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

COMMON MISCONCEPTION Root Canals Are Assumed Round

SHAPE OF ROOT CANALS Root Canals are Primarily Oval - Wider Buccolingual Dimension Compared to the Mesiodistal

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

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

PERCENTAGE OF ROOT CANAL SURFACE UNTOUCHED BY NITI ROTARY FILES Mesio-buccal Disto-buccal Palatal %(±29) 43 %(±19) 33 %(±29) 49 Peterset al 2003, Int Endod J 36: 86-92, 2003

Preserving the Future: The New Approach to Endodontic Therapy AAE Conference in Washington D.C. – Friday, May 2, 2014 Dr. George Bruder "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 obturate to the apex – all essential components of successful root canal therapy.“

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.

CROSS SECTION by MedicNRG BY NITI ROTARY FILES The cross section 2 mm from the apex . Note : all the debris (and bacteria) around the master cone 28

MM FROM THE 4 by MedicNRG APEX Note : all the debris (and bacteria) around the master cone 29

NITI ROTARY FILES REMOVE TOO MUCH DENTINE • Taper of most popular NiTi rotary files is 6% to 8%. Greater taper cuts dentin excessively which can lead to post- treatment fracture

Research: NiTi Root Fractures • Shemesh et al. 2009 • Bier et al. 2009 • Adorno et al. 2011 • Bürklein et al. 2013 • Liu et al. 2013 1 6

NITI ROTARY FILES EXERT HIGH VERTICAL FORCES ON CANAL WALLS 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

2.5MM average 300.0 242.3 PROTAPER Yellow 250.0 PROTAPER Red 213.7 PROTAPER Blue Moment 𝒍𝒉𝒈 ∗ 𝒅𝒏 194.3 200.0 NEXT Yellow NEXT Red 154.7 150.0 NEXT Blue 131.3 GF Yellow GF Red 100.0 GF Blue 68.0 50.0 3.7 2.7 2.7 0.0 GF Blue GF Red GF Yellow NEXT Blue NEXT Red NEXT PROTAPER PROTAPER PROTAPER Yellow Blue Red Yellow

5MM average 450.0 391.0 381.7 400.0 364.3 350.0 300.0 258.3 255.3 250.0 178.3 200.0 150.0 100.0 50.0 5.7 4.7 4.7 0.0

700.0 7MM average 604.0 600.0 542.3 504.0 500.0 400.0 343.0 337.7 322.3 300.0 200.0 100.0 6.3 5.7 5.7 0.0

NITI ROTARY FILE CAUSES TRANSPORTATION ProTaper 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

NITI ROTARY FILE CAUSES CANAL STRAIGHTENING ProTaper 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 2 3

Gentlefile’s greater NiTi metal has memory. NiTi flexibility provides easy rotary files tend to return to negotiation of extreme Comparison between NiTi their original shape and cause curvatures and eliminates transportation and files and Gentlefile in endo perforation and ledging of straightening. block prepared for 0.25 canals. 2 4

NITI ROTARY FILES PRONE TO UNEXPECTED FILE SEPARATION 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

Cyclic fatigue Torsional fatigue 2 6

Torsional fatigue causes file breakage at the apical third 2 7

Fracture of rotary NiTi instruments may occur without warning… Ankrum MT et al. 2004 Distortion of rotary NiTi instruments is often not visible… Gabel WP et al. 1999 Yared GM et al, 2003 Parashos et al. 2004 Rotary NiTi instrument separation is 7 times greater than hand files Iqbal et al. 2006 2 8

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. 2 9

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

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 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 3 2 torque, low torsional fatigue

GF NITI ABRASIVE 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.

Gentlefile Rotary File System • Ultra Flexible • Shape by Filing • Operates at 6,500 rpm • Taper 3% - 4% Light weight cordless handpiece 3 4

Patent Design : File made of 3 medical grade stainless wires Built-in Abrasive Properties 3 5

The upper file section is made of a 3-layer structure that provides the vertical force required for efficient file progression in the canal The apical file section is a bi-layer structure with greater flexibility for shaping extremely curved canals Innovative Approach to User-Friendly Root Canal Preparation 3 6

Gentlefile Handpiece • Cordless, light weight, ergonomic • Operates at 6,500 rpm • Disposable head is autoclavable 3 7

File Friction-grip Mechanism Innovative Approach to User-Friendly Root Canal Preparation 3 8

Automatic Load Control Innovative Approach to User-Friendly Root Canal Preparation 3 9

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

UNPARALLELED CLEANING EFFECT BY 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

EVALUATE THE CLEANLINESS BY GENTLEFILE 7

Cases prepared using Gentlefile: Upper part of the slices - thickness of 1.6 mm each . 2 mm. 4. mm 6 mm. 8mm Measure from the apex Dr. Stone

, DEMONSTRATE THE UPPER PART OF THE SLICES THICKNESS OF 1.6 MM PREPARED BY GENTLEFILE by MedicNRG 4. mm 6 mm. mm . 2 8mm Measure from the apex Stav-Serial no. 58 1 1

Before Sealing After Preparation By Gentlefile 8 mm from the apex. 45

by Me CROSS SECTION BY NITI ROTARY FILE VS GENTLEFILE Both cross section are 4 mm from the apex NiTi Gentlefile debris Gutta- flow 2 Master cone Master cone 2

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

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

Gentlefile for Better Access Good access is imperative for quality endodontic NiTi files require straight line access and t he treatment and prevention of iatrogenic problems. bending stiffness of these files limits access to molar Gentlefile can be inserted up to a 45 degree angle teeth resulting in painful mouth opening. for superior cleaning and shaping of the root canal. The stiffness contributes to instrument separation and The files elasticity is not limited by the size and may lead to canal perforation and ledge taper. formation. These factors can ultimately lead to failure of root canal treatment. Bending Stiffness Superior Flexibility Innovative Approach to User-Friendly Root Canal Preparation