The document discusses root canal preparation techniques using rotary nickel titanium (NiTi) instruments. It introduces the concepts of "cleaning and shaping" root canals put forth by Schilder in 1974. It then discusses the design objectives and characteristics of different generations of NiTi rotary instruments, including taper, rake angle, radial land, helical angle, and pitch number. The document also covers the functions of NiTi instruments regarding torsional stress, bending fatigue, speed and torque. Finally, it compares root canal preparation techniques like crown-down versus step-back approaches and addresses advances in NiTi metallurgy.
introduction, history of rotary instruments in endodontics, classification, properties of NiTi, generations and design features, rotary file systems available
The Niti rotary files have become the standard for the prepration of the root canal system because of their superelasticity they cause less canal transportation however shaping ability and resistance to cyclic fatigue fracture are of the special significance when evaluating the performance of Niti files .The shaping ability of Niti files depend on several factors such as taper,geometrical cross section,movement file system and alloy microstructure
Protaper Next File the newest to the protaper system which is the efficient solution for endo practitioner who seeking a versatile flexible system that will handle the vast majority of root canal treatment
introduction, history of rotary instruments in endodontics, classification, properties of NiTi, generations and design features, rotary file systems available
The Niti rotary files have become the standard for the prepration of the root canal system because of their superelasticity they cause less canal transportation however shaping ability and resistance to cyclic fatigue fracture are of the special significance when evaluating the performance of Niti files .The shaping ability of Niti files depend on several factors such as taper,geometrical cross section,movement file system and alloy microstructure
Protaper Next File the newest to the protaper system which is the efficient solution for endo practitioner who seeking a versatile flexible system that will handle the vast majority of root canal treatment
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you
XP-Endo files are three instruments for cleaning and shaping of the canals whatever the shape of the canals when compare with other standard Niti instruments they impose the original shape of the canal and reach area that impossible to reach by other instruments
This presentation describes about evolution of nitinol (NiTi), its properties, manufacturing, metallurgy and various rotary systems in the field of endodontics.
Understanding the basic metallurgy, commonly used instruments and newly available rotary systems in the market enable us to better disinfect the root canal.
Protaper means progressively taper.
•NiTi
Protaper means progressively taper.
•NiTi
Increased flexibility
• Each instrument produces its own 'crown down effect' as larger tapers make way for smaller tapers.
• Protaper files engage a smaller area of dentine reducing torsional loads and file fatigue
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
A quick and concise recap of Endodontic Instruments.
This presentation resolves the basic doubts within terminologies and provides visual conceptualization of the same.
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you
XP-Endo files are three instruments for cleaning and shaping of the canals whatever the shape of the canals when compare with other standard Niti instruments they impose the original shape of the canal and reach area that impossible to reach by other instruments
This presentation describes about evolution of nitinol (NiTi), its properties, manufacturing, metallurgy and various rotary systems in the field of endodontics.
Understanding the basic metallurgy, commonly used instruments and newly available rotary systems in the market enable us to better disinfect the root canal.
Protaper means progressively taper.
•NiTi
Protaper means progressively taper.
•NiTi
Increased flexibility
• Each instrument produces its own 'crown down effect' as larger tapers make way for smaller tapers.
• Protaper files engage a smaller area of dentine reducing torsional loads and file fatigue
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
A quick and concise recap of Endodontic Instruments.
This presentation resolves the basic doubts within terminologies and provides visual conceptualization of the same.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
CLEANING AND SHAPING USING ROTARY ENDODONTIC INSTRUMENTS /certified fixed or...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Rotary cutting instruments in conservative dentistrySaraSultana10
A detailed explanation of rotary cutting instruments used in operative dentistry. This is based on the Textbook of preclinical conservative dentistry by Nisha Garg and Amit Garg
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
Rotary instruments
1. Dr. Lena Ali Hassan
M.Sc. Conservative Dentistry
Endodontic Department
2.
3. In 1974, Schilder introduced the concept of
“cleaning and shaping” root canals. “Cleaning” refers
to removing all contents of the root canal system before
and during shaping; “shaping” refers to a specific root
canal cavity form with four design objectives.
4. Design (Mechanical )Objectives:
The opening should be a continuously tapering
funnel from the access cavity to the apical foramen.
The root canal preparation should maintain the path
of the original canal.
The apical foramen should remain in its original
position.
The apical opening should be kept as small as
practical.
5. Rotary Instruments use
Stainless steel & NiTi
Use rotary or not depend on :
Skill of the dentist
Complexity of the case
The choice of a particular design depends on:
Clinical experience
Handling properties
Usage safety
Case outcomes
7. Types of rotary instruments according
to their design
Group I: (LightSpeed)
Group II: rotary instruments with 2% (.04) & 6% (.06)
tapers (ProFile +other models)
Group III: rotary instruments with specific design
changes(the ProTaper and RaCe)
Group IV: thermomechanically treated NiTi
instruments.
9. Nickel Titanium alloy
Nitinol 55
Characteristics:
• Softer
• Not heat treatable
• Tougher
• Low elastic modulous(Shape memory+super elasticity+high
resistance to cyclic fatigue)
• More resilient
Shape memory alloys(austenite +martensite phase or
crystalline structure)
More sensitive to Torque than SS files
10.
11. Design features of rotary instruments:
Tip design and transition angle(cutting or not)
Taper (affects canal prep shape + decrease area
engagement if graduate or variable)
Rake angle
Radial Land
Helical or flute angle
Pitch Number
15. Taper (affects canal prep shape + decrease area
engagement if graduate or variable )
16. Rake angle
.
Rake angle is the angle formed by the cutting edge and
a cross section taken perpendicular to the long axis of
the instrument.
The more positive the rake angle (closed), the greater the
cutting efficiency. Alternately, a neutral or negative rake
angle (open) reduces the file’s cutting efficiency.
Most conventional endodontic files use a negative or
substantially neutral rake angle.
Positive rake angles cut more efficiently than neutral rake
angles, which scrape the inside of the canal.
Overly positive rake angle digs and gouges the dentin. This
can lead to separation.
18. Radial Land
A surface that projects axially from the central axis, between
flutes, as far as the cutting edge (blade support).
Blade support can be defined as the amount of material
supporting the cutting blades of the instrument.
A radial land surface produces a planing or scraping effect
on the dentin walls, and a blade surface engraves them.
The less blade support (the amount of metal behind the
cutting edge), the less resistant the instrument is to torsional
or rotary stresses.
19. Radial Land
With radial land surfaces, friction is enhanced, reducing the
mechanical resistance of the files.
An attempt has been made to lower the friction, thus creating
a kind of recessed radial land (Quantec and K3 instruments).
This helps to prevent the propagation of cracks and reduces
the chances of separation and deformation from torsional
stresses.
Rotary files with radial land areas are further subdivided
depending on the shape of the grooves, U-shaped or L-
shaped, resulting in a U-type or H-type file. The U-type file
is constructed by grinding three equally spaced U-shaped
grooves around the shaft of a tapered wire, whereas the H-
type file consists of a single L-shaped groove (Hedström
type) produced in the same way.
20. Radial Land
It is this combination of a noncutting tip and radial land that
keeps a rotary file centered in the canal and reduces the
chances of transporting the root canal. An important concept
of rotary instrumentation should be remembered. The
concept is not of drilling a hole in a root. Rather, it is one of
taking a small hole, planning the inside, and making it larger.
23. Helical Angle:
The angle that the cutting edge makes with the long axis of
the file.
Files with a constant helical flute angle :
1. Allow debris to accumulate, particularly in the coronal part
of the file.
2. More susceptible to the effect of screwing-in forces.
By varying the flute angles,
1. Debris will be removed in a more efficient manner
2. File will be less likely to screw into the canal
25. Pitch number:
The number of spirals or threads per unit length.
The result of a constant pitch and constant helical
angles is a pulling down or sucking down into the canal.
This is of significance in rotary instrumentation when
using files with a constant taper. For example, the K3 file
has been designed with constant tapers but with variable
pitch and helical angles. This reduces the sense of being
sucked down into the canal
26.
27. Functioning of NiTi rotary instruments
Torsional stress
Very harmful and if they are of elevated intensity, they
rapidly cause the fracture of the instrument. This
generally happens in three situations:
1) when a large surface of the instrument rubs
excessively against the canal walls (taper lock)
2) when the instrument tip is larger than the canal
section to be shaped
3) when the operator exerts excessive pressure on the
handpiece
29. Functioning of NiTi rotary instruments
Torsional stress
Initially a brief manual instrumentation, allows
us to:
– drastically reduce the torsional stresses, by
creating a canal at least as large as the diameter
of the NiTi rotary instrument tip with greater
taper, that will be used successively
– interpret the original anatomy.
30. Functioning of NiTi rotary instruments
Bending fatigue
The main cause of strain
Factors responsible for it are
1. Canal anatomy(curve radius)
2. Bending angle
3. Largeness of the instrument
31.
32. Functioning of NiTi rotary instruments
Bending fatigue
Astationary rotary instrument inside a curved canal
,will be subjected to two different types of stresses :
– compression stress on the internal surface of the curve
– tensile stress on the external surfaces of the curve.
33.
34. Spead and Torque
Speed
Revolutions per minute but also to the surface feet per unit
that the tool has with the work to be cut.
Endodontic motors range of speed: 150 rpm to 40,000
rpm.
The greater the speed, the greater the cutting efficiency.
Higher speed disadvantages:
1. of loss of tactile sensation.
2. Breakage of instruments preceded by flute distortion.
3. Change in anatomical curvature of canal.
4. Loss of control [22].
36. Spead and Torque
Torque(moment)
Forces that act in a rotational manner.
e.g. turning a dial, flipping a light switch, or tightening
a screw.
Torque is the ability of the handpiece to withstand
lateral pressure on the revolving tool without
decreasing its speed or reducing its cutting efficiency
Dependent upon the type of bearing used and the
amount of energy supplied to the handpiece .
37. Spead and Torque
Torque(moment)
High torque advantage = very active instrument.
High torque disadvantage = incidence of instrument locking
and consequently deformation and separation increase.
low torque would= reduce the cutting efficiency of the
instrument, and difficult instrument progression in the
canal.
The ideal configuration is slow-speed and low-
torque or preferably right-torque motors, because
each instrument has a specific ideal (right) torque.
38. Spead and Torque
Torque(moment)
The torque generated during the canal preparation
depends on a variety of factors, especially the contact
area .The size of the surface area contacted by
an instrument is influenced by the instrumentation
sequence or the taper of the instrument in use . In
straight canals where the resistance to dentin removal is
low, the high torque provided by the motor can lead to
fracture of the blocked instrument, especially because
the clinician usually has no time to stop or retract the
instrument. Hence, use of slow-speed, high-torque
NiTi rotary instruments leads to many iatrogenic errors.
41. Rotation Vs Reciprocation
Reciprocation
• 1st used with stainless steel due to its safety(SS not sensitive
to Torque as NiTi)
• Now used with NiTi (Wave one, Reciproc ,Protaper F2)
• Can be 90degree CW vs CCW and non equal reciprocation
cycles
• Advantages :safe ,less torque, less torsional stress and less
cyclic fatigue
• Disadvantages
1. Debris accumulation =debris extruded apically =post -op
pain
2. With single file technique it exerts lot of force on canal
walls causing microcracks(high torque)
44. Rotation Vs Reciprocation
Rotation
• Only with NiTi
• Debris accumulates in file spaces
• Needs removal of the file and cleaning to remove debris
• Less post-op pain (less apically extruded debris)
• Less safe
• Less damage to canal walls
• File Fatigue and separation more frequent
• Needs torque monitoring
• Torsional stress and cyclic fatigue more frequent
50. Advances In NiTi matallurgy
Because the martensitic form of NiTi has remarkable
fatigue resistance, instruments in the martensite phase
can easily be deformed and yet recover their shape on
heating above the transformation temperatures. The
explanation for this may be that heating transforms the
metal temporarily into the austenitic phase and makes
it superelastic, which makes it possible for the file to
regain its original shape before cooling down again.
51. M-wire NiTi(Dentsply Tulsa)
Applying a series of heat treatments to NiTi wire blanks
Greater flexibility and an increased resistance to cyclic
fatigue when compared to traditional NiTi alloys.
Resistance to cyclic fatigue by almost 400% compared to
commercially available NiTi files
ProFile Vortex, Vortex Blue, GT Series X, and ProTaper
Next files.
52. R-phase NiTi (Sybron Endo)
R-phase is an intermediate phase with a rhombohedral
structure that can be formed either during the martensite-
to-austenite or the austenite-to-martensite transition.
Developed by transforming a raw NiTi wire in the
austenite phase into the R-phase through a thermal
process.
advantages:
It overcomes many of the limitations of ground file
technology
and opens up new opportunities for improved file design,
such as twisting.
It optimizes the molecular phase structure, thus resulting
in improved properties of nickel–titanium.
53. R-phase NiTi (Sybron Endo)
Advantages:
It employs a crystalline structural modification that
maximizes flexibility and resistance to breakage.
The Twisted File (TF) and K3XF file (reduced stiffness
and more fracture ) and Adaptive files.
Good superelasticity and shape-memory effects
55. Controlled-Memory (CM) (D&S Dental)
Manufactured using a special thermomechanical process
that controls the memory of the material, making the files
extremely flexible but without the shape memory of other,
conventional NiTi files.
Allows the instrument to be precurved before it is placed
into the root canal.
Sterilization of these files returns them to their original
shape.
e.g. HyFlex (Coltène Whaledent) and Typhoon (TYP)
(Clinician’s Choice Dental products, USA).
56. Clinical Strategies to safely & successfully use
NiTi rotaries:
1. Assess case difficulty
2. provide adequate access preparation
3. Use hand files up to size #20 prior to rotary use
4. Proceed with crown-down sequence
5. Use light touch and low rpm
6. Don’t force files
7. Don’t overuse files
57. Clinical Strategies to safely & successfully use
NiTi rotaries:
8. Replace rotary instruments frequently
9. Don’t start and stop
10. Avoiding breakage takes practice
11. Don’t try to bypass ledges
12. Avoid cutting with the entire length of file
13. Length control is critical