SAF System presentation - July 2014

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

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SAF System presentation - July 2014

  1. 1. 1Dr. Alon Amit Minimally Invasive Endodontics Minimally Invasive EndodonticsDr. Alon Amit July 2014
  2. 2. 2Dr. Alon Amit Minimally Invasive Endodontics Comfort Zone
  3. 3. 3Dr. Alon Amit Minimally Invasive Endodontics The mind is like a parachute – It works better when it’s open
  4. 4. 4Dr. Alon Amit Minimally Invasive Endodontics Let’s start with a short question
  5. 5. 5Dr. Alon Amit Minimally Invasive Endodontics Rate the following factors according to their importance when choosing an endodontic file system: 1. Preserves more sound dentin 2. Easy to use 3. Low chance for file separation 4. Cheap price 5. Reduces treatment time 6. Provides better cleaning Let’s start with a short question
  6. 6. 6Dr. Alon Amit Minimally Invasive Endodontics What are we going to discuss today? Requirements of RCT Current technologies New technology
  7. 7. 7Dr. Alon Amit Minimally Invasive Endodontics Healing The “Holy Trinity” of Endodontics & 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
  8. 8. 8Dr. Alon Amit Minimally Invasive Endodontics Root Canal Treatment success rate Absence of Apical Periodontitis as seen in X-ray photos • Orstavik 1996 Int J Endod 29:150-155 85% • Hoskinson et al 2002, OOOOE 93: 705-715 74% • Orstavik et al 2004, Europ J Oral Science 112: 224-230 79% • Kojima et al 2004, OOOOE 97:95-9 79%-83% • de Chevinggy et al 2008, J Endod 34: 258-263 82% • Siqueira et al 2008, OOOOE 106: 757-762 76% By Specialists: ~80% • De moor (Belgium) 2000 Int J Endod 33: 113-120 40% • Dugas, Friedman (Canada) 2003 Int J Endod 36: 181-192 49%-56% • Jimenez-Pinzon (Spain) 2004, Int J Endod 37: 167-173 36% • Tsuneishi (Japan) 2005, OOOOE 100(5): 631-5 60% • Georgopoulou (Greece) 2005, Int J Endod 38: 105-111 40% • Kirkevanget (Denmark) 2006, Int J Endod 39: 100-107 40% In general: ~50%
  9. 9. 9Dr. Alon Amit Minimally Invasive Endodontics
  10. 10. 10Dr. Alon Amit Minimally Invasive Endodontics Root CanalAnatomy on 2D X-ray
  11. 11. 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
  12. 12. 12Dr. Alon Amit Minimally Invasive Endodontics Complex Anatomy µ-CT courtesy of Prof. Frank Paqué
  13. 13. 13Dr. Alon Amit Minimally Invasive Endodontics µ-CT by Prof. Marco Versiani
  14. 14. 14Dr. Alon Amit Minimally Invasive Endodontics Tooth Anatomy
  15. 15. 15Dr. Alon Amit Minimally Invasive Endodontics Oval cross section: mandibular incisors canines premolars distal roots of mandibular molars “Tear-shaped” cross section: premolars mesial roots of mandibular molars mesio-buccal roots of maxillary molars “Long-oval–shaped 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 50%” Wu & Wesselink Oral Med Oral Pathol Oral Radiol Endod 2000; 89:739-43
  16. 16. 16Dr. Alon Amit Minimally Invasive Endodontics And in reality… Dr.Amir Weissman (Israel)
  17. 17. 17Dr. Alon Amit Minimally Invasive Endodontics Combined with ComplexWall Surface SEM (Scanning Electron Microscopy) data
  18. 18. 18Dr. Alon Amit Minimally Invasive Endodontics Inexpensive, has a track record, usually safe, but… • Time consuming • Inflexible - difficulty negotiating curved canals • Extrude debris periapically • Pack debris into recesses • Sequential irrigation Traditional Technology Stainless-Steel Hand Files
  19. 19. 19Dr. Alon Amit Minimally Invasive Endodontics Advanced technology, a game-changer in modern endodontics: • Motorized instrumentation • Faster preparation • Able to negotiate curved canals However… CurrentTechnology Rotary Files
  20. 20. 20Dr. Alon Amit Minimally Invasive Endodontics Evolution of Rotary NiTi Files • Profile 1993 • Quantec 1996 • GT 1998 • Hero642 1999 • FlexMaster 2000 1st Generation Symmetrical Flutes & UniformTaper • Race 1999 • ProTaper 2001 • K3 2001 • Hero Shaper 2002 • Revo-S 2009 2nd Generation Asymmetrical Flutes and/or Non-UniformTaper • GT – X (M-wire) 2009 •TF (R-phase) 2009 • ProTaper Next 2013 3rd Generation Innovative Metallurgy
  21. 21. 21Dr. Alon Amit Minimally Invasive Endodontics Evolution of Rotary NiTi Files • Reciproc 2011 • WaveOne 2011 4th Generation Same design, Reciprocation • BFR 2014 •TRUshape 2015 5th Generation Innovative Metallurgy, Curved Rotating Blade with Flutes
  22. 22. 22Dr. Alon Amit Minimally Invasive Endodontics Peer-reviewed research has shown, so far, the following consequences: • Unpredictable File separation – even with advanced metallurgy and reciprocation reciprocation • Excessive removal of dentin – especially with high-taper systems • Periapical debris extrusion – especially with reciprocation • Packing of debris into recesses • Efficiency of NaOCl is reduced when used with single-file systems, due to shorter to shorter working time and non-sequential work • Formation of dentinal Micro-cracks, especially with single-file systems Issues with Rotary NiTi Files
  23. 23. 23Dr. Alon Amit Minimally Invasive Endodontics 1st Generation 4th Generation Profile 1993 WaveOne 2011 This represents 20 years of NiTi rotary files evolution! Evolution of Rotary NiTi Files
  24. 24. 24Dr. Alon Amit Minimally Invasive Endodontics Rotating Blade with Flutes = A Machining Device
  25. 25. 25Dr. Alon Amit Minimally Invasive Endodontics Ignoring the 3D shape of the root canals ! Common to all
  26. 26. 26Dr. Alon Amit Minimally Invasive Endodontics Cone beam CT presenting oval cross-sections of canals
  27. 27. 27Dr. Alon Amit Minimally Invasive Endodontics Efficacy of rotary instruments with greater taper in preparing oval root canals A. El-Ayouti et al, Int Endod J 2008; 41(12):1088-92 “No 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 thickness.” * All instruments were used in Brushing/ Circumferential filing
  28. 28. 28Dr. Alon Amit Minimally Invasive Endodontics 2 mm 4 mm 6 mm Yellow - After preparationRed - Before preparation Rotary File – µCT Analysis Metzger et al, J Endod 2010; 36(4):679-90
  29. 29. 29Dr. Alon Amit Minimally Invasive Endodontics All root canals are machined to a round cross-section
  30. 30. 30Dr. Alon Amit Minimally Invasive Endodontics Rotary File – Excessive enlargement Excessive enlargement: To include all canal surface To allow effective irrigation To shape for industrial master cones
  31. 31. 31Dr. Alon Amit Minimally Invasive Endodontics Rotary File – Excessive enlargement * - would make a great 2D X-ray * SAF Rotary
  32. 32. 32Dr. Alon Amit Minimally Invasive Endodontics Peters & Paqué, 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 µCT Analysis - Root Canal Transportation
  33. 33. 33Dr. Alon Amit Minimally Invasive Endodontics Percentage of Untreated Root Canal Surface Paqué et al J Endod 2009; 35:1056-9 µCT Analysis - Maxillary Molars Paqué et al 2009 ProFile ProTaper Flexmaster Lightspeed GT NiTiKFile Can we do Better?
  34. 34. 34Dr. Alon Amit Minimally Invasive Endodontics Paqué et al. J Endod 2010; 36:703–707 Distal canal (n= 12)* Whole canal Apical third Hedström 73.3% 74.7% ProTaper - as 1 canal 79.9% 65.2% ProTaper - as 2 canals 59.6% 65.2% Percentage of Untreated Root Canal Surface (long-oval canals) µCT Analysis - Distal roots of mandibular molars Can we do better ?
  35. 35. 35Dr. Alon Amit Minimally Invasive Endodontics Paqué et al. J Endod 2009; 35:1044-1047 Before After Packed Debris µCT Analysis - Hard Tissue Debris Accumulation
  36. 36. 36Dr. Alon Amit Minimally Invasive Endodontics Packing of Debris During Rotary Instrumentation
  37. 37. 37Dr. Alon Amit Minimally Invasive Endodontics Dr. Clifford Ruddle Packing of Debris During Rotary Instrumentation
  38. 38. 38Dr. Alon Amit Minimally Invasive Endodontics Can conventional irrigation really clean? “The notion that “the file shapes; the irrigant cleans” represents wishful thinking rather than a scientifically based fact, at least in flat-oval root canals” De Deus et al., J Endod 2011; 37:701-705
  39. 39. 39Dr. Alon Amit Minimally Invasive Endodontics De Deus et al., Int Endod J, 2008; 34:1401–1405 “key- hole” appearance of preparation
  40. 40. 40Dr. Alon Amit Minimally Invasive Endodontics Irrigation - “vapor-lock” effect Excessive pressure = NaOCl accident
  41. 41. 41Dr. Alon Amit Minimally Invasive Endodontics Packing of Debris Dr. AmirWeissman (Israel) “50.8% of the packed dentin debris could not be removed even with EDTA irrigation and PUI (passive ultrasonic irrigation)” Paqué, Boessler & Zehnder, Int Endod J, 2011; 44(2):148-53
  42. 42. 42Dr. Alon Amit Minimally Invasive Endodontics Onnick et al., J Endod 1994; 20:32-7 Incomplete root fractures in the history of endodontic research Turek et al., J Endod 1982; 8:437-43 Association with excessive removal of dentin: Association with obturation techniques:
  43. 43. 43Dr. Alon Amit Minimally Invasive Endodontics Shemesh et al. J Endod 2011; 37: 63- Iatrogenic Micro-Cracks & Craze Line Formation During Rotary Instrumentation
  44. 44. 44Dr. Alon Amit Minimally Invasive Endodontics Kim 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
  45. 45. 45Dr. Alon Amit Minimally Invasive Endodontics
  46. 46. 46Dr. Alon Amit Minimally Invasive Endodontics Minimally Invasive Endodontics Paradigm Shift In Root CanalTreatment
  47. 47. 47Dr. Alon Amit Minimally Invasive Endodontics Achieve minimally-invasive 3D root canal shaping, cleaning and simultaneous Irrigation.
  48. 48. 48Dr. Alon Amit Minimally Invasive Endodontics Abrasive Surface
  49. 49. 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
  50. 50. 50Dr. Alon Amit Minimally Invasive Endodontics
  51. 51. 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
  52. 52. 52Dr. Alon Amit Minimally Invasive Endodontics Compressibility 0 2 4 6 8 10 12 14 16 18 20 0.15 0.25 0.35 0.45 0.55 0.65 0.75 0.85 Diameter (mm) DistancefromTip(mm) 1.5 mm 0.450.20
  53. 53. 53Dr. Alon Amit Minimally Invasive Endodontics Adaptation to oval cross-sections 2.4 mm 0.2 mm 1.5 mm
  54. 54. 54Dr. Alon Amit Minimally Invasive Endodontics Force applied by a compressed SAF 100 150 200 250 300 350 400 450 500 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 0.55 0.6 0.65 Canal Diameter (mm) SAFForce(g)
  55. 55. 55Dr. Alon Amit Minimally Invasive Endodontics Gradual expansion by the SAF Dr. Michael Solomonov, Israel
  56. 56. 56Dr. Alon Amit Minimally Invasive Endodontics Circumferential 3D adaptation * Compare this to the last rotary instrument
  57. 57. 57Dr. Alon Amit Minimally Invasive Endodontics Mode of operation 1. Vertical vibration – 0.4 mm amplitude at 5,000 rpm 2. Slow low-torque rotation – at ~80 rpm 3. Clutch mechanism to avoid rotation while engaged with canal walls 4. Continuous irrigation
  58. 58. 58Dr. Alon Amit Minimally Invasive Endodontics Repeated Motion The gentle vertical vibration helps achieve a gradual enlargement of the root canal.
  59. 59. 59Dr. Alon Amit Minimally Invasive Endodontics All these create the “Sand Paper effect” • Abrasive Surface • Repeated Motion • Light pressure • Creation of “Dentin Dust” • Irrigation washes the debris away
  60. 60. 60Dr. Alon Amit Minimally Invasive Endodontics 0 0.5 1 1.5 2 2.5 3 3.5 4 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 Working Time (min) EnlargementbyISO#Dentin removal by the SAF Working time (min.) Dentinremoval–standardizedbyISO#
  61. 61. 61Dr. Alon Amit Minimally Invasive Endodontics Continuous Irrigation
  62. 62. 62Dr. Alon Amit Minimally Invasive Endodontics Continuous Irrigation
  63. 63. 63Dr. Alon Amit Minimally Invasive Endodontics The SAF’s hollow design allows continuous irrigation of the root canal through its lumen Continuous Irrigation -VATEA
  64. 64. 64Dr. Alon Amit Minimally Invasive Endodontics Continuous Irrigation - EndoStation
  65. 65. 65Dr. Alon Amit Minimally Invasive Endodontics Continuous simultaneous irrigation
  66. 66. 66Dr. Alon Amit Minimally Invasive Endodontics Low-pressure irrigation
  67. 67. 67Dr. Alon Amit Minimally Invasive Endodontics NaOCl refresh rate during irrigation
  68. 68. 68Dr. Alon Amit Minimally Invasive Endodontics Three Standard Lengths: 21mm, 25mm, 31mm Diameters: 1.5mm, 2.0mm
  69. 69. 70Dr. Alon Amit Minimally Invasive Endodontics SAF - introduction
  70. 70. 71Dr. Alon Amit Minimally Invasive Endodontics Evidence Based Endodontics
  71. 71. 72Dr. Alon Amit Minimally Invasive Endodontics 57 published peer-reviewed articles in 4Years 33 articles on Journal of Endodontics 8 articles on International Endodontic Journal
  72. 72. 73Dr. Alon Amit Minimally Invasive Endodontics No Micro-cracks Formation Safety in Use
  73. 73. 74Dr. Alon Amit Minimally Invasive Endodontics Hero Shaper Yoldas et al, J Endod 2012; 38:232-235
  74. 74. 75Dr. Alon Amit Minimally Invasive Endodontics ProTaper (complete fracture) Yoldas et al, J Endod 2012; 38:232-235
  75. 75. 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; 38:232-235
  76. 76. 77Dr. Alon Amit Minimally Invasive Endodontics SAF Yoldas et al, J Endod 2012; 38:232-235
  77. 77. 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 – comparison of rotary files to SAF “SAF generated a minimal reaction force and resulted in minimal dentin removal. This could contribute to the reduction of the fracture risk and dentinal defects”
  78. 78. 79Dr. Alon Amit Minimally Invasive Endodontics No Packing of Debris Safety in Use
  79. 79. 80Dr. Alon Amit Minimally Invasive Endodontics SAF 1.7% debris Paqué et al, Int Endod J 2012; 45(5):413-8 ProTaper 10.1% debris Hard-tissue debris accumulation created by conventional rotary versus self-adjusting file instrumentation in mesial root canal systems of mandibular molars + EDTA 1.3% debris + EDTA 7.9% debris
  80. 80. 81Dr. Alon Amit Minimally Invasive Endodontics Virtually No File Separation Safety in Use
  81. 81. 82Dr. Alon Amit Minimally Invasive Endodontics Mechanical Failure Patterns
  82. 82. 83Dr. Alon Amit Minimally Invasive Endodontics Mechanical Failure Patterns
  83. 83. 84Dr. Alon Amit Minimally Invasive Endodontics Chance for file separation Dr. Guillaume Jouanny (France) 15 / 2517 (0.6%) • 12 / 15 retrieved manually (by Hedström or otherwise) • 3 / 15 bypassed and obturated Solomonov et al (manuscript submitted)
  84. 84. 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 Paqué, Bing Fan, Louis Berman. J Endod Feb 2012
  85. 85. 86Dr. Alon Amit Minimally Invasive Endodontics 3DView of C-shaped Canals Solomonov et al, J Endod 2012; 38:209-214
  86. 86. 87Dr. Alon Amit Minimally Invasive Endodontics C-Shaped canals - Danger zone SAF ProTaper Solomonov et al, J Endod 2012; 38:209-214 Green - before preparation Red - after preparation
  87. 87. 88Dr. Alon Amit Minimally Invasive Endodontics C-Shaped canals - Danger zone SAF ProTaper Green - before preparation Red - after preparationSolomonov et al, J Endod 2012; 38:209-214
  88. 88. 89Dr. Alon Amit Minimally Invasive Endodontics SAF 39% ProTaper 67% 80 70 60 50 40 30 20 Percentage ofArea Unaffected by the Procedure C-Shaped canals
  89. 89. 90Dr. Alon Amit Minimally Invasive Endodontics Extreme oval canals Green - before preparation Red - after preparation
  90. 90. 91Dr. Alon Amit Minimally Invasive Endodontics Percent Untreated Root Canal Surface µCT Analysis -Maxillary Molars 1 Paqué et al 2009 ProFile ProTaper Flexmaster Lightspeed GT NiTiKFile 2 Peters et al 20111. Paqué et al 2009 ProFile ProTaper Flexmaster Lightspeed GT NiTiKFile SAF 2. Paqué et al 2011
  91. 91. 92Dr. Alon Amit Minimally Invasive Endodontics SAF (n= 20)** SAF 37.4% 40.1% Paqué et al J Endod 2011;37:517–521 Percent Untreated Root Canal Surface µCT Analysis - Distal roots of mandibular molars (long-oval canals) Rotary (n= 12)* Whole canal Apical third Hedström 73.3% 74.7% ProTaper - as 1 canal 79.9% 65.2% ProTaper - as 2 canals 59.6% 65.2%
  92. 92. 93Dr. Alon Amit Minimally Invasive Endodontics Circumferential Adaptation Red – before preparation Blue – after preparation with SAF
  93. 93. 94Dr. Alon Amit Minimally Invasive Endodontics “key- hole” appearance of preparation Preparation of vital extracted teeth with oval canal anatomy De-Deus et al, J Endod 2011; 37:701-705 HistologicalAnalysis
  94. 94. 95Dr. Alon Amit Minimally Invasive Endodontics Continuous No-pressure Irrigation with Activation & Scrubbing
  95. 95. 96Dr. Alon Amit Minimally Invasive Endodontics RinsingScrubbing
  96. 96. 97Dr. Alon Amit Minimally Invasive Endodontics The Self-adjusting File (SAF). Part 3: Removal of Debris and Smear Layer—A Scanning Electron Microscope Study Cleaning by the SAF, with a hybrid irrigation technique – 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; 36:697–702
  97. 97. 98Dr. Alon Amit Minimally Invasive Endodontics Removal of Debris and Smear Layer in Curved Root Canals Using Self-Adjusting File with Different OperationTimes – A Scanning Electron Microscope Study ApicalThird Results: Debris removal: SAF: 75% – 90% Rotary: 39% Smear layer removal: SAF: 64% – 67% Rotary: 25% YİĞİT ÖZER; Int Dent Res, 2011; 1:1-6
  98. 98. 99Dr. Alon Amit Minimally Invasive Endodontics SAF Bio-Race Siqueira et al, J Endod 2010; 36:1860-65 Ability of chemomechanical preparation using Rotaries vs. SAF MicrobiologicalAnalysis
  99. 99. 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 InVitro Biofilm Model Lin, Haapasalo et al, J Endod 2012; 39:658-63 SAF 3.25% Profile 19.25% K-file 26.98% Percentage area inside the groove covered by bacterial biofilm after treatment:
  100. 100. 101Dr. Alon Amit Minimally Invasive Endodontics SAF is the first true Chemo-mechanical endodontic instrument !
  101. 101. 102Dr. Alon Amit Minimally Invasive Endodontics Root canal Obturation
  102. 102. 103Dr. Alon Amit Minimally Invasive Endodontics DeDeus et al, J Endod 2012; 38:846–849 ProTaper 77.5%SAF 90.5% “A 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 irrigation”
  103. 103. 104Dr. Alon Amit Minimally Invasive Endodontics Box-plots of micropush-out bond strength data DeDeus et al, J Endod 2013; 39:254–257 Self-Adjusting File Cleaning-Shaping-Irrigation System Improves Root-filling Bond Strength
  104. 104. 105Dr. Alon Amit Minimally Invasive Endodontics Obturation should take morphology into consideration What is the apical size? Dr. Amir Weissman, Israel
  105. 105. 106Dr. Alon Amit Minimally Invasive Endodontics ? ? #40 or #110? Obturation should take morphology into consideration What is the apical size?
  106. 106. 107Dr. Alon Amit Minimally Invasive Endodontics What is the apical shape? Step 1: Assess the canal shape and the apical size
  107. 107. 108Dr. Alon Amit Minimally Invasive Endodontics Shape… Dry… Fill… Not suitable in irregular canals Single cone concept
  108. 108. 109Dr. Alon Amit Minimally Invasive Endodontics Multiple master cones Lateral compaction
  109. 109. 110Dr. Alon Amit Minimally Invasive Endodontics Oval pluggers? Heat-softened GP
  110. 110. 111Dr. Alon Amit Minimally Invasive Endodontics Cold oval pluggers? Injectable GP
  111. 111. 112Dr. Alon Amit Minimally Invasive Endodontics Two obturators? Obturators
  112. 112. 113Dr. Alon Amit Minimally Invasive Endodontics • BC sealer only • BC + BC-coated GP • BC + Uncoated GP • BC + C-point Bioceramic Sealer
  113. 113. 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 cone to the individual canal
  114. 114. 115Dr. Alon Amit Minimally Invasive Endodontics Customized GP 2-3 mm 5-6 mm
  115. 115. 116Dr. Alon Amit Minimally Invasive Endodontics Customized GP 2 seconds15 seconds
  116. 116. 117Dr. Alon Amit Minimally Invasive Endodontics Customized GP #80 #110 Buccal Mesial
  117. 117. 118Dr. Alon Amit Minimally Invasive Endodontics Buccal Mesial Buccal Mesial 2 sec. 15 sec. Customized GP
  118. 118. 119Dr. Alon Amit Minimally Invasive Endodontics Root canal Re-treatment
  119. 119. 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
  120. 120. 121Dr. Alon Amit Minimally Invasive Endodontics Obturation SAF Solomonov et al, J Endod 2012; 38:1283–1287 ProTaper D1 - D2 - D3 + F1, F2 (Brushing) Remaining GP volume: 0.4% 5 minutes Self-Adjusting Files in Retreatment: A High-Resolution Micro–ComputedTomography Study Remaining GP volume: 5.4% 10 minutes Profile 25/0.4 + SAF 2.0mm
  121. 121. 122Dr. Alon Amit Minimally Invasive Endodontics Clinical Cases
  122. 122. 123Dr. Alon Amit Minimally Invasive Endodontics Dr. Michael Solomonov DMD Tel- Aviv, Israel
  123. 123. 124Dr. Alon Amit Minimally Invasive Endodontics Dr. Michael Solomonov DMD Tel- Aviv, Israel
  124. 124. 125Dr. Alon Amit Minimally Invasive Endodontics Jan 2011 – C-shaped Dr. Ephie Sharlin DMD Tel- Aviv, Israel 5 months follow-up
  125. 125. 126Dr. Alon Amit Minimally Invasive Endodontics Dr. Ajinkya Pawar DMD Mumbai, India
  126. 126. 127Dr. Alon Amit Minimally Invasive Endodontics Dr. Adam Zawadka DDS Poznan, Poland
  127. 127. 128Dr. Alon Amit Minimally Invasive Endodontics Dr. Massimo Mori DMD Genova, Italy
  128. 128. 129Dr. Alon Amit Minimally Invasive Endodontics Dr. Massimo Mori DMD Genova, Italy
  129. 129. 130Dr. Alon Amit Minimally Invasive Endodontics Dr. Michael Solomonov DMD Tel- Aviv, Israel
  130. 130. 131Dr. Alon Amit Minimally Invasive Endodontics October 2011 5 months follow-up Dr. JoAnn Lam BDS Singapore
  131. 131. 132Dr. Alon Amit Minimally Invasive Endodontics March 2012 Dr. JoAnn Lam BDS Singapore
  132. 132. 133Dr. Alon Amit Minimally Invasive Endodontics Dr. Marino Borrelli DMD Salerno, Italy
  133. 133. 134Dr. Alon Amit Minimally Invasive Endodontics Dr. Dmitriy Koudryashov D.M.D Samara, Russia Before After
  134. 134. 135Dr. Alon Amit Minimally Invasive Endodontics May 2012 4 months follow-upJune 2012 Dr. Shalom Arbiv DMD Jerusalem, Israel
  135. 135. 136Dr. Alon Amit Minimally Invasive Endodontics One year follow-up Dr. Osnat Keisar DMD Tel- Aviv, Israel
  136. 136. 144Dr. Alon Amit Minimally Invasive Endodontics What did we discuss today? Requirements of RCT Current technologies New technology
  137. 137. 145Dr. Alon Amit Minimally Invasive Endodontics Better Shaping 3D adaptation, Preservation of sound dentin Better Cleaning Simultaneous irrigation and disinfection, Removal of debris and smear layer Safety in treatment Very low chance of separation, Avoiding “NaOCl accidents”, Avoiding debris extrusion/packing, No risk of micro-cracks Better Re-treatment Improved removal of GP remnants Better Obturation 3D adaptation to the canal, Compatible with various techniques
  138. 138. 146Dr. Alon Amit Minimally Invasive Endodontics SAF – Principles of operation
  139. 139. 147Dr. Alon Amit Minimally Invasive Endodontics Clinical guidelines – main points • Creation of reproducible glide-path:  Coronal access  Apical access: • Wide Canals: over #35  SAF 2.0mm • Easy Canals: #20-#30  SAF 1.5mm • Moderate Canals: #15  Glidepath + SAF 1.5mm • Difficult Canals: ≤#10  Glidepath + SAF 1.5mm • Choose the length of the SAF according to the active part.
  140. 140. 148Dr. Alon Amit Minimally Invasive Endodontics Clinical guidelines – main points
  141. 141. 149Dr. Alon Amit Minimally Invasive Endodontics Clinical guidelines – main points • Insert the SAF manually, to assure access and examine root’s axis • If working length is not achieved with the SAF in 30 seconds –re-establish glide-path • Beware of buckling of the SAF during work – keep the root’s axis
  142. 142. 150Dr. Alon Amit Minimally Invasive Endodontics ThankYou!

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