rotary in endodontic

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Learn everything you can, anytime you can, from anyone you can, there will always come a time when you will be

grateful you did.

Sarah Caldwell

Good Morning

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Recent advacne in rotary endodontics

Mohd. Sibghatullah khatib2nd year pg

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• Introduction

• History

• Material science

•Mechanics and Design features

•Nickel titanium Rotary instruments

• Rotary engine systems

• Recent advances

• Sterilization and Disinfection

• Conclusion

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To provide a canal shape that is conformable to sealing

To provide a biological environment that is conducive to healing.

Understanding the ramifications of file and technique design relative to canal anatomy enables the dentist to consistently achieve the most excellent treatment with the least risks

Frank Weine 1975

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• 1800 - First Endodontic instrument- Barbed Broach by Edward Maynard

• 1852-Arthur recommended the use of small files for Cleaning and shaping

• 1885-The Gates Glidden drill were introduced.

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1889-William H. Rollins developed the first endodontic hand piece for automated root canal preparation (Specially designed needles 360 degree rotation and 100 R.P.M. )

1892-Oltramare – fine needles with rectangular cross section mounted in dental handpieces

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• 1915- K files

• 1928- The Cursor Handpiece

• 1962- Nickel titanium discovered by William Beuhler and Frederick Wang

• 1964- Giromatic Handpiece

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Material science

Materials for manufacture of Endodontic instruments

Carbon steel

Stainless steel

Nickel titanium alloys

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Carbon steel-

Rigidity increases with increased size

Less resistant to breakage by bending or twisting

The instruments are easily corroded

Low cost

CRAIG, R.G., PEYTON, F.A.: Physical properties of stainless steel endodontic files and reamers. Oral Surg. 16:206, 1963

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Stainless Steel-

Greater flexibility than their carbon steel counterparts

Greater resistance to fracturing by twisting

Less sharper than Carbon steel

Resistant to corrosion

CRAIG, R.G., PEYTON, F.A.: Physical properties of stainless steel endodontic files and reamers. Oral Surg. 16:206, 1963

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Nickel Titanium Alloys

• Group of inter metallic alloys containing Nickel and Titanium

• Discovered by Buehler in 1962 in the Space Program of the Naval Ordnance Laboratory, Maryland

• Introduced into dentistry by Anderson in 1972

55 NiTiNOL55% nickel 45% titaniumMay contain 2% cobalt

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•In 1991, the first commercial nickel titanium manual and rotary files were introduced by NT Co. in 1994,

•NT Co. also introduced the first series of nickel titanium rotary files having multiple non-conventional tapers: the McXIM Series, which had six graduating tapers ranging from the conventional 0.02 taper to a 0.05 taper file

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Properties Of NiTi

Unique ability to negotiate curvatures during continuous rotation without undergoing the permanent plastic deformation

Super elastic

Shape Memory

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Temperature

Stress Temperature

Stress

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Forward transformation sequenceM →R → A (Heating)

Reverse transformation sequenceA → R → M (Cooling)

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Metallurgical Characterization of Thermomechanically-treated NiTi Instruments

Alapati et al found that heat treatments at 400C, 500C, and 600C raised the Af temperature of ProFile to 45C–50C, and heat treatment at 850C caused a loss of SE behavior and recrystallization of the wrought microstructure.

M-Wire (Dentsply Tulsa Dental Specialties) was introduced in 2007 &is produced by applying a series of heat treatments to NiTi wire blanks.

•Dentsply’s ProFile GT Series X

•ProFile Vortex

•Vortex Blue.

JOE — Volume 39, Number 2, February 2013

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•In 2008, SybronEndo to create a NiTi endodontic instrument—TFs.

•According to the manufacturer, TF instruments were developed by transforming a raw NiTi wire in the austenite phase into the R-phase through a thermal process.

•CM Wire (DS Dental, Johnson City, TN) is a novel NiTi alloy with flexible properties that was introduced in 2010.

•Manufactured using a special thermo mechanical process that controls the memory of the material, making the files extremely flexible but without the shape memory of other NiTi files.

JOE — Volume 39, Number 2, February 2013

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Martensitic PhaseUnique properties that have made it an ideal material for many

applications

Remarkable fatigue resistanceInstruments in the martensite phase can easily be deformed, yet they

will recover their shape on heating above the transformation temperatures.

Austenite finish temperature (Af),

CM Wire

M-Wire

TF

Conventional SE Niti

55C

50C

17C

16-31CJOE — Volume 39, Number 2, February 2013

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1094 MPa 1415 MPa

CM Wires 128–251 MPa

The conventional SE NiTi file has an austenite structure whereas NiTi file with thermal processing would essentially be in the martensite

condition at body temperature

Critical Stress

SE wires490–582 MPa

At Room Temperature And 37C

Ultimate Tensile Strength

Maximum Strain Of Before Fracture58.4%–84.7% 16.7%–27.5%

Results Indicate The Superior Flexibility Of CM Wire Compared With Conventional SE Niti Wire

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Material science

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Why Rotary..???

• Improved safety and consistency of result.

• Improved efficiency.

• Improved procedural simplicity

Dr. Stephen. Buchanan

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What are the components of a file?

Manufacturers have placed great emphasis on various NiTi rotary design details but only two major factors have been identified that impact shaping potential-

•Cross-sectional design

•Tip configuration

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•All currently available rotaries have noncutting tips, but some have radial land areas while others have a nonlanded design .

• Generally, radial lands make preparation slower but safer while a nonlanded rotary cuts more rapidly, but can also lead to preparation errors. When used according to their specific guidelines both types of rotary files perform well.

•As a general rule, fine and flexible files are vulnerable to torsional load but are resistant to cyclic fatigue.

American Association of Endodontists 2008

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•Conversely, more rigid and larger files can withstand more torque but are susceptible to cyclic fatigue. The greater the amount and the more peripheral the distribution of metal in the cross section, the stiffer the file. Therefore, a file with a greater taper and larger diameter is more susceptible to fatigue failure; moreover, canal configuration becomes important here.

•A coronal root canal curvature is more dangerous than an apical one in terms of fracture, and a very acute canal curvature generates more fatigue than one with a larger radius

American Association of Endodontists 2008

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Nickel Titanium Rotary Instruments

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Protaper Next Light speedTwisted fileK3 XFProfile rotaryTyphoon NITIEndo-EzeEndosequenceNaviflexAlpha systemRace systemSafe siderEndowaveQuantec systemHero 642V taperLibratorMTWOFlexmasterTango endo…..

Rapid body shaperGT seriesVortex bluePathfile AProgliderEndomagic hornet fileHyflex CM SAFEdge fileEndoStar MANI SILK BT RaceXp endoOne shapeReciproc single file Wave oneWave one goldNeo-NitiRevo-sHyflex EDM…….

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The “Golden Rules” for NiTi Rotary Preparation

1. Assess case difficulty

2. Provide adequate access

3. Prepare with hand files up to size #20 prior to rotary use

4. Use light touch and low rpm

5. Proceed with crown-down sequence

6. Replace rotary instruments frequently

American Association of Endodontists 2008

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Types of Rotary Endodontic Instruments

American Association of Endodontists 2008

Group I - Passive preparation

Group II- Active cutting

Group III- Unique designs that do not fit in either group I or group II.

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GENERATIONS OF ROTARY SYSTEMS1st

2nd

Journal of Advanced Medical and Dental Sciences Research |Vol. 4|Issue 2| March - April 2016

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3rd

4th

5th

Journal of Advanced Medical and Dental Sciences Research |Vol. 4|Issue 2| March - April 2016

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Design features of rotary root canal instruments

ENDO (Lond Engl) 2012;6(1):29–39

35ENDO (Lond Engl) 2012;6(1):29–39

36ENDO (Lond Engl) 2012;6(1):29–39

37ENDO (Lond Engl) 2012;6(1):29–39

38ENDO (Lond Engl) 2012;6(1):29–39

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Nickel Titanium Rotary Instruments : Making The Right Choice

“What we remove from the pulp space is far more

important than what we replace it with…”

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Salient Features of Various Nickel Titanium Instruments

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Salient Features of Various Nickel Titanium Instruments

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300 rpm/4-5.2 Ncm

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Revo-S

Sequence of 3 instruments with asymmetrical cross-section

The instrument works in a cyclic way (3C Concept):

1) Cutting2) Clearance (debris elimination)3) Cleaning

250 - 400 rpm

Snake like movement inside the canal

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ProFile Vortex

Technology Helical angle

Speed Size Taper

M-Wire varying 500 #15 to #50 .04 and .06Blue wire varying 500 #15 to #50 .04 and .06

Cohen 11th edition

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First fluted NiTi file manufactured by plastic deformation

A size tip from #25 to #50 and in tapers from .04 to .12.

R-phase™ heat treatment technology

Twisting of the NiTi alloy instead of being ground

A proprietary surface Conditioning treatment of the file

JOE — Volume 34, Number 8, August 2008

3 Unique Feature

Twisted File

• Better Cyclic Fatigue resistance

• Variable Taper Pack– 12%,10%,8%,6%,4%– #25 tip

• Simplified Pack– #25-8%, #25-6%, #30-6%, – Apical sizes= #35, #40, - 6%

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Speed - 350-500 rpm’s

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Coltene Whaledent

Controlled Memory NiTiProprietary Thermo mechanical TreatmentRetain Shape After Bending

Regains shape after Sterilization

Superior canal tracking Ability

300 % more resistant to Cyclic fatigue than Conventional NiTi

Taper- 0.04,0.06

Size - #15- #60

Speed – 500 rpm

Torque – 2 N.cm

HyFlex CM

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HyFlex EDM OneFile

Pre-Sterile

Variable Cross Section Design

Almost triangular cross section at top

Trapezoidal cross section in middle

Quadratic cross section at tip 500 rpm/2.5 Ncm Glidepath files-300 rpm/1.8 Ncm

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Self Adjusting File

•Unique Hollow Adaptive DesignLaser Milled NiTi LatticeCardiac stents

• Abrasive Design

• Extreme Flexibility and Adaptive ability

• Hollow Design- Continuous Irrigant Delivery

• File breakage - Non Existent

• Available in– 21, 25, 31 mm– 1.5 and 2 mm Diameter

• 0.4 mm Vertical strokes with 5000 Rpm

• Excellent adaptation to irregular canal anatomy

• Supplied with inbuilt irrigation System- The Vatea System

• Poor cutting efficiency

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NiTi Instrument Complications

The most critical factors being- •Operator experience

•Instrument geometry

•Root canal morphology

Torsional

Flexural Fatigue

Instruments Fracture Occurs By

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ProFile Vortex, Twisted File, and GTX files appear to offer greater cyclic fatigue resistance than EndoSequence and ProFile files.

JOE — Volume 38, Number 5, May 2012

Vortex Blue showed a significant increase in cyclic fatigue resistance when compared with the same sizes of ProFile Vortex

JOE — 2014

Single File Endodontics

WaveOne

Unique Reciprocating Single File system

M Wire Technology

3 filesSmall #21, 6%

Primary #25, 8%

Large #40, 8%

Small file- fixed 6% taper

Primary and large File

8% taper in first 4mm

Decreasing taper from 4 to 16 mm

Cross sectionApical- modified Triangular

Coronal- convex Triangular

Reverse Helix, Safe Tip

Changing pitch and Helical angle

Single use Only

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WaveOne file selection and clinical procedure

1.If a 10 K-file is very resistant to movement, use WaveOne Small file.

2. If a 10 K-file moves to length easily, is loose or very loose, use WaveOne Primary file.

3. If a 20 hand file or larger goes to length, use WaveOne Large file

ReciprocThe Reciproc instrument series possesses many similarities to the WaveOne set of instruments

But differs mainly in the cross sectional design and as well as the sizes of the three instruments available

WaveOne instruments are based on the ProTaper

The Reciproc instruments are based on Mtwo,

R25 (size: 25/0.08) for smaller canals

R40 (size: 40/0.06) for medium canal

R50 (size: 50/0.06) for larger canals

• MicroMega

• Works in continuous Rotation

• Variable Pitch

• Continuously Changing Cross section

• Anti Breakage Control-File Unwinds on use

OneShape

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“Rotary when you want it, Reciprocation when you need it”

TF Adaptive file system

Automatically adapts and changes the file motion based upon the stress placed on the instrument while in use

Continuous rotary movement Reciprocating movement

Advantage of

Stress

Reciprocation Motion

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• SM1- 20/0.04

• SM2- 25/0.06

• SM3-35/0.04

• ML1- 25/0.08

• ML2- 35/0.06

• ML3- 50/0.04

Small (SM) sized canals Medium–large (ML) Sized canals

TF Adaptive file system

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The positive load needed to introduce the instrument into the canal, and The latter represented the negative load developed when the instrument Was withdrawn from the canal against frictional resistance

TFA instrumentswere associated favorably with the lowest values of peak loads followed by TF, PTN, and PTU.

NOTE

JOE — Volume 42, Number 12, December 2016

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Advantages of Reciprocation InstrumentationTorsional Fatigue On The Instrument

Cyclic Fatigue Life Of The Instrument

Safer Endodontic Instrumentation

Disadvantages of Reciprocation Instrumentation

•Increase in the amount of debris extrusion during instrumentation procedure.

•Induction of dentin damage or cracks in dentin resulting from reciprocating instrumentation techniques

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Reciprocal motion showed a significantly higher cyclic fatigue resistance in all brands compared with continuous rotation

JOE — Volume 39, Number 2, February 2013

Reciprocating motion and R-phase increase CF resistance.

TF was significantly more resistant to CF when it was used at 300 rpm.

JOE — Volume 39, Number 12, December 2013

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Full-sequence rotary instrumentation was associated with less debris extrusion Compared with the use of reciprocating single-file systems.

JOE — Volume 38, Number 6, June 2012

JOE — Volume 39, Number 4, April 2013

Under the conditions of this study, root canal preparation with both rotary and reciprocating instruments resulted in dentinal defects. At the apical level of the canals, reciprocating files produced significantly more incomplete dentinal cracks thanfull-sequence rotary systems

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Is Shaping Actually Possible..?

•All instruments maintained the original canal curvature well and were safe to use.

•The use of Mtwo and Reciproc instruments resulted in better canal cleanliness in the apical part compared with ProTaper and WaveOne.

International Endodontic Journal, 45, 449–461, 2012

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One F2 file can be safely used to the working length of curved canals at least six times under reciprocating motion.

Reciprocating preparation with only one F2 file was much faster than root canal instrumentation with continuous rotation

JOE — Volume 36, Number 12, December 2010

Life Span……..

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SAF and K3 files performed significantly better than the WaveOne with respect to isthmus cleanliness.

When used as a final irrigation adjunct device after instrumentation, the SAF provided a significant improvement only in a subset of the K3 group.

JOE — Volume 38, Number 8, August 2012

Canal Cleanliness…

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Remaining endodontic filling material was observed on the canal walls of all teeth regardless of the technique used. Hand files combined with Gates–Glidden burs (group I) and the reciprocating technique (group III) removed more filling material from the canal walls than the Mtwo R files.

The reciprocating technique was the most rapid method for removing gutta-percha and sealer, followed by the rotary technique and the hand file technique

Int Endod J; 2013 Feb 12

Retreatment…

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Wave One Gold File

Modified dimensions and geometryOff-center design

Gold heat treatment is executed manually by heating the file and then cooling slowly.

Webber J. Shaping canals with confidence: WaveOne GOLD single-file reciprocating system. Roots 2015;1:34–40.

Cross-section is a parallelogram with two 85-degree cutting edges

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Constant helical angle of 24 degrees

Ogival, Roundly Tapered

150-degreeCCW direction and 30 degrees CW

D0

D4D8

D12D16

3.0%

6.0%

7.0%

Variable and reducing tapers ensure a more conservatively shaped canal with greater preservation of tooth structure at D16, the coronal

extent of the preparation

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Primary

If primary does not progress

Small Primary

If apex larger than 025

Medium

If apex larger than 035

Shaping finished

Large

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The cyclic fatigue resistance of the WaveOne Gold Primary single-file system was higher than the WaveOne Primary and Reciproc R25 single-file instruments.

JOE — Volume 42, Number 10, October 2016

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Protaper Gold File

Progressively Changing Helical Angle and Pitch

Variable Tip Diameters

Shorter 11 mm Handle

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JOE — 2016

Hyflex EDM files demonstrated significantly higher cyclic fatigue resistance.

Although PTG and PTU have similar cross-sectional design, PTG instruments presented higher cyclic fatigue and torsional resistance than PTU instruments.

The enhanced alloy properties of PTG might be considered as the main reason for those differences

NOTE

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File name Price Protaper universal (6) S- 2400 R- 2200MTWO(6) S- 1900 R- 1900Protaper next(3) S- 3900 R- 3450K3XF(6) 1600Twisted file(3) 1600Hyflex CM 2400Protaper gold 3000Wave one gold 4000Wave one 4500One shape 4500HERO SHAPER(6) 2150REVO S 4500

At A Glance

Sterilization and Disinfection

Sterilization And Disinfection

• Autoclave

• Chemiclave

• Glass bead/Salt sterilizer

• Plasma Sterilizer

• Dry heat

• Ethylene Oxide

• Alcohol

Methods

•Lasers

•Ultrasonic cleaning

•Chlorhexidine

•Hypochlorite

•Quaternary ammonium compounds

•Hydrogen peroxide

•Sodium dodecyl Sulphate

Australian Dental Journal 2004;49:(1):20-27

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Endodontology volume: 25 issue 2 december 2013

The most efficient cleaning protocol with the lowest level of residual biological organic debris was found in instruments that were cleaned mechanically with a nylon brush, pre-soaked in 3% sodium hypochlorite for 10 minutes and ultrasonically cleaned in an enzymatic detergent for 15 minutes.

Mechanical cleansing using a brushing showed significantly better effectiveness thancleansing with gauze

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Int J Infect Control 2013

The methods used to clean endodontic instruments appear to be generally ineffective for the removal of biological debris.

The best method was the one that included mechanical, chemical and ultrasonic cleaningof the instruments

•Hand and ultrasonic cleaning of instruments immediately after use

•Autoclave

• Scrub the instruments with soap and warm water.

• Rinse thoroughly with distilled or deionized water,Allow to air dry.

• Place the instruments, unwrapped, in the autoclave tray.

• Use fresh distilled or deionized water.

• Steam Autoclave at 136° C (plus or minus 2° C) for 20 minutes.

• Recommended File Disposal: Place used files in a Biohazard Sharps container.

ANSI/ADA Specification 28

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Evaluate root anatomy as well as the existence, extent and position of Canal curvatures.

General Strategic Principles

Access Preparation

Don’t Force Files

Don’t Overuse Files

Avoiding Breakage Takes Practice

Don’t Try to Bypass Ledges

Avoid Cutting With the Entire Length of File

Don’t Start and Stop

Length Control is Critical

Difficult Canal Anatomy

Nickel titanium rotary instruments are NOT indicated –

S-shaped canals

Canals that join within a single root

Severe dilacerations

Ledge is present

Very large canals where they fail to contact the canal walls.

Straight line access to the canal is essential and the instruments should be used passively.

CONCLUSION

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Know your instrument“The tools are only as good as the man who wields them”

Follow the Guidelines for use

Selection based on– Case requirement– Ease of use– Safety– Efficiency / Time

Nickel-titanium rotary instruments have become an important adjunct in endodontic therapy.

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Despite the existence of one ever present risk factor—dental anatomy—shaping outcomes with these

instruments are mostly predictable.

Rotary is a step forward

“What is removed from the root canal is more important than what is placed inside”

-Dr. Herbert Schilder

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Clinical Scenario Rotary Reciprocation

Shaping √√ √√

Life Span…….. Less More Canal Cleanliness… More clean Less clean

Retreatment… - Comparatively fast

Cost Less More Apical extrusion Less More Crack formation Less More Number of file More Less

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Clinical Scenario

Rotary Reciprocation

Is Shaping Actually Possible..?

Life Span……..

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Clinical Scenario

Retreatment

Rotary Reciprocation

Cost

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Clinical Scenario

Rotary Reciprocation

Apical extrusion

Crack formation

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Which is The Best System ?

Which system gives us the best looking “shape’?

Competition where in which system does the fastest ?

Healing of the intra-canal and extra-radicular infection

i.Shaping the canal in order to physically remove the inflamed / infected contents.

ii. Cleaning the canal with appropriate irrigants, which would clean and disinfect the pulp space

What is the ideal size of canal enlargement???

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DISPROVED

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The minimum appropriate and acceptable debridement was achieved with MAF=25.08 in the curved canals

International Journal of Current Research, Vol. 08, Issue, 05, May, 2016

30.06 may be considered as the minimum MAF size for acceptable debridement.

Journal of Dentistry, Tehran University of Medical Sciences January 2014

105BRITISH DENTAL JOURNAL VOLUME 216 NO. 6 MAR 21 2014

106BRITISH DENTAL JOURNAL VOLUME 216 NO. 6 MAR 21 2014

107BRITISH DENTAL JOURNAL VOLUME 216 NO. 6 MAR 21 2014

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1. Initial size of the canal

2. Degree of canal curvature

3. Presence / Absence of extra-radicular radiolucency

4. Clinical ease of use of a particular system

Take Home Message

Need taking into consideration the following parametersThe choice of a rotary system has to be based on a case-to-case

The only clinical parameter one has to keep in mind is to ensure that the chosen system is able to enlarge the

canal to size #50 at a level 3 mm short of the working length

Size of enlargement at 3 mm short of Working lengthMAF X TAPER