Self-adjusting File Research Articles

Apical extrusion of debris by supplementary files used for retreatment: An ex vivo comparative study.

Aim:This study evaluated whether using supplementary files for removing root canal filling residues after ProTaper Universal Retreatment files (RFs) increased the debris extrusion apically.Materials and Methods:Eighty mandibular premolars with single root and canal were instrumented with ProTaper Universal rotary system (SX-F3) and obturated. The samples were divided randomly into four groups (n = 20). Group 1 served as a control; only ProTaper Universal RFs D1–D3 were used, and the extruded debris was weighed. Groups 2, 3, and 4 were the experimental groups, receiving a twofold retreatment protocol: Removal of the bulk, followed by the use of supplementary files. The bulk was removed by RFs, followed by the use of ProTaper NEXT (PTN), WaveOne (WO), and Self-Adjusting File (SAF) for removal of the remaining root filling residues. Debris extruded apically were weighed and compared to the control group. Statistical analysis was performed using one-way analysis of variance (ANOVA) and post hoc Tukey's test.Results:All the three experimental groups presented significant difference (P < .01). The post hoc Tukey's test confirmed that Group 4 (SAF) exhibited significantly less (P < .01) debris extrusion between the three groups tested.Conclusion:SAF results in less extrusion of debris when used as supplementary file to remove root-filling residues, compared to WO and PTN.

Comparative evaluation of the efficacy of three different irrigation devices in removal of debris from isthmus: An in vitro study

Aim: To evaluate the cleaning efficacy of endoactivator, EndoVac (EV), and self-adjusting file (SAF) as irrigant adjunct in the removal of debris from isthmus. Materials and Methods: Forty extracted human mandibular molars were taken. Canals were prepared up to F4 protaper file. Irrigation after each file size was done by 1 ml normal saline. Final irrigation was done by 4 ml of 5% NaOCl and activated in each canal for 1 min with different activating systems. Teeth were divided randomly into 4 groups according to activation system as manual activation (control group, n = 10), Group 2 SAF system (n = 10), Group 3 endoactivator (n = 10), and Group 4 EV (n = 10). After activation final flush was done with 1 ml saline. The mesial root of each tooth was sectioned and checked for isthmus cleanliness by stereomicroscopic analysis. Images were analyzed by ImageJ software. Percentage of debris remaining in each group was calculated. Results: There is no statistically significant difference in cleaning efficacy of endoactivator, EV, and SAF systems. Conclusion: All three techniques remove debris from isthmus area more efficiently than manual dynamic activation.

Comparative evaluation of canal cleaning ability of various rotary endodontic filesin apical third: A scanning electron microscopic study.

The purpose of this study was to evaluate the canal cleaning ability of three novel endodontic rotary instruments and compare with ProTaper files as a control in apical third of root canals under scanning electron microscopy (SEM). Eighty freshly extracted mandibular premolars were selected according to inclusion criteria. Buccal cusp tips were ground to ensure having a flat coronal reference point with a total tooth length of 16 mm for all samples. Teeth were divided equally into four groups: Group I (ProTaper group), Group II (ProTaper next group), Group III (variable taper group), and Group IV (self-adjusting file [SAF] group). Using SEM, the dentinal surfaces were observed and rated at apical thirds with a magnification of ×1000 for the presence/absence of smear layer and debris. Descriptive analysis was performed, and analysis of variance with Bonferroni post hoc test was carried out for comparison between the groups, at a significance level of 0.05. There was statistically significant difference between Group II and Group IV for debris (P = 0.047) and smear layer (P = 0.037). In apical third of root canal, SAF showed statistically significant canal cleaning ability due to combined effect of continuous streaming irrigation with effectively replacing the irrigant from the apical portion of the root canal, irrigants activation through the creation of turbulence, and its self-adapting design to root canal anatomy with a scrubbing motion on the canal walls.

A comparative evaluation of the retreatment efficiency of the Self-Adjusting File system and other root canal instrumentation techniques

A comparative evaluation of the retreatment efficiency of the Self-Adjusting File system and other root canal instrumentation techniques

Radiological, stereological, and microscopic evaluation of the quality of canal fillings in oval-shaped root canals prepared with self-adjusting file.

The aim of this study was to evaluate the quality of the canal fillings performed by thermoplastic technique (Herofill) and cold lateral condensation (CLC) techniques in oval shaped canals following self-adjusting file (SAF) preparation using radiological, stereological, and microscopic evaluation methods. Twelve pairs of oval-shaped root canals were prepared with SAF and filled using CLC (n = 12) or the Herofill system (n = 12). The quality of the root canal filling was evaluated by (i) scoring bidirectional storage phosphor plate images, (ii) stereological (volumetric) analysis of cone beam computerized tomography (CBCT) images, and (iii) microscopic analysis of the cross-sectioned area of the canal and gutta-percha via image analysis software. Chi-square test, t-test, and Mann-Whitney U-tests were used respectively (p < 0.05) for the aforementioned evaluations. 58.33% of the fillings (total n = 24) that were found to be sufficient in a bucco-lingual (BL) projection were considered insufficient in the mesio-distal (MD) projection according to radiological scoring. The difference in the findings between the two types of projections (BL and MD) was significant (p < 0.05). The results of the stereological evaluation of CBCT images and image analysis of cross-sections showed no statistically significant difference between the CLC and Herofill (p > 0.05). Herofill was not superior to cold lateral compaction. Stereology can be used to obtain unbiased information about the volume of root canal fillings. Both filling techniques failed to achieve the desirable goal of 0% empty volume in all of the cases and all evaluation systems confirmed this result. SCANNING 38:427-433, 2016. © 2015 Wiley Periodicals, Inc.

Modern Endodontic Principles Part 3: Preparation.

The purpose of instrumentation is to facilitate irrigation and allow controlled obturation. This article will revisit methods of instrumentation of the root canal system with consideration given to length determination, apical preparation and the concept of patency filing. It will discuss hand instrumentation and rotary preparation looking at emerging technology such as reciprocating systems and the self-adjusting file. CPD/CLINICAL RELEVANCE: Mechanical preparation of the root canal system is of fundamental importance in achieving success, creating a more easily managed environment from a biological perspective.

Infection Control in Retreatment Cases: In Vivo Antibacterial Effects of 2 Instrumentation Systems

IntroductionThis in vivo study compared the antibacterial effects of 2 instrumentation systems in root canal–treated teeth with apical periodontitis. MethodsForty-eight teeth with a single root and a single canal showing post-treatment apical periodontitis were selected for this study. For retreatment, teeth were randomly divided into 2 groups according to the instrumentation system used: Self-Adjusting File (SAF; ReDent-Nova, Ra'anana, Israel) and Twisted File Adaptive (TFA; SybronEndo, Orange, CA). In both groups, 2.5% sodium hypochlorite was the irrigant. Bacteriological samples were taken before (S1) and after chemomechanical preparation (S2). In the TFA group, passive ultrasonic irrigation (PUI) was performed after instrumentation, and samples were also taken after this supplementary step (S2b). DNA was extracted from the clinical samples and subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria, streptococci, and Enterococcus faecalis. Statistical analyses from quantitative real-time polymerase chain reaction data were performed within groups using the Wilcoxon matched pairs test and between groups using the Mann-Whitney U test and the Fisher exact test with the significance level set at P < .05. ResultsBacteria were detected in S1 samples from 43 teeth, which were then included in the antibacterial experiment. Both SAF and TFA instrumentation protocols showed a highly significant intracanal bacterial reduction (P < .001). Intergroup quantitative comparisons disclosed no significant differences between TFA with or without PUI and SAF (P > .05). PUI did not result in significant improvement in disinfection (P > .05). ConclusionsBoth instrumentation systems/treatment protocols were highly effective in significantly reducing the intracanal bacterial counts. No significant difference was observed between the 2 systems in disinfecting the canals of teeth with post-treatment apical periodontitis.

Push-out bond strength of root fillings made with C-Point and BC sealer versus gutta-percha and AH Plus after the instrumentation of oval canals with the Self-Adjusting File versus WaveOne.

To compare the push-out bond strength exhibited by root fillings performed with either C-Point and Endosequence® BC sealer™ (BC Sealer) or gutta-percha and AH Plus® after the instrumentation of oval canals with either the Self-Adjusting File (SAF) System or WaveOne (WO) reciprocating file. Eighty extracted premolars were selected and divided randomly into the following four groups (n = 20): group 1, SAF instrumentation and filling using gutta-percha and AH Plus sealer; group 2, SAF instrumentation and C-Point and BC sealer filling; group 3, WO instrumentation and filling using gutta-percha and AH Plus sealer; and group 4, WO instrumentation and filling with C-Point and BC sealer. Sodium hypochlorite (5.25%) and EDTA (17%) were used as irrigants for all groups. After the sealer was set completely, the teeth were prepared for micro push-out assessment using 1.0-mm-thick root slices. Loading was performed with a universal testing machine at a speed of 0.5 mm min(-1) . Two-way anova and Student's t-test for pairwise comparisons were used to compare groups. All specimens filled with C-Point and BC sealer were associated with significantly higher push-out bond strength compared with gutta-percha and AH Plus sealer (P < 0.001). The bond strength was higher for the coronal and apical samples of the C-Point/BC sealer/SAF group (6.6 ± 0.3 and 3.2 ± 0.3 MPa) versus those of the gutta-percha/AH Plus/WO group (4.8 ± 0.3 and 1.8 ± 0.3 MPa), by 38% and by 80% in the coronal and apical parts, respectively (P < 0.001, P < 0.0001). Adhesive bond failure was more common in the WaveOne-instrumented group in general and in the buccal and lingual recesses in this group in particular. In oval canals, the instrument used and the root filling material significantly affected the push-out values of root fillings. The highest value was recorded in oval root canals instrumented with the SAF System and filled with C-Point and BC sealer, whereas the lowest strength was noted in oval canals instrumented with WaveOne and filled with gutta-percha and AH Plus sealer.

Comparison of Different Irrigation Activation Regimens and Conventional Irrigation Techniques for the Removal of Modified Triple Antibiotic Paste from Root Canals

IntroductionThe aim of this study was to compare the efficacy of irrigation activation regimens and conventional syringe irrigation technique in the removal of modified triple antibiotic paste (mTAP) from root canal walls. MethodsFifty-six extracted human mandibular premolars were prepared using ProTaper rotary files (Dentsply Maillefer, Ballaigues, Switzerland) up to size F4. The root canals were filled with mTAP medicament, and after 21 days, the roots were randomly assigned to 5 groups (n = 10) according to the irrigation regimens used: conventional syringe irrigation (CI), Self-Adjusting File (SAF; ReDent-Nova, Ra'anana, Israel), EndoVac (Discus Dental, Culver City, CA), EndoActivator (Dentsply, Tulsa, OK), and passive ultrasonic irrigation (PUI). In 3 teeth, mTAP was not removed (positive controls), and another 3 teeth were not filled with mTAP (negative controls). The roots were sectioned, and the amount of remaining medicament at each root half (n = 20) was evaluated at 30× magnification using a 4-grade scoring system. Data were evaluated using the Kruskal-Wallis and Mann-Whitney U tests. ResultsThere were statistically significant differences among all experimental groups; of which, the CI group was the significantly least efficient in removing mTAP from the root canal (P < .05). At the apical and middle third, the PUI, SAF, EndoVac, and EndoActivator groups removed significantly more mTAP medicament than the CI group (P < .05); however, there were no significant differences between these groups (P > .05). The SAF and PUI showed significantly better performances in removing mTAP from the coronal third (P < .05). ConclusionsThe use of irrigation activation regimens significantly improves the removal of mTAP from root canals when compared with CI.

Efficacy of different devices in removing calcium hydroxide from the root canal

Objectives: The aim was to compare the efficiency of removing calcium hydroxide (CH) with different devices and irrigants. Materials and Methods: Ten roots were served as positive and negative controls, the remaining roots (n=75) were assigned into 5 respect to the removal techniques: Group (G) I, Master apical file- manual needle irrigation (MNI); GII, Canal Brush (CB)-MNI; GIII, RinsEndo; GIV, Self-adjusting file(SAF)-Vatea; GV, CB+MNI, followed by SAF+Vatea. The roots were grooved longitudinally and split into halves. Three specimens from each group were randomly selected to evaluate CH remnants under the SEM. A digital camera acquired images of each half of the canal. A scoring system was used to assess amount of residue. Data were analyzed using Kruskal–Wallis and Mann–Whitney U tests (p < 0.05). Results: Remnants of CH were found in all experimental groups. Examining the efficacy of CH removal from the each third of the canal showed that there was a statistically significant difference between the middle (p=0,003) and cervical (p=0,006) thirds. Conclusions: None of the techniques removed the CH medicament completely; the use of the RE and SAF facilitated removal of CH especially from the cervical third.

Self-adjusting file (SAF) separation in clinical use: A preliminary survey among experienced SAF users regarding prevalence and retrieval methods.

Context:The self-adjusting file (SAFs) is reported to be resistant to file separation in laboratory tests. No information is currently available regarding SAF separation during clinical use.Aim:To conduct preliminary clinical survey among experienced SAF users in order to establish the prevalence of SAF separation during clinical use and to study how were such cases treated.Materials and Methods:A questionnaire was sent to experienced SAF users to make inquiries regarding incidence of SAF separation and how were such events treated. Only responses from operators who had used 50 SAFs or more were included in the present study. Fisher's exact test was used to compare file separation occurrence.Results:A total of 2517 SAFs had been used by these operators, and 15 cases of file separation were reported (0.6%). Twelve of these 15 separated files could be retrieved within a few minutes using Hedström files, with no additional dentine removal required. In the three cases in which the separated files could not be retrieved, the separated file segment was successfully bypassed.Conclusions:The SAF might separate during clinical use, but the incidence of such an event was low. In most such cases, the separated file segment was easily and quickly retrieved without additional removal of dentin.

Minimally Invasive Endodontic Management of a Maxillary Second Premolar with an S-shaped Root Canal using the Self-adjusting File

ABSTRACTThe main objective of an endodontic treatment is thorough shaping and cleaning of the root canal system, with the aim to obtain a fluid tight seal by a biocompatible obturating material. Complex unusual root canal morphology is an often-occurring phenomenon. Knowledge and understanding the unusual root canal morphology predicts the successful outcome in endodontic treatment. One such variant root canal morphology is the ‘S’ shaped root canal.The self-adjusting file (SAF) is a hollow compressible file made up of nickel-titanium lattice. The new concept associated with the SAF is that it adapts itself to the anatomical shape of the root canal and performs mechanical shaping and chemical cleaning with continuous irrigation simultaneously.This case report discusses endodontic treatment of a maxillary second premolar with a ‘S’ shaped root canal and its successful management with the SAF.How to cite this articlePawar AM, Pawar MG, Kokate SR. Minimally Invasive Endodontic Management of a Maxillary Second Premolar with an S-shaped Root Canal using the Self-adjusting File. J Contemp Dent 2015;5(1):35-37.

C-shaped root canal management with Self-Adjusting File (SAF): A three-dimensional concept

Successful root canal treatment relies on addressing to the root canal anatomy and possible variation with its thorough management. C-shaped root canal is an anatomic variation that presents an endodontist with diagnostic, operational, debridement and obturation challenges. A mandibular second molar frequently exhibits this root canal configuration with some cases reported in mandibular premolars and maxillary molars also. The Self-Adjusting File (SAF) (Re-Dent-Nova, Ra'anana, Israel) has introduced a new era of three-dimensional adaptive endodontics for treating irregularly shaped canals, including flat-oval canals like those in C-shaped. This file is advantageous as it is associated with continuous irrigation during shaping, effectively debriding and disinfecting the root canals. This paper presents a case series of C-shaped canals seen in mandibular second molar, diagnosed and endodontically managed using the novel three-dimensional concept of the Self-Adjusting File system.

The self-adjusting file instrumentation results in less debris extrusion apically when compared to WaveOne and ProTaper NEXT.

Aim:The present ex vivo study aimed to evaluate the debris extrusion after instrumenting the root canals by three different files systems.Materials and Methods:Sixty extracted human mandibular premolars with single canals were selected and randomly divided into three groups (n = 20) for instrumentation with three different files. Group 1: WaveOne (primary) single reciprocating file (WO; Dentsply Maillefer, Ballaigues, Switzerland) (25/08), Group 2: Self-adjusting file (SAF; ReDent-Nova, Ra’anana, Israel) (1.5 mm), and Group 3: ProTaper NEXT X1 and X2 (PTN; Dentsply Tulsa Dental, Tulsa, OK) (25/06). Debris extruding by instrumentation were collected into pre-weighed Eppendorf tubes. These tubes were then stored in an incubator at 70°C for 5 days. The tubes were then weighed to obtain the final weight, with the extruded debris. Statistical analysis for the debris extruded apically was performed using one-way analysis of variance and post hoc Tukey's test.Results:The statistical analysis showed a significant difference between all the three groups tested (P < 0.01). The following post hoc Tukey's test confirmed that Group 2 (SAF) exhibited significantly least (P < 0.01) debris extrusion between the three groups tested.Conclusions:The SAF resulted in significantly less extrusion of debris when compared to reciprocating WO and rotary PTN.

Push-out bond strength of root-fillings made with gutta-percha and AH Plus in oval canals instrumented with Self-Adjusting File (SAF), WaveOne and Protaper NEXT– A comparative ex vivo study

Push-out bond strength of root-fillings made with gutta-percha and AH Plus in oval canals instrumented with Self-Adjusting File (SAF), WaveOne and Protaper NEXT– A comparative ex vivo study

Comparison of Apical Extrusion of Sodium Hypochlorite Using 4 Different Root Canal Irrigation Techniques

IntroductionWe compared the apical extrusion of sodium hypochlorite delivered with a 27-G needle, self-adjusting file (SAF), passive ultrasonic irrigation, or the EndoVac system (SybronEndo, Orange, CA) during the instrumentation and final irrigation of root canals. MethodsMatched paired single-canal teeth were divided into 8 groups. The experimental groups were needle irrigation size #30 (NI30) and #50 (NI50), SAF size #30 (SAF30) and #50 (SAF50), passive ultrasonic irrigation size #30 (PUI30) and #50 (PUI50), and EndoVac size #30 (EV30) and #50 (EV50). Teeth were embedded in 0.2% agarose gel (pH = 7.4) containing 1 mL 0.1% m-Cresol purple (Sigma-Aldrich, St Louis, MO), which changes color at a pH level of 9.0. Root canals were irrigated with sodium hypochlorite and EDTA using 4 different techniques, and the amount of irrigant was controlled. Standardized digital photographs were taken 20 minutes after the first irrigant was used and were analyzed to determine the amount of extrusion (expressed as a percentage of total pixels). ResultsThe amounts of apical extrusion obtained in the NI30, NI50, SAF30, SAF50, PUI30, PUI50, EV30, and EV50 groups were 30% (3/10), 50% (5/10), 20% (2/10), 70% (7/10), 40% (4/10), 40% (4/10), 10% (1/10), and 10% (1/10), respectively. The overall extrusion frequency, regardless of the apical preparation size, was 40% (8/20) for needle, 45% (9/20) for SAF, 40% (8/20) for ultrasonic irrigation, and 10% (2/20) for EndoVac. Although the SAF group showed more extrusion, the percentage of pixels was significantly higher in the needle irrigation group (P < .01). The EndoVac group showed significantly lower extrusion values than the other techniques in terms of the number of teeth and pixels (P < .05 and P < .01, respectively). ConclusionsThe risk of apical extrusion is significantly lower with the EndoVac in comparison with the 3 other techniques.

Apical Extrusion of Debris in Flat-oval Root Canals after Using Different Instrumentation Systems

IntroductionThe purpose of this study was to evaluate the amount of apically extruded debris in flat-oval root canal systems during cleaning and shaping with different instrumentation systems. MethodsSeventy-two mandibular incisors were randomly assigned to 4 groups (n = 18) according to the instrumentation system to be used: the ProTaper Next rotary system (PTN; Dentsply Tulsa Dental, Tulsa, OK), the WaveOne reciprocating system (WO, Dentsply Tulsa Dental), the Twisted File Adaptive (TFA; SybronEndo, Orange, CA) rotary/reciprocating system, and the Self-Adjusting File (SAF) system (ReDent-Nova, Ra'anana, Israel). Debris extruded during the instrumentation was collected and dried in preweighed Eppendorf tubes. Three consecutive weights were obtained for each tube, and the average was calculated. The data were analyzed using the t test and analysis of variance (Games-Howell test). ResultsThe SAF produced significantly more debris compared with the other systems (P < .05). No significant difference was noted amongst the PTN, WO, and TFA (P > .05). ConclusionsRegardless of the instrumentation system used, apical extrusion of debris was exhibited at some level, regardless of the instrumentation system used. The SAF was associated with the highest amount of debris extrusion compared with PTN, WO, and TFA.

Quantitative evaluation of apically extruded debris during root canal instrumentation with ProTaper Universal, ProTaper Next, WaveOne, and self-adjusting file systems.

Objectives:The aim of this study was to compare the amount of apically extruded debris during preparation with ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Next (Dentsply Maillefer), a reciprocating single-file (WaveOne; VDW GmbH, Munich, Germany), and a self-adjusting file (SAF; ReDent Nova, Ra’anna, Israel).Materials and Methods:Fifty-six intact mandibular premolar teeth were randomly assigned to four groups. The root canals were prepared according to the manufacturers’ instructions using the ProTaper Universal, ProTaper Next, WaveOne, and SAF. Apically extruded debris was collected in preweighted Eppendorf tubes during instrumentation. The net weight of the apically extruded debris was determined by subtracting the preweights and postweights of the tubes. The data were statistically analyzed using the one-way analysis of variance and the least significant difference tests at a significance level of P < 0.05.Results:A measurable amount of debris was apically extruded in all groups, and the amounts of debris extrusion in the groups were statistically significant (P < 0.001). The ProTaper Next and WaveOne groups resulted in less debris extrusion than the ProTaper Universal group (P < 0.05), and the SAF group resulted in the least debris extrusion.Conclusions:Within the limitations of the present study, it can be concluded that all systems extruded debris beyond the apical foramen.

Efficacy of Two Irrigants Used with Self-Adjusting File System on Smear Layer: A Scanning Electron Microscopy Study.

Mechanical instrumentation of root canals produces a smear layer that adversely affects the root canal seal. The aim of this study was to evaluate efficacy of MTAD and citric acid solutions used with self-adjusting file (SAF) system on smear layer. Twenty-three single-rooted human teeth were used for the study. Canals were instrumented manually up to a number 20 K file size. SAF was used to prepare the root canals. The following groups were studied: Group 1: MTAD + 5.25% NaOCl, Group 2: 20% citric acid + 5.25% NaOCl, and Group 3: Control (5.25% NaOCl). All roots were split longitudinally and subjected to scanning electron microscopy. The presence of smear layer in the coronal, middle, and apical thirds was evaluated using a five-score evaluation system. Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis. In the coronal third, Group 2 exhibited the best results and was statistically different froms the other groups (P < 0.05). There was not a significant difference among the three thirds of groups according to in-group comparisons (P > 0.05). The solutions used in Group 1 and 2 could effectively remove smear layer in most of the specimens. However, citric acid was more effective than MTAD in the three thirds of the canal.

The Quality of Root Canal Preparation in Canals Treated with Rotary versus Self-adjusting Files: A Three-Dimensional Micro-Computed Tomography Study

Background and Objectives: The study was designed to quantitatively evaluate the quality of root canal preparation in canals treated with either rotary (ProTaper Next) or self adjusting files (SAF), using high resolution three-dimensional micro–computed tomographic (Micro-CT) analysis Methods : twenty extracted single canal tooth were selected, the root canal divided in 2 groups. In the first group, the root canal instrumented by using ProTaper Next rotary system and the root canal irrigated with 4ml of NaOCl after each instrument. The root canals in the second group were prepared using SAF for 2min, with continuous irrigation (NaOCl), after rescanning, the area of the canal wall unaffected by the preparation procedure was analyzed using before and after micro-CT images. Result: A high percentage of unaffected root canal walls were found in canals treated with rotary files, with no significant difference between two groups. Conclusion: Within the limitations of the present study, the self-adjusting files allowed better cleaning and shaping of the root canal filling than those allowed by rotary files.