Self-Adjusting File: SAF
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The document discusses a new paradigm in nickel-titanium (NiTi) instrumentation called the Self-Adjusting File (SAF) system. The SAF represents an improvement over traditional rotary NiTi files by adapting to the three-dimensional anatomy of the root canal, continuously irrigating during instrumentation, and requiring only a single file per canal. Studies have shown the SAF more effectively cleans and shapes canals while preventing issues like canal transportation compared to traditional rotary files. The simple SAF procedure and ability to respect root canal anatomy may provide more effective and higher quality root canal treatments.
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Self-Adjusting File: SAF
- 2. A New Paradigm in NiTi Instrumentation Raviv Zary
- 3. Paradigm “ A framework of thoughts and concepts within which scientific experiments are performed”
- 4. The Introduction of Nickel-Titanium Rotary Instruments Represented a Paradigm Shift in Endodontics
- 5. Profile 1993 A Disruptive Technology
- 6. Evolution of Rotary NiTi Files Profile 1993 Quantec 1996 GT 1998 Hero642 1999 FlexMaster 2000 1 st Generation Symmetrical & Uniform
- 7. Evolution of Rotary NiTi Files Race 1999 ProTaper 2001 K3 2001 Hero Shaper 2002 Revo-S 2009 2nd Generation Asymmetrical and/or Not Uniform
- 8. Evolution of Rotary NiTi Files 3rd Generation GT - X 2009 M Wire TF 2009 R Phase Innovative Metallurgy
- 9. Motorized instrumentation Faster instrumentation Able to negotiate curved canals Great Technology !
- 10. Nevertheless Rotaries are Rotaries are Rotaries …
- 11. Common to all : Many instruments Complicated sequences Tedious repeated rinsing is essential
- 12. Common to all : Instruments break unexpectedly Separated apical part is difficult to remove A Major Drawback !
- 13. Common to all : Ignoring the 3D shape of the root canals !
- 14. The Common Misconception Dentists tend to relate to all root canals as if they had a uniform round cross section
- 15. This is true in upper incisors but wrong in many other teeth
- 16. Oval or flat canals are common in lower incisors canines premolars distal roots of lower molars
- 18. Canals with “ tear-shaped” cross section are common in premolars mesial roots of lower molars mesio-buccal roots of upper molars
- 19. All appear the same on a 2D X-ray
- 20. Current High-End Technology Rotating Blade with Flutes
- 21. All root canals are machined to a round cross section
- 22. Root Canals with a Tear-Shaped Cross-Section
- 23. Treated with Rotary Nickel Titanium Files Flat Canals * * Will look great on the radiograph
- 24. Treated with Rotary Nickel Titanium Files Canals with a “ Tear-Shaped” Cross Section * * Will look great on the radiograph
- 25. Do We Aim for Nice Radiographs or High Quality Endodontic Treatment ?
- 26. This may explain the frequently encountered enigma : Endodontic failures in roots with apparently good root canal fillings * * Misleading 2D X-Ray images
- 27. Wu & Wesselink, Int Endod J 34: 137-141, 2001
- 28. De Deus et al. Int Endod J 41: 183-190, 2008
- 29. De Deus et al. J Endod 34: 1401-1405, 2008
- 30. Micro CT Analysis B12 Rotary File
- 31. Bucco-Lingual B12 Rotary File Mesio-Distal
- 32. B12 Rotary File 2 mm 4 mm 6 mm
- 33. B53 Rotary File Micro CT Analysis Bucco-Lingual Mesio-Distal
- 34. 2 mm B53 Rotary File 2 mm 4 mm 6 mm
- 35. J Endod 35: 1044-1047, 2009 Hard Tissue Debris Accumulation Analysis by High Resolution Computed Tomography Scans Paqué et al 2009 New Insight !
- 36. Packing of Debris into the Isthmus Area During Rotary Instrumentation
- 37. The Longitudinal 3D challenge Curved Canals
- 38. Int Endod J 36: 86-92, 2003 ProTaper Rotary Root Canal Preparation: Effects of Canal Anatomy on Final Shape Analyzed by Micro CT Peters et al 2003 3 D X-Ray
- 39. Peters et al 2003 Superimposed Images Red : Surface untouched by file Green : Affected surface Clear : Final preparation
- 40. Percent of Root Canal Surface Unchanged by the File Int Endod J 36: 86-92, 2003 Peters et al 2003 Disto-buccal (n=11) 33 (±19)% Mesio-buccal (n=11) 43 (±29)% Palatal (n=11) 49 (±29)%
- 41. Paqué et al 2009 ProFile ProTaper Flexmaster Lightspeed GT NiTi K File Percent Untreated Root Canal Surface Adapted from: Paqué et al J Endod 35:1056-9, 2009 Can we do Better ?
- 42. Peters et al. Int Endod J 2003, 36:86-92 Canal Transportation* (µm) & Canal Straightening (%) in Upper Molars * CM shift
- 43. (2) Peters et al. Int Endod J 2003, 36:86-92 Canal Transportation* (µm) P MB DB * CM shift Can we do better ?
- 44. (2) Peters et al, Int Endod J 2003, 36:86-92 Canal Straightening (%) P MB DB Can we do better ?
- 45. NiTi Rotary Files Resulted in a Great Progress in Endodontics
- 46. Which Frontiers Still Remain to be Engaged ?
- 47. Many instruments Complicated Sequences
- 48. Unexpected instrument separation
- 49. Flat oval root canals Canal transportation Curved root canals
- 50. Need for effective irrigation
- 51. These Call for Out-of-the-Box Thinking
- 52. Paradigm Shift in Canal Instrumentation
- 53. A New Concept SAF System
- 54. A Self Adjusting File SAF System Operated by a Vibrating Handpiece Made of NiTi
- 55. The hollow file is used with continuous irrigation
- 56. Cleaning & Shaping and Irrigation are Achieved Simultaneously
- 57. SAF System A New Concept A Compressible File 1
- 58. A hollow, compressible file
- 59. SAF Adapted into a # 20 K File Path
- 60. SAF System A New Concept A File Which Adapts Itself to the Canal’s 3D Anatomy 2
- 61. Adaptation to Longitudinal Curvature
- 62. Mandibular Incisor Adaptation to Oval Cross Section
- 63. SAF System Circumferential Removal of Dentin 3 A New Concept
- 64. Sand Paper Rough Surface Pressure Repeated Motion
- 65. Roughness : 2.8 µm ± 10%
- 66. The vibrating hand-piece provides 5000 vibrations per min + Pecking Motion
- 67. Goal attained with a minimal and uniform wall thickness reduction !
- 68. SAF Current Nickel Titanium Rotary Files Flat Canals
- 69. Current Nickel Titanium Rotary Files SAF Canals with a “ Tear-Shaped ” Cross Section
- 70. Micro CT Analysis Red : before treatment Blue over red : after 4 min treatment G93
- 71. Micro CT Analysis Red : before treatment Blue over red : after 4 min treatment A 32
- 72. Cross section at 6 mm from the apex A 32
- 73. An Extreme Case C-Shaped Canal
- 74. 2 nd Lower Molar TLS 16
- 75. 0° - 45° - 180° 90° 45° TLS 16 1 mm
- 76. SAF preparation 0° - 40° - 120° - 80° 120° 80° 40° Green: before preparation Red: after preparation 1 mm
- 77. Cross Sections 4mm 2mm Distance from the apex
- 78. Distal Roots of Lower Molars Paqué et al J Endod 36:703-707, 2010 ProTaper – Manufacturer’s Instructions 79.9 (±10.3)% Untreated
- 79. Distal Roots of Lower Molars ProTaper Circumferential Filing 69.1 (±9.2)% Untreated Paqué et al J Endod 36:703-707, 2010
- 80. Distal Roots of Lower Molars SAF System 23.5 ( ± 8.9)% Untreated
- 81. SAF System Prevention of Canal Transportation 4 A New Concept
- 82. Micro CT Analysis A 22
- 83. Paqué et al 2009 SAF Current Study ProFile ProTaper Flexmaster Lightspeed GT NiTi K File Percent Untreated Root Canal Surface Adapted from: Paqué et al J Endod 35:1056-9, 2009
- 84. (1) (2) (1) Peters et al, Int Endod J 2003, 36:86-92 (2) Metzger et al, on-going study Canal Transportation* (µm) P MB DB * CM shift
- 85. (1) (2) (1) Peters et al, Int Endod J 2003, 36:86-92 (2) Metzger et al , on-going study Canal Straightening (%) P MB DB
- 86. SAF System Continuous Irrigation with Sodium Hypochlorite 5 A New Concept
- 87. Irrigator Attachment Hollow File
- 88. LCD Display Flow Control Buttons Foot Switch SAF System Irrigator VATEA ©
- 89. Irrigation Solution Reservoir 400 ml SAF Sytem Irrigator VATEA
- 90. Flow Rate 1-10 mL / min = 4 - 40 mL in 4 min
- 91. Positive Pressure Irrigation Negative Pressure Irrigation vs No-Pressure Irrigation
- 92. Will the solution flow beyond the apex ?
- 93. Rinsing efficacy : Transparent Blocks
- 97. SAF System Continuous No-Pressure Irrigation with Activation & Scrubbing
- 98. Cleaning the root canal SEM Study
- 99. SAF Cleaning and shaping with NaOCl 3% alternating with EDTA 17% SEM
- 100. Smear Layer Scoring (Hülsmann 1997) Score 1 No smear layer, dentinal tubules open. Score 2 Small amount of smear layer, some dentinal tubules open. Score 3 Homogenous smear layer, only few dentinal tubules open. Score 4 Complete root canal covered, no open dentinal tubules. Score 5 Heavy, non homogenous smear layer covering the complete root canal wall. X 1000
- 101. Debris Scoring (Hülsmann 1997) Score 1 Clean root canal wall, few small debris particles. Score 2 Few small agglomerations of debris. Score 3 Many agglomerations of debris covering less than 50% of root canal wall. Score 4 More than 50% of root canal covered by debris. Score 5 Complete or nearly complete root canal wall covered by debris. X 200
- 102. Apical Mid-Root Coronal D75 X 500 Apical
- 103. Apical Mid-Root Coronal D75 X 200 Apical
- 104. Apical Mid-Root Coronal F48 X 1000 Apical
- 105. Canal Wall Free of Debris Coronal Third Middle Third Apical Third 20/20 100% 20/20 100% 20/20 100% Metzger et al, J Endod 36:697-702, 2010
- 106. Canal Wall Free of Smear Layer Coronal Third Middle Third Apical Third 20/20 100% 16/20 80% 13/20 65% Metzger et al, J Endod 36:697-702, 2010
- 107. SAF System High Durability : No File Separation 6 A New Concept
- 108. Torque Durability Separation after ~ 1.3 turns Rotary file
- 109. Torque Durability Separation after ~ 3.5 turns SAF
- 112. The SAF Procedure
- 113. The SAF Procedure Orifice funneled Irrigating while working One instrument ! Path established up to # 20
- 114. SAF – Benefits = H igher quality of treatment Improved cleaning Improved irrigation Improved sealing Improved preservation of canal walls
- 115. SAF – Benefits A simple armamentarium
- 116. S 16/21 mm M 18/25 mm L 21/31 mm Ø 1.5 mm One File Per Procedure
- 117. SAF – Benefits A simple, easy procedure = Short learning curve A simple armamentarium
- 118. SAF – Benefits A simple, easy procedure A simple armamentarium Improved Safety !
- 119. Obturation Methods
- 120. A New Method for Evaluation of Root Canal Filling– Dentin Contact by 3D Micro CT Analysis Resolution:17 µm
- 121. RCF- Dentin Contact – 98% Scan after Treatment + Scan after Obturation Yellow : touched by the RCF Red : un-touched by the RCF Resolution:17 µm
- 122. Tooth A22 - Lateral Compaction Bucco-lingual Mesio-distal
- 123. RCF / Dentin contact – 89.6% Tooth A22 - Lateral Compaction
- 124. Tooth A04 – Heated Gutta-Percha Injection Bucco-lingual Mesio-distal
- 125. RCF / Dentin contact – 98.6% Tooth A04 – Heated Gutta-Percha Injection
- 126. Bucco-lingual Mesio-distal Tooth A60 - Thermafil
- 127. RCF- Dentin Contact – 90% Tooth A60 - Thermafil
- 128. Obturation Study
- 129. Obturation Study % canal wall affected by the file Red: Area unaffected by the file
- 130. Obturation Study % canal wall touched by the root canal filling Yellow: Area untouched by the RCF
- 131. Figure 3 Correlation between % Unaffected Canal Wall and % untouched by RCF )
- 133. March 2010 >250 Clinical Cases
- 134. * * * * * * *
- 135. Conclusion
- 136. The SAF System Represents A Paradigm Shift In NiTi Instrumentation
- 137. Journal of Endodontics April 2010 The Self Adjusting File (SAF). Part 1: Respecting the Root Canal Anatomy A New Concept of Endodontic Files and Its Implementation Metzger Z, Teperovich E, Zary R, Cohen R, Hof R J Endod 36:679-690, 2010
- 138. Journal of Endodontics April 2010 The Self-Adjusting File. Part 2: Mechanical Analysis Hof R, Perevalov V, Eltanany M, Zary R, Metzger Z J Endod 36:691-696, 2010
- 139. Journal of Endodontics April 2010 The Self-Adjusting File (SAF). Part 3: Removal of Debris and Smear Layer A Scanning Electron Microscope Study Metzger Z, Teperovich E, Cohen R, Zary R, Paqué F, Hülsmann M J Endod 36:697-702, 2010
- 140. Thank You Raviv Zary [email_address]