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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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