MINIMIZE RISKS AND MAXIMIZE SUCCESS WITH A REVOLUTIONARY FILE SYSTEM - - PowerPoint PPT Presentation

MINIMIZE RISKS AND MAXIMIZE SUCCESS WITH A REVOLUTIONARY FILE SYSTEM

ROUND CUTTING DESIGN

a – K File b-Hedstrom File a – Profile b-ProTaper Both stainless steel files and NiTi rotary files are round cutting like a drill.

Root Canals Are Assumed Round

COMMON MISCONCEPTION

Root Canals are Primarily Oval - Wider Buccolingual Dimension Compared to the Mesiodistal

SHAPE OF ROOT CANALS

ROOT CANALS ARE PRIMARILY OVAL AND IRREGULAR

ROUND CUTTING CANNOT THOROUGHLY CLEAN THE CANALS

NiTi rotary files cut in circle

ROUND CUTTING CANNOT THOROUGHLY CLEAN THE CANALS

Results:

• Instrumentation of canals increased volume and surface area.
• Prepared canals were significantly more rounded, had greater

diameters and were straighter than unprepared canals.

• All instrumentation techniques left 35% or more of the canals’

surface area unchanged.

Peters OA, Schonenberger K, LaibA. International Endodontic Journal 34, 2001

A RESEARCH ON ROOT CANAL PREPARATION BY 4 TYPES OF NITI ROTARY FILES

Mesio-buccal Disto-buccal

Palatal %(±29) 43 %(±19) 33 %(±29) 49

PERCENTAGE OF ROOT CANAL SURFACE UNTOUCHED BY NITI ROTARY FILES

Peterset al 2003, Int Endod J 36: 86-92, 2003

"Over the past 15 years, many new endodontic products have enabled endodontists to more effectively treat all canals, creating shapes that enable them to properly irrigate and

• bturate to the apex – all essential components of successful

root canal therapy.“ Preserving the Future: The New Approach to Endodontic Therapy

AAE Conference in Washington D.C. – Friday, May 2, 2014

• Dr. George Bruder

And yet, while RCT is generally a successful procedure, today patients are living longer and need functioning teeth to maintain their quality of life for a longer period of time than previous generations. While many significant advancements have been made in metallurgy and file design, today’s rotary files don’t adequately conform to irregular shaped canal anatomy, leaving 35% or more of the canal’s surface area unchanged thus leaving bacteria behind.

by MedicNRG

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The cross section 2 mm from the apex . Note: all the debris (and bacteria) around the master cone

CROSS SECTION BY NITI ROTARY FILES

by MedicNRG

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4 MM FROM THE APEX Note: all the debris (and bacteria) around the master cone

• Taper of most popular NiTi rotary files is

6% to 8%. Greater taper cuts dentin excessively which can lead to post- treatment fracture

NITI ROTARY FILES REMOVE TOO MUCH DENTINE

• Shemesh et al. 2009
• Bier et al. 2009
• Adorno et al. 2011
• Bürklein et al. 2013
• Liu et al. 2013

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Research: NiTi Root Fractures

Transportation, ledging, perforation, straightening are often found with NiTi rotary files due to:

• NiTi files are not flexible enough for curved

root canal

• High Vertical Forces

NITI ROTARY FILES EXERT HIGH VERTICAL FORCES ON CANAL WALLS

194.3 213.7 242.3 68.0 131.3 154.7 2.7 2.7 3.7 0.0 50.0 100.0 150.0 200.0 250.0 300.0

PROTAPER Yellow PROTAPER Red PROTAPER Blue NEXT Yellow NEXT Red NEXT Blue GF Yellow GF Red GF Blue

2.5MM average

PROTAPER Yellow PROTAPER Red PROTAPER Blue NEXT Yellow NEXT Red NEXT Blue GF Yellow GF Red GF Blue

Moment 𝒍𝒉𝒈 ∗ 𝒅𝒏

381.7 364.3 391.0 178.3 255.3 258.3 4.7 4.7 5.7 0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 400.0 450.0

5MM average

542.3 504.0 604.0 322.3 343.0 337.7 5.7 5.7 6.3 0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0

7MM average

ProTaper

NITI ROTARY FILE CAUSES TRANSPORTATION

Mean (um) StD MB 128.33 73.66 DB 131.66 69.66 P 178.33 85 Peters et al. Int Endod J 2003, 36:86:92

ProTaper

NITI ROTARY FILE CAUSES CANAL STRAIGHTENING

Mean (%) StD MB 17.4 16.7 DB 30 19.5 P 13.3 19.6 Peters et al, Int Endod J 2003, 36:86:92

NITI FILE - APICAL LEDGE FORMATION

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NiTi metal has memory. NiTi rotary files tend to return to their original shape and cause transportation and straightening. Gentlefile’s greater flexibility provides easy negotiation of extreme curvatures and eliminates perforation and ledging of canals.

Comparison between NiTi files and Gentlefile in endo block prepared for 0.25

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Breakage of NiTi rotary files due to:

• No tactile sensation
• Torsional fatigue due to drill cutting and

high torque from handpiece

• Low resistance to cyclic fatigue

NITI ROTARY FILES PRONE TO UNEXPECTED FILE SEPARATION

Cyclic fatigue Torsional fatigue

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Torsional fatigue causes file breakage at the apical third

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Fracture of rotary NiTi instruments may

• ccur without warning…

Distortion of rotary NiTi instruments is often not visible…

Gabel WP et al. 1999 Yared GM et al, 2003 Parashos et al. 2004

Ankrum MT et al. 2004

Rotary NiTi instrument separation is 7 times greater than hand files Iqbal et al. 2006

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NiTi File Separation Problem

NiTi files demonstrate an increased likelihood of breakage caused by cyclic fatigue and torsional material stress. Removal of a separated instrument can be difficult and leads to extreme stress and discomfort for the patient.

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A NEW DESIGN OF FILES IS SELF-EVIDENT

GENTLEFILE SYSTEM

• GF NiTi abrasive hand file: For

setting glide path and patency

• Gentlefile non-niti rotary file: For

mechanical debridement

• GF Finisher Brush: Irrigation device

for cleaning and disinfection

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NiTi cutting hand file with sharp edge-cutting : High resistance, high torque, high torsional

fatigue, easy file separation

Gentlefile NiTi abrasive hand file with round abrasive edge : smooth filling , low resistance, low

torque, low torsional fatigue

Regular NiTi Cutting Hand File – Sharp edge

Gentlefile-NiTi Abrasive Hand File: The rough surface collects and removes more dentin than the smooth NiTi file

Gentlefile NiTi Abrasive Hand Files

• No cutting blade
• Action by abrasion
• Size: #17 and #25
• Benefits:
• More flexible than stainless steel for canal negotiation, especially in curved

canals.

• No worry of torsional fatigue causing file separation due to its non-cutting

nature.

• Easy to use: clock-wise, counter-clock wise, and up or down movement.

GF NITI ABRASIVE FILES

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Gentlefile Rotary File System

• Ultra Flexible
• Shape by Filing
• Operates at 6,500 rpm
• Taper 3% - 4%

Light weight cordless handpiece

Patent Design : File made of 3 medical grade stainless wires

Built-in Abrasive Properties

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Innovative Approach to User-Friendly Root Canal Preparation The apical file section is a bi-layer structure with greater flexibility for shaping extremely curved canals The upper file section is made of a 3-layer structure that provides the vertical force required for efficient file progression in the canal

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• Cordless, light weight, ergonomic
• Operates at 6,500 rpm
• Disposable head is autoclavable

3 7

Gentlefile Handpiece

File Friction-grip Mechanism

Innovative Approach to User-Friendly Root Canal Preparation

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Automatic Load Control

Innovative Approach to User-Friendly Root Canal Preparation

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CENTRIFUGAL FORCE Gentlefile rotates at 6,500 rpm creating centrifugal force The coach in roller coaster revolves along the track with centrifugal force

Gentlefile operates at 6,500 rpm creating centrifugal force which enables Gentlefile to abrade against canal walls to shape and to achieve 3 dimensional cleaning

UNPARALLELED CLEANING EFFECT BY CENTRIFUGAL FORCE

EVALUATE THE CLEANLINESS BY GENTLEFILE

7

Measure from the apex

2 mm. 4. mm 6 mm. 8mm

Cases prepared using Gentlefile: Upper part of the slices - thickness of 1.6 mm each.

• Dr. Stone

by MedicNRG

1 1

2 mm. 8mm

• 4. mm

6 mm.

DEMONSTRATE THE UPPER PART OF THE SLICES

,

THICKNESS OF 1.6 MM PREPARED BY GENTLEFILE

Stav-Serial no. 58

Measure from the apex

45

8 mm from the apex.

Before Sealing After Preparation By Gentlefile

by Me

2

Gutta- flow 2

Master cone

debris Master cone

Gentlefile NiTi

Both cross section are 4 mm from the apex

CROSS SECTION BY NITI ROTARY FILE VS GENTLEFILE

Its superior flexibility conforms to canal anatomy, even irregular shapes and cleans the entire canal wall.

GENTLEFILE: ULTRA FLEXIBLE

Ultra flexibility of Gentlefile avoids transportation, ledging, perforation, straightening… in curved canals GENTLEFILE’S ULTRA FLEXIBILITY CAN SHAPE EVEN THE MOST CHALLENGING CANALS

Gentlefile for Better Access

Good access is imperative for quality endodontic treatment and prevention of iatrogenic problems. Gentlefile can be inserted up to a 45 degree angle for superior cleaning and shaping of the root canal. The files elasticity is not limited by the size and taper. NiTi files require straight line access and the bending stiffness of these files limits access to molar teeth resulting in painful mouth opening. The stiffness contributes to instrument separation and may lead to canal perforation and ledge

• formation. These factors can ultimately lead to failure
• f root canal treatment.

Superior Flexibility Bending Stiffness

Innovative Approach to User-Friendly Root Canal Preparation

Rough surface structure is achieved by metal particle injection technology

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Shaping by Filing:

• Light vertical force avoids micro-cracks
• Non-cutting avoids torsional fatigue
• Produces dentinal dust for easy driven out of canals

NiTi – Breakage after 20 seconds Gentlefile – NO breakage after 5 minutes

Cyclic Fatigue Test

5 1

By Dr. Stone July 2015

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Taper : 3% - 4%, Preserve Natural Tooth Anatomy

by MedicNRG

1

The purpose of this clinical evaluation : show that the Gentlefile system follow The neutral shape of the canal And Preserve the canal anatomy. Therefore keep the strength of the canal wall, Extend the tooth life better hold the post Keep the symmetric canal axis Avoid ledge and perforation The attached case accidently show-3 different canal with the same patient but the last tooth performed by Gentlefile

PRESERVE THE CANAL ANATOMY

• Simple file system
• Short learning curve
• Easy to learn and simple

to use With Gentlefile Every Dentist Can Do Rotary Endodontics

• Clean the canals thoroughly
• Preserve natural canal anatomy
• Prevent ledging, transportation, perforation
• Virtually no file breakage
• Easy to learn and simple to use

Minimize Risk. Maximize Success.

GENTLEFILE – ENDODONTIC GAME CHANGER

IRRIGATION: A CRITICAL STEP FOR CLEANING BEYOND THE ROOT CANAL INSTRUMENTS

• Root canal system is complex and irregular having lateral canals, webs, fins,

isthmus that no endo instruments can reach.

• Effective irrigation is essential for success of a root canal treatment.
• An ideal irrigation product should perform effectively these critical functions:
• Remove pulp tissue
• Remove microorganism (planktonic or biofilm)
• Remove smear layer
• Remove debris

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GF Finisher Brush– Unparalleled Cleaning Capabilities

GF Finisher Brush is made up of 7 medical grade stainless strands. When operates at 6,500 rpm inside the canal, the 7 strands open

• up. Each strand rotates at a speed of 6,500

rpm creating a tornado like current and superbly achieves unmatched cleaning and disinfection:

• Strongly activates sodium hypochlorite to

drive irrigant into canal irregularities for eliminating microorganisms.

• Scrubs canal walls to eliminate smear layer

and biofilm.

• Flushes debris out of canal with strong

current.

TORNADO FINISHER BRUSH: PERFORM 3 FUNCTIONS SIMULTANEOUSLY

CLEANING RESULT BY GF FINISHER BRUSH

The apical zone . Magnified by x 500

• Effectiveness of supplementary irrigant agitation with the Finisher GF

Brush on the debridement of oval toot canals instrumented with the Gentlefile or nickel titanium rotary instruments.

• Conclusions: Supplementary irrigant agitation with the Finisher GF Brush

improved debridement of canals prepared with Gentlefile and size 25, 04 taper rotary NiTi. Root Canal debridement did not significantly differ between the instruments when syringe irrigation was used.

• P.Neelakantan, K.Kan, K.Y.Li, H.Shetty, W.Xi, accepted manuscript online

24 January, 2018

RESEARCH ON THE CLEANING EFFECTIVENESS OF GF FINISHER

PASSIVE ULTRASONIC IRRIGATION Strength:

• Strong Activation

Weakness:

• Ineffective in apical part for

cleaning and disinfection

SONIC IRRIGATION AND NITI ROTARY FINISHER Weakness:

• Unable to achieve Strong Activation
• Ineffective in the removal of dentine

debris Sonic irrigation has low operating frequency. NiTi rotary finisher has low rotation speed. Both do not have the capability of creating strong activation.

RIDER S3 APEX LOCATOR: UNPARALLELED ACCURACY, RELIABILITY, AND INSTANT FEEDBACK

• World’s only Digital Signal Processing (DSP)

technology that avoids frequent false readings, and with a deviation tolerance of only 0.1 mm vs competition of 0.5 – 1.8 mm. Greatly reduce chance of over-and under-instrumentation.

• The only apex locator can give 12 times feedback

per second vs 2 - 4 times in analog devices. This feature enables Rider S3 to be used with niti endo handpiece without trouble of stop-and-check.

• Accurate measurement is unaffected by the

presence of blood, electrolytes, saline, hydrogen peroxide, EDTA, sodium hypochlorite. Thanks to its powerful algorithm automatic calibration.

.

Micrometer show: 0.002

OPTIMIZING YOUR ENDO PERFORMANCE

RZX: 0.50 XFR: 0.00

Micrometer show: 0.210 RZX: 0.700 XFR: 0.25

OPTIMIZING YOUR ENDO PERFORMANCE

CLINICAL CASES BY GENTLEFILE

by MedicNRG

PRESERVE THE CANAL ANATOMY

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K-0.10> Mgf-0.17 > gray>red > brush > red

by MedicNRG K0.10 > Mgf 0.17 > gray > blue > red > brush. 10.2016 dr. stone

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by MedicNRG One GF file case: K-0.10 > Red and fibished by GF brush . Less than 2.min

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S-shape

by Dr. Tsesis

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S-SHAPE PREPARED BY GENTLEFILE

by MedicNRG RCT to old dentist . 0.10 > manual 17 GF > gray > red > brush > red. 3/2017 Stone

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10>15>MANUAL GF 17>RED>GREY>BRUSH>RED Dr stone 3.2017

19

18

young patient - easy canals 15>red>brush>red>brush> Guttaflow 2.

• Dr. Stone

K-FILE 10>GF MANUAL YELLOW#17 >GRAY > GF BLUE

PREPARED THE CANAL JUST BY GENTLEFILE BRUSH

GENTLEFILE SYSTEM: MINIMIZE RISKS. MAXIMIZE SUCCESS

Gentlefile and GF Finisher Brush cleans canals thoroughly with much reduced procedural errors

PROCEDURE

• Explore canals with #10 K-file (#6 or #8 K-file in narrow canals)
• Establish glide path with #15 K-file and GF manual file #17
• Start with coronal file Gentlefile Grey.
• If Gentlefile Grey reaches the apical third, the next file is Gentlefile

Red.

• If Gentlefile Grey cannot reach apical third in the case of narrow

canals, use Gentlefile Blue and then Gentlefile Red. Repeat the step – Gentlefile Blue and then Red – until the apex is reached.

• Use GF Finisher for 20 to 30 seconds with EDTA as the final step

for final cleaning and disinfection.

OPERATION PROCEDURE

Basic Steps: #10 K-File>Irrigation> #15 K-File > Irrigation > #17 GF manual File >Irrigation>Gentlefile Grey>Patency>Irrigation>Gentlefile Red>Irrigation>GF Finisher Brush

OPERATION PROCEDURE AT A GLANCE

• Gentlefile is not a pathfinder. Use #10 K-file, #15 K-file and

GF manual file #17 to set glide path before applying Gentlefile.

• Gentlefile is operated with vertical quick pecking motion.

Each pecking motion lasts for 5 seconds. 5 seconds is ideal to prevent accumulation of debris and for easy removal of debris.

• When encounter resistance for advancement, do not push the
• file. Use GF #17 manual file or GF Finisher Brush to clear

blockage by debris.

• In narrow canals where Gentlefile Grey cannot advance, use

Gentlefile Blue with light force to gently push without pecking motion. POINTS TO OBSERVE

• Make sure the canal is irrigated before applying Gentlefile and

GF Finisher Brush.

• For the application of GF Finisher Brush, no pecking motion

but just move slowly up & down.

• Always follow this sequence: Patency file, irrigation, and

Gentlefile.

• Do not use plastic block for practice. In case plastic block is

used, add soap water.

• Use GP points size 25, 4% taper for obturation.

POINTS TO OBSERVE

• Gentlefile is virtually unbreakable. It breaks under two

conditions:

• The canal is dry. So always irrigate before applying Gentlefile.
• Push Gentlefile when it meets with resistance. When

resistance is met, it means the canal is either blocked by debris

• r narrow calcified. Use GF manual file or GF Finisher Brush

to clear the debris in case of blockage by debris. Use Gentlefile Blue and Gentlefile Red in case of narrow calcified canals.

POINTS TO OBSERVE