current technologies New technology

7Dr Alon Amit Minimally Invasive Endodontics

Shaping

Disinfection Obturation

Healing

The ldquoHoly Trinityrdquo of Endodontics

Clea

ning

amp

Cleaning The removal of tissue remnants

harboring bacteria and preventing proper seal

Shaping The removal of infected Inner layer of dentin

to facilitate effective irrigation and obturation

Disinfection The use of irrigants

to remove biofilm from the canal

Obturation Preventing re-infection

of the clean root canals

8Dr Alon Amit Minimally Invasive Endodontics

Root Canal Treatment success rate

Absence of Apical Periodontitis as seen in X-ray photosbull Orstavik 1996 Int J Endod 29150-155 85

bull Hoskinson et al 2002 OOOOE 93 705-715 74

bull Orstavik et al 2004 Europ J Oral Science 112 224-230

79

bull Kojima et al 2004 OOOOE 9795-9 79-83

bull de Chevinggy et al 2008 J Endod 34 258-263 82

bull Siqueira et al 2008 OOOOE 106 757-762 76

By Specialists

~80 bull De moor (Belgium) 2000 Int J Endod 33 113-120 40

bull Dugas Friedman (Canada) 2003 Int J Endod 36 181-192

49-56

bull Jimenez-Pinzon (Spain) 2004 Int J Endod 37 167-173

36

bull Tsuneishi (Japan) 2005 OOOOE 100(5) 631-5 60

bull Georgopoulou (Greece) 2005 Int J Endod 38 105-111

40

bull Kirkevanget (Denmark) 2006 Int J Endod 39 100-107

40

In general~50

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

6Dr Alon Amit Minimally Invasive Endodontics

What are we going to discuss today

Requirements of RCT Current technologies New technology

7Dr Alon Amit Minimally Invasive Endodontics

Shaping

Disinfection Obturation

Healing

The ldquoHoly Trinityrdquo of Endodontics

Clea

ning

amp

Cleaning The removal of tissue remnants

harboring bacteria and preventing proper seal

Shaping The removal of infected Inner layer of dentin

to facilitate effective irrigation and obturation

Disinfection The use of irrigants

to remove biofilm from the canal

Obturation Preventing re-infection

of the clean root canals

8Dr Alon Amit Minimally Invasive Endodontics

Root Canal Treatment success rate

Absence of Apical Periodontitis as seen in X-ray photosbull Orstavik 1996 Int J Endod 29150-155 85

bull Hoskinson et al 2002 OOOOE 93 705-715 74

bull Orstavik et al 2004 Europ J Oral Science 112 224-230

79

bull Kojima et al 2004 OOOOE 9795-9 79-83

bull de Chevinggy et al 2008 J Endod 34 258-263 82

bull Siqueira et al 2008 OOOOE 106 757-762 76

By Specialists

~80 bull De moor (Belgium) 2000 Int J Endod 33 113-120 40

bull Dugas Friedman (Canada) 2003 Int J Endod 36 181-192

49-56

bull Jimenez-Pinzon (Spain) 2004 Int J Endod 37 167-173

36

bull Tsuneishi (Japan) 2005 OOOOE 100(5) 631-5 60

bull Georgopoulou (Greece) 2005 Int J Endod 38 105-111

40

bull Kirkevanget (Denmark) 2006 Int J Endod 39 100-107

40

In general~50

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

7Dr Alon Amit Minimally Invasive Endodontics

Shaping

Disinfection Obturation

Healing

The ldquoHoly Trinityrdquo of Endodontics

Clea

ning

amp

Cleaning The removal of tissue remnants

harboring bacteria and preventing proper seal

Shaping The removal of infected Inner layer of dentin

to facilitate effective irrigation and obturation

Disinfection The use of irrigants

to remove biofilm from the canal

Obturation Preventing re-infection

of the clean root canals

8Dr Alon Amit Minimally Invasive Endodontics

Root Canal Treatment success rate

Absence of Apical Periodontitis as seen in X-ray photosbull Orstavik 1996 Int J Endod 29150-155 85

bull Hoskinson et al 2002 OOOOE 93 705-715 74

bull Orstavik et al 2004 Europ J Oral Science 112 224-230

79

bull Kojima et al 2004 OOOOE 9795-9 79-83

bull de Chevinggy et al 2008 J Endod 34 258-263 82

bull Siqueira et al 2008 OOOOE 106 757-762 76

By Specialists

~80 bull De moor (Belgium) 2000 Int J Endod 33 113-120 40

bull Dugas Friedman (Canada) 2003 Int J Endod 36 181-192

49-56

bull Jimenez-Pinzon (Spain) 2004 Int J Endod 37 167-173

36

bull Tsuneishi (Japan) 2005 OOOOE 100(5) 631-5 60

bull Georgopoulou (Greece) 2005 Int J Endod 38 105-111

40

bull Kirkevanget (Denmark) 2006 Int J Endod 39 100-107

40

In general~50

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

8Dr Alon Amit Minimally Invasive Endodontics

Root Canal Treatment success rate

Absence of Apical Periodontitis as seen in X-ray photosbull Orstavik 1996 Int J Endod 29150-155 85

bull Hoskinson et al 2002 OOOOE 93 705-715 74

bull Orstavik et al 2004 Europ J Oral Science 112 224-230

79

bull Kojima et al 2004 OOOOE 9795-9 79-83

bull de Chevinggy et al 2008 J Endod 34 258-263 82

bull Siqueira et al 2008 OOOOE 106 757-762 76

By Specialists

~80 bull De moor (Belgium) 2000 Int J Endod 33 113-120 40

bull Dugas Friedman (Canada) 2003 Int J Endod 36 181-192

49-56

bull Jimenez-Pinzon (Spain) 2004 Int J Endod 37 167-173

36

bull Tsuneishi (Japan) 2005 OOOOE 100(5) 631-5 60

bull Georgopoulou (Greece) 2005 Int J Endod 38 105-111

40

bull Kirkevanget (Denmark) 2006 Int J Endod 39 100-107

40

In general~50

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

9Dr Alon Amit Minimally Invasive Endodontics

>

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

10Dr Alon Amit Minimally Invasive Endodontics

Root Canal Anatomy on 2D X-ray

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

11Dr Alon Amit Minimally Invasive Endodontics

Dentists tend to relate to all root canals as if they had a

uniform round cross section

The Common Misconception

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

12Dr Alon Amit Minimally Invasive Endodontics

Complex Anatomy

micro-CT courtesy of Prof Frank Paqueacute

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

13Dr Alon Amit Minimally Invasive Endodonticsmicro-CT by Prof Marco Versiani

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

14Dr Alon Amit Minimally Invasive Endodontics

Tooth Anatomy

>

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

15Dr Alon Amit Minimally Invasive Endodontics

Oval cross section mandibular incisors

caninespremolars

distal roots of mandibular molars

ldquoTear-shapedrdquo cross section

premolarsmesial roots of mandibular molars

mesio-buccal roots of maxillary molars

ldquoLong-ovalndashshaped canals are relatively common with

a prevalence of about 25 in the apical third of human

teeth In some teeth the prevalence may be greater

than 50rdquoWu amp Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000 89739-43

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

16Dr Alon Amit Minimally Invasive Endodontics

And in realityhellip

Dr Amir Weissman (Israel)

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

17Dr Alon Amit Minimally Invasive Endodontics

Combined with Complex Wall Surface

SEM (Scanning Electron Microscopy) data

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

18Dr Alon Amit Minimally Invasive Endodontics

Inexpensive has a track record usually safe buthellip

bull Time consuming

bull Inflexible - difficulty negotiating curved canals

bull Extrude debris periapically

bull Pack debris into recesses

bull Sequential irrigation

Traditional TechnologyStainless-Steel Hand Files

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

19Dr Alon Amit Minimally Invasive Endodontics

Advanced technology a game-changer in modern endodontics

bull Motorized instrumentationbull Faster preparationbull Able to negotiate curved

canals

Howeverhellip

Current TechnologyRotary Files

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

20Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Profile 1993bull Quantec 1996bull GT 1998bull Hero642 1999bull FlexMaster 2000

1st GenerationSymmetrical

Flutes amp

Uniform Taper bull Race 1999bull ProTaper 2001bull K3 2001bull Hero Shaper

2002bull Revo-S 2009

2nd GenerationAsymmetrical

Flutes andor

Non-Uniform Taper

bull GT ndash X (M-wire)

2009bull TF (R-phase) 2009bull ProTaper Next

2013

3rd GenerationInnovative Metallurgy

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

21Dr Alon Amit Minimally Invasive Endodontics

Evolution of Rotary NiTi Files

bull Reciproc 2011 bull WaveOne 2011

4th GenerationSame design Reciprocation

bull BFR 2014bull TRUshape 2015

5th GenerationInnovative

Metallurgy Curved

Rotating Blade with Flutes

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

22Dr Alon Amit Minimally Invasive Endodontics

Peer-reviewed research has shown so far the following consequences

bull Unpredictable File separation ndash even with advanced metallurgy

and reciprocation

bull Excessive removal of dentin ndash especially with high-taper systems

bull Periapical debris extrusion ndash especially with reciprocation

bull Packing of debris into recesses

bull Efficiency of NaOCl is reduced when used with single-file systems

due to shorter working time and non-sequential work

bull Formation of dentinal Micro-cracks especially with single-file

systems

Issues with Rotary NiTi Files

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

23Dr Alon Amit Minimally Invasive Endodontics

1st Generation 4th Generation

Profile 1993 WaveOne 2011

This represents 20 years of NiTi

rotary files evolution

Rotating Blade with

Flutes

Evolution of Rotary NiTi Files

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

24Dr Alon Amit Minimally Invasive Endodontics

Rotating Blade with Flutes =

A Machining Device

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

25Dr Alon Amit Minimally Invasive Endodontics

Ignoring

the

3D shape

of the root canals

Common to all

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

26Dr Alon Amit Minimally Invasive Endodontics

Cone beam CT presenting oval cross-sections of canals

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

27Dr Alon Amit Minimally Invasive Endodontics

Efficacy of rotary instruments with greater taper inpreparing oval root canalsA El-Ayouti et al Int Endod J 2008 41(12)1088-92

ldquoNo instrumentation technique was able to circumferentially prepare the oval outline of root canals Nevertheless instruments with greater taper (ProTaper and Mtwo) were more efficient than NiTi hand-files but this was in some cases at the expense of remaining dentine-wall thicknessrdquo

All instruments were used in Brushing Circumferential filing

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

28Dr Alon Amit Minimally Invasive Endodontics

2 mm 4 mm 6 mmYellow - After preparationRed - Before preparation

Rotary File ndash microCT AnalysisMetzger et al J Endod 2010 36(4)679-90

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

29Dr Alon Amit Minimally Invasive Endodontics

All root canals

are machined to a

round cross-section

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

30Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

Excessive enlargement To include all canal

surface

To allow effective irrigation

To shape for industrial master

cones

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

31Dr Alon Amit Minimally Invasive Endodontics

Rotary File ndash Excessive enlargement

- would make a great 2D X-

ray

SAF

Rotar

y

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

32Dr Alon Amit Minimally Invasive Endodontics

Peters amp Paqueacute Int Endod J 2003 36(2)86-92

Red - Over 40 of the surface is untouched by the

file

Green - Affected surface Clear - Final preparation

Before After Superposition

microCT Analysis - Root Canal Transportation

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

33Dr Alon Amit Minimally Invasive Endodontics

Percentage of Untreated Root Canal Surface

Paqueacute et al J Endod 2009 351056-9

microCT Analysis - Maxillary Molars

Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

Canwe do

Better

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

34Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2010 36703ndash707

Distal canal (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

Percentage of Untreated Root Canal Surface

(long-oval canals)

microCT Analysis - Distal roots of mandibular molars

Can we do better

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

35Dr Alon Amit Minimally Invasive Endodontics

Paqueacute et al J Endod 2009 351044-1047

Before After Packed Debris

microCT Analysis - Hard Tissue Debris

Accumulation

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

36Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris During Rotary Instrumentation

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

37Dr Alon Amit Minimally Invasive Endodontics

Dr Clifford Ruddle

Packing of Debris During Rotary Instrumentation

>

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

38Dr Alon Amit Minimally Invasive Endodontics

Can conventional irrigation really clean

ldquoThe notion that ldquothe file shapes the irrigant cleansrdquo represents

wishful thinking rather than a scientifically based fact at least in flat-

oval root canalsrdquoDe Deus et al J Endod 2011 37701-705

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

39Dr Alon Amit Minimally Invasive Endodontics

De Deus et al Int Endod J 2008 341401ndash1405

ldquokey- holerdquo appearance

of preparation

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

40Dr Alon Amit Minimally Invasive Endodontics

Irrigation - ldquovapor-lockrdquo effect

Excessive pressure = NaOCl accident

>

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

41Dr Alon Amit Minimally Invasive Endodontics

Packing of Debris

Dr Amir Weissman (Israel)

ldquo508 of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)rdquoPaqueacute Boessler amp Zehnder Int Endod J 2011 44(2)148-53

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

42Dr Alon Amit Minimally Invasive Endodontics

Onnick et al J Endod 1994 2032-7

Incomplete root fractures in the history of endodontic research

Turek et al J Endod 1982 8437-43

Association with excessive removal of dentin

Association with obturation techniques

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

43Dr Alon Amit Minimally Invasive Endodontics

Shemesh et al J Endod 2011 37 63-66

Iatrogenic Micro-Cracks amp Craze Line Formation During Rotary Instrumentation

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

44Dr Alon Amit Minimally Invasive EndodonticsKim et al J Endod 2010 36(7)1195-9

Stress generation by rotary files and its relation to micro-cracks

The stiffer file designs generated higher stress concentrations in the apical root dentin during shaping of the curved canal which raises the risk of dentinal defects that may lead to apical root cracking

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

45Dr Alon Amit Minimally Invasive Endodontics

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

46Dr Alon Amit Minimally Invasive Endodontics

Minimally Invasive Endodontics

Paradigm Shift

In Root Canal Treatment

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

47Dr Alon Amit Minimally Invasive Endodontics

Achieve minimally-invasive

3D root canal shaping cleaning

and simultaneous Irrigation

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

48Dr Alon Amit Minimally Invasive Endodontics

Abrasive Surface

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

49Dr Alon Amit Minimally Invasive Endodontics

The hollow design enables the SAF to be elastically compressed along its cross section (A) when inserted into a canal previously negotiated with a no 20 K-file (B)

Compression

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

50Dr Alon Amit Minimally Invasive Endodontics

>

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

51Dr Alon Amit Minimally Invasive Endodontics

Attempting to expand the SAF applies light continuous pressure along the entire circumference of the root canal wall

Gradual Expansion

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

52Dr Alon Amit Minimally Invasive Endodontics

Compressibility

0

2

4

6

8

10

12

14

16

18

20

015 025 035 045 055 065 075 085

Diameter (mm)

Dis

tanc

e fr

om T

ip (

mm

)

15 mm

045020

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

53Dr Alon Amit Minimally Invasive Endodontics

Adaptation to oval cross-sections

24 mm

02 mm

15 mm

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

54Dr Alon Amit Minimally Invasive Endodontics

Force applied by a compressed SAF

100

150

200

250

300

350

400

450

500

015 02 025 03 035 04 045 05 055 06 065

Canal Diameter (mm)

SA

F F

orce

(g)

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

55Dr Alon Amit Minimally Invasive Endodontics

Gradual expansion by the SAF

Dr Michael Solomonov Israel

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

56Dr Alon Amit Minimally Invasive Endodontics

Circumferential 3D adaptation

Compare this to the last rotary instrument

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

57Dr Alon Amit Minimally Invasive Endodontics

Mode of operation

1 Vertical vibration ndash 04 mm amplitude at 5000 rpm

2 Slow low-torque rotation ndash at ~80 rpm

3 Clutch mechanism to avoid rotation while engaged with canal walls

4 Continuous irrigation

04

mm

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

58Dr Alon Amit Minimally Invasive Endodontics

Repeated Motion

The gentle vertical vibration helps achieve a gradual enlargement of the root canal

04

mm

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

59Dr Alon Amit Minimally Invasive Endodontics

All these create theldquoSand Paper effectrdquo

bull Abrasive Surface

bull Repeated Motion

bull Light pressure

bull Creation of ldquoDentin Dustrdquo

bull Irrigation washes the debris

away

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

60Dr Alon Amit Minimally Invasive Endodontics

0

05

1

15

2

25

3

35

4

0 05 1 15 2 25 3 35 4 45

Working Time (min)

Enl

arge

men

t by

IS

O

Dentin removal by the SAF

Working time (min)

Denti

n r

em

oval ndash

standard

ized b

y ISO

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

61Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

62Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

63Dr Alon Amit Minimally Invasive Endodontics

The SAFrsquos hollow design allowscontinuous irrigation of the root canal through its lumen

Continuous Irrigation - VATEA

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

64Dr Alon Amit Minimally Invasive Endodontics

Continuous Irrigation - EndoStation

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

65Dr Alon Amit Minimally Invasive Endodontics

Continuous simultaneous irrigation

>

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

66Dr Alon Amit Minimally Invasive Endodontics

Low-pressure irrigation

>

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

67Dr Alon Amit Minimally Invasive Endodontics

NaOCl refresh rate during irrigation

>

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

68Dr Alon Amit Minimally Invasive Endodontics

Three Standard Lengths 21mm 25mm 31mm

Diameters 15mm 20mm

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

70Dr Alon Amit Minimally Invasive Endodontics

SAF - introduction

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

71Dr Alon Amit Minimally Invasive Endodontics

Evidence Based Endodontics

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

72Dr Alon Amit Minimally Invasive Endodontics

57 published peer-reviewed articles in 4 Years 33 articles

on Journal of Endodontics8 articles on International Endodontic Journal

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

73Dr Alon Amit Minimally Invasive Endodontics

No Micro-cracks

Formation

Safety in Use

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

74Dr Alon Amit Minimally Invasive Endodontics

Hero Shaper

Yoldas et al J Endod 2012 38232-235

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

75Dr Alon Amit Minimally Invasive Endodontics

ProTaper (complete fracture)

Yoldas et al J Endod 2012 38232-235

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

76Dr Alon Amit Minimally Invasive Endodontics

Dentinal micro-Crack Formation during Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File

60

25

40

30

Yoldas et al J Endod 2012 38232-235

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

77Dr Alon Amit Minimally Invasive Endodontics

SAF

Yoldas et al J Endod 2012 38232-235

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

78Dr Alon Amit Minimally Invasive Endodontics

Kim et al J Endod 2010 36(7)1195-9 Kim et al J Endod 2013 39(12)1572-5

Stress generation in the dentin ndash comparison of rotary files to SAF

ldquoSAF generated a minimal reaction force and resulted in minimal dentin removal This could contribute to the reduction of the fracture risk and dentinal defectsrdquo

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

79Dr Alon Amit Minimally Invasive Endodontics

No Packing of Debris

Safety in Use

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

80Dr Alon Amit Minimally Invasive Endodontics

SAF

17 debris

Paqueacute et al Int Endod J 2012 45(5)413-8

ProTaper

101 debris

Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars

+ EDTA

13 debris

+ EDTA

79 debris

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

81Dr Alon Amit Minimally Invasive Endodontics

Virtually No File

Separation

Safety in Use

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

82Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

83Dr Alon Amit Minimally Invasive Endodontics

Mechanical Failure Patterns

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

84Dr Alon Amit Minimally Invasive Endodontics

Chance for file separation

Dr Guillaume Jouanny (France)

15 2517 (06)

bull 12 15 retrieved manually (by

Hedstroumlm or otherwise)

bull 3 15 bypassed and obturated

Solomonov et al (manuscript submitted)

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

85Dr Alon Amit Minimally Invasive Endodontics

Treating C-Shaped Canals

The Challenge of C-Shaped Canals A

Comparative Study with Self Adjusting

File (SAF) and ProTaper

Michael Solomonov Frank Paqueacute Bing Fan Louis

Berman

J Endod Feb 2012

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

86Dr Alon Amit Minimally Invasive Endodontics

3D View of C-shaped Canals

Solomonov et al J Endod 2012 38209-214

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

87Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Solomonov et al J Endod 2012 38209-214Green - before preparationRed - after preparation

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

88Dr Alon Amit Minimally Invasive Endodontics

C-Shaped canals - Danger zone

SAF ProTaper

Green - before preparationRed - after preparationSolomonov et al J Endod 2012 38209-214

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

89Dr Alon Amit Minimally Invasive Endodontics

SAF39

ProTaper67

80

70

60

50

40

30

20

Percentage of Area Unaffected by the Procedure

C-Shaped canals

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

90Dr Alon Amit Minimally Invasive Endodontics

Extreme oval canals

Green - before preparationRed - after preparation

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

91Dr Alon Amit Minimally Invasive Endodontics

Percent Untreated Root Canal Surface

microCT Analysis - Maxillary Molars

1 Paqueacute et al 2009

Pro

File

Pro

Tap

er

Flexm

ast

er

Lig

hts

peed

GT

NiT

i K

File

2 Peters et al 20111 Paqueacute et al 2009

Pro

File

Pro

Tape

rFlexm

ast

er

Lig

hts

pee

dGT

NiT

i K

Fi

le

SAF

2 Paqueacute et al 2011

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

92Dr Alon Amit Minimally Invasive Endodontics

SAF (n= 20)

SAF 374 401

Paqueacute et al J Endod 201137517ndash521

Percent Untreated Root Canal Surface

microCT Analysis - Distal roots of mandibular molars (long-oval

canals)

Rotary (n= 12)

Whole canal Apical third

Hedstroumlm 733 747

ProTaper - as 1 canal 799 652

ProTaper - as 2 canals 596 652

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

93Dr Alon Amit Minimally Invasive Endodontics

Circumferential Adaptation

Red ndash before preparation Blue ndash after preparation with SAF

>

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

94Dr Alon Amit Minimally Invasive Endodontics

ldquokey- holerdquo appearanc

e of preparation

Preparation of vital extracted teeth with oval canal anatomy

De-Deus et al J Endod 2011 37701-705

Histological Analysis

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

95Dr Alon Amit Minimally Invasive Endodontics

Continuous No-pressure

Irrigation with

Activation amp Scrubbing

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

96Dr Alon Amit Minimally Invasive Endodontics

RinsingScrubbing

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

97Dr Alon Amit Minimally Invasive Endodontics

The Self-adjusting File (SAF) Part 3 Removal of Debris andSmear LayermdashA Scanning Electron Microscope Study

Cleaning by the SAF with a hybrid irrigation technique ndash NaOCl and EDTA

Coronal third 100 free of debris

100 free of smear layer

Middle third 100 free of debris

80 free of smear layer

Apical third 100 free of debris

65 free of smear layer

Metzger et al J Endod 2010 36697ndash702

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
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  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
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  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

98Dr Alon Amit Minimally Invasive Endodontics

Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different Operation Times ndash A Scanning Electron Microscope Study

Apical Third Results

Debris removal

SAF 75 ndash 90

Rotary 39

Smear layer removal

SAF 64 ndash 67

Rotary 25

YİĞİT OumlZER Int Dent Res 2011 11-6

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

99Dr Alon Amit Minimally Invasive Endodontics

SAF

Bio-Race

Siqueira et al J Endod 2010 361860-65

Ability of chemomechanical preparation using Rotaries vs SAF

Microbiological Analysis

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

100Dr Alon Amit Minimally Invasive Endodontics

A Comparative Study of Biofilm Removal with Hand

Rotary Nickel-Titanium and Self-Adjusting File Instrumentation

Using a Novel In Vitro Biofilm Model

Lin Haapasalo et al J Endod 2012 39658-63

SAF 325

Profile1925

K-file2698

Percentage area inside the groove covered by bacterial biofilm after treatment

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

101Dr Alon Amit Minimally Invasive Endodontics

SAF

is the first true

Chemo-mechanical

endodontic instrument

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

102Dr Alon Amit Minimally Invasive Endodontics

Root canal Obturation

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

103Dr Alon Amit Minimally Invasive EndodonticsDeDeus et al J Endod 2012 38846ndash849

ProTaper 775

SAF 905

ldquoA significantly higher PGFA was found in oval-shaped canals prepared using the SAF system with continuous irrigation compared with similar canals prepared using a conventional NiTi rotary system (ProTaper Universal) with syringe and needle irrigationrdquo

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

104Dr Alon Amit Minimally Invasive Endodontics

Box-plots of micropush-out bond strength data

DeDeus et al J Endod 2013 39254ndash257

Self-Adjusting File Cleaning-Shaping-Irrigation System

Improves Root-filling Bond Strength

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

105Dr Alon Amit Minimally Invasive Endodontics

Obturation should take morphology into

consideration

What is the apical size

Dr Amir Weissman Israel

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

106Dr Alon Amit Minimally Invasive Endodontics

40 or 110

40

110

Obturation should take morphology into

consideration

What is the apical size

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

107Dr Alon Amit Minimally Invasive Endodontics

What is the apical shape

Step 1Assess the canal shape

and the apical size

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

108Dr Alon Amit Minimally Invasive Endodontics

Shapehellip Dryhellip Fillhellip

Not suitablein irregular canals

Single cone concept

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

109Dr Alon Amit Minimally Invasive Endodontics

Multiple master cones

Lateral compaction

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

110Dr Alon Amit Minimally Invasive Endodontics

Oval pluggers

Heat-softened GP

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

111Dr Alon Amit Minimally Invasive Endodontics

Cold oval pluggers

Injectable GP

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

112Dr Alon Amit Minimally Invasive Endodontics

Two obturators

Obturators

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

113Dr Alon Amit Minimally Invasive Endodontics

bull BC sealer onlybull BC + BC-coated GPbull BC + Uncoated GPbull BC + C-point

Bioceramic Sealer

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

114Dr Alon Amit Minimally Invasive Endodontics

Customized GP

Industrial master cones = Adapting the canal

to a given master cone

Customized master cones = Adapting a master coneto the individual canal

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

115Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2-3 mm

5-6 mm

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

116Dr Alon Amit Minimally Invasive Endodontics

Customized GP

2 seconds15 seconds

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

117Dr Alon Amit Minimally Invasive Endodontics

Customized GP80 110 Buccal Mesial

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

118Dr Alon Amit Minimally Invasive Endodontics

Buccal Mesial Buccal Mesial

2 sec

15 sec

Customized GP

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

119Dr Alon Amit Minimally Invasive Endodontics

Root canal Re-treatment

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

120Dr Alon Amit Minimally Invasive Endodontics

Obturation ProTaper

35

SAF

7

Abramovitz et al Int Endod J 2012 45(4)386-92

of unclean canals in the apical section

Effectiveness of a Self-Adjusting File to Remove Residual Gutta-Percha after Retreatment with Rotary Files

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

121Dr Alon Amit Minimally Invasive Endodontics

Obturation SAF

Solomonov et al J Endod 2012 381283ndash1287

ProTaper D1 - D2 - D3

+F1 F2

(Brushing)

Remaining GP volume

04

5 minutes

Self-Adjusting Files in Retreatment A High-Resolution MicrondashComputed Tomography Study

Remaining GP volume

54

10 minutes

Profile 2504+

SAF 20mm

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

122Dr Alon Amit Minimally Invasive Endodontics

Clinical Cases

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

123Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

124Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

125Dr Alon Amit Minimally Invasive Endodontics

Jan 2011 ndash C-shaped

Dr Ephie Sharlin DMD

Tel- Aviv Israel

5 months follow-up

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

126Dr Alon Amit Minimally Invasive Endodontics

Dr Ajinkya Pawar

DMD

Mumbai India

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

127Dr Alon Amit Minimally Invasive Endodontics

Dr Adam Zawadka

DDS

Poznan Poland

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

128Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

129Dr Alon Amit Minimally Invasive Endodontics

Dr Massimo Mori

DMD

Genova Italy

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

130Dr Alon Amit Minimally Invasive Endodontics

Dr Michael Solomonov DMD

Tel- Aviv Israel

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

131Dr Alon Amit Minimally Invasive Endodontics

October 20115 months follow-

up

Dr JoAnn Lam BDS

Singapore

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

132Dr Alon Amit Minimally Invasive Endodontics

March 2012

Dr JoAnn Lam BDS

Singapore

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

133Dr Alon Amit Minimally Invasive Endodontics

Dr Marino Borrelli

DMD

Salerno Italy

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

134Dr Alon Amit Minimally Invasive Endodontics

Dr Dmitriy Koudryashov DMD

Samara Russia

Before

After

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

135Dr Alon Amit Minimally Invasive Endodontics

May 2012 4 months follow-upJune 2012

Dr Shalom Arbiv DMD

Jerusalem Israel

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

136Dr Alon Amit Minimally Invasive Endodontics

One year follow-up

Dr Osnat Keisar DMD

Tel- Aviv Israel

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

144Dr Alon Amit Minimally Invasive Endodontics

What did we discuss today

Requirements of RCT Current technologies New technology

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

145Dr Alon Amit Minimally Invasive Endodontics

Better Shaping3D adaptation

Preservation of sound dentin

1

Better CleaningSimultaneous irrigation and

disinfectionRemoval of debris and smear layer

2

Safety in treatmentVery low chance of separation

Avoiding ldquoNaOCl accidentsrdquoAvoiding debris extrusionpacking

No risk of micro-cracks

3

BetterRe-treatment

Improved removal of GP remnants

4Better Obturation3D adaptation to the canal

Compatible withvarious techniques

5

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

146Dr Alon Amit Minimally Invasive Endodontics

SAF ndash Principles of operation

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

147Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Creation of reproducible glide-path

Coronal access

Apical access

bull Wide Canals over 35 SAF 20mm

bull Easy Canals 20-30 SAF 15mm

bull Moderate Canals 15 Glidepath + SAF 15mm

bull Difficult Canals le10 Glidepath + SAF 15mm

bull Choose the length of the SAF according to the active part

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Slide 56
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Slide 68
  • Slide 70
  • Slide 71
  • Slide 72
  • Slide 73
  • Slide 74
  • Slide 75
  • Slide 76
  • Slide 77
  • Slide 78
  • Slide 79
  • Slide 80
  • Slide 81
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

148Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main points

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
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  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
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  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

149Dr Alon Amit Minimally Invasive Endodontics

Clinical guidelines ndash main pointsbull Insert the SAF manually to

assure access and examine rootrsquos axis

bull If working length is not achieved with the SAF in 30 seconds ndashre-establish glide-path

bull Beware of buckling of the SAF during work ndash keep the rootrsquos axis

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
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  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150

150Dr Alon Amit Minimally Invasive Endodontics

Thank You

  • Slide 1
  • Slide 2
  • Slide 3
  • Slide 4
  • Slide 5
  • Slide 6
  • Slide 7
  • Slide 8
  • Slide 9
  • Root Canal Anatomy on 2D X-ray
  • The Common Misconception
  • Slide 12
  • Slide 13
  • Slide 14
  • Slide 15
  • And in realityhellip
  • Combined with Complex Wall Surface
  • Slide 18
  • Slide 19
  • Slide 20
  • Slide 21
  • Slide 22
  • Slide 23
  • Slide 24
  • Slide 25
  • Slide 26
  • Slide 27
  • Slide 28
  • Slide 29
  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Slide 38
  • Slide 39
  • Slide 40
  • Slide 41
  • Slide 42
  • Slide 43
  • Slide 44
  • Slide 45
  • Slide 46
  • Slide 47
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  • Slide 50
  • Slide 51
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  • Slide 54
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  • Slide 58
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  • Slide 70
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  • Slide 80
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  • Slide 83
  • Slide 84
  • Slide 85
  • Slide 86
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  • Slide 88
  • Slide 89
  • Slide 90
  • Slide 91
  • Slide 92
  • Slide 93
  • Slide 94
  • Slide 95
  • Slide 96
  • The Self-adjusting File (SAF) Part 3 Removal of Debris and Sm
  • Removal of Debris and Smear Layer in Curved Root Canals Using
  • Slide 99
  • Slide 100
  • Slide 101
  • Slide 102
  • Slide 103
  • Slide 104
  • Slide 105
  • Slide 106
  • Slide 107
  • Slide 108
  • Slide 109
  • Slide 110
  • Slide 111
  • Slide 112
  • Slide 113
  • Slide 114
  • Slide 115
  • Slide 116
  • Slide 117
  • Slide 118
  • Slide 119
  • Slide 120
  • Slide 121
  • Clinical Cases
  • Dr Michael Solomonov DMD Tel- Aviv Israel
  • Dr Michael Solomonov DMD Tel- Aviv Israel (2)
  • Slide 125
  • Slide 126
  • Slide 127
  • Slide 128
  • Slide 129
  • Dr Michael Solomonov DMD Tel- Aviv Israel (3)
  • Dr JoAnn Lam BDS Singapore
  • Dr JoAnn Lam BDS Singapore (2)
  • Slide 133
  • Dr Dmitriy Koudryashov DMD Samara Russia
  • Dr Shalom Arbiv DMD Jerusalem Israel
  • Slide 136
  • Slide 144
  • Slide 145
  • SAF ndash Principles of operation
  • Slide 147
  • Slide 148
  • Slide 149
  • Slide 150