recent advance in rotary endodontic. wave one wave one gold protaper , protaper gold, reciproc,

1. 1
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

2. 2
Recent advacne in rotary endodontics
Mohd. Sibghatullah khatib
2nd year pg

3. 3
• Introduction
• History
• Material science
•Mechanics and Design
features
•Nickel titanium Rotary
instruments
• Rotary engine systems
• Recent advances
• Sterilization and
Disinfection
• Conclusion

4. 4
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

5. • 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.
5

6. 6
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

7. • 1915- K files
• 1928- The Cursor Handpiece
• 1962- Nickel titanium discovered by William
Beuhler and Frederick Wang
• 1964- Giromatic Handpiece
7

8. 8

9. Material science
Materials for manufacture of Endodontic instruments
Carbon steel
Stainless steel
Nickel titanium alloys
9

10. 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
10

11. 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
11

12. 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 NiTiNOL
55% nickel 45% titanium
May contain 2% cobalt
12

13. 13
•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

14. 14
Properties Of NiTi
Unique ability to negotiate curvatures during continuous rotation
without undergoing the permanent plastic deformation
Super elastic
Shape Memory

15. Temperature
Stress Temperature
Stress
15

16. 16
Forward transformation sequence
M →R → A (Heating)
Reverse transformation sequence
A → R → M (Cooling)

17. 17
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

18. 18
•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

19. 19
Martensitic Phase
Unique properties that have made it an ideal material for many
applications
Remarkable fatigue resistance
Instruments 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
16-31C
JOE — Volume 39, Number 2, February 2013

20. 1094 MPa 1415 MPa
CM Wires
128–251 MPa
20
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 wires
490–582 MPa
At Room Temperature And 37C
Ultimate Tensile Strength
Maximum Strain Of Before Fracture
58.4%–84.7% 16.7%–27.5%
Results Indicate The Superior Flexibility Of CM Wire Compared With
Conventional SE Niti Wire

21. 21
Material science

22. 22
Why Rotary..???
• Improved safety and consistency of result.
• Improved efficiency.
• Improved procedural simplicity
Dr. Stephen. Buchanan

23. 23
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

24. 24

25. 25
•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

26. 26
•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

27. 27

28. 28
Nickel Titanium Rotary Instruments

29. 29
Protaper Next
Light speed
Twisted file
K3 XF
Profile rotary
Typhoon NITI
Endo-Eze
Endosequence
Naviflex
Alpha system
Race system
Safe sider
Endowave
Quantec system
Hero 642
V taper
Librator
MTWO
Flexmaster
Tango endo
…..
Rapid body shaper
GT series
Vortex blue
Pathfile A
Proglider
Endomagic hornet file
Hyflex CM
SAF
Edge file
EndoStar
MANI SILK
BT Race
Xp endo
One shape
Reciproc single file
Wave one
Wave one gold
Neo-Niti
Revo-s
Hyflex EDM
…….

30. 30
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

31. 31
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.

32. 32
GENERATIONS OF ROTARY SYSTEMS1st
2nd
Journal of Advanced Medical and Dental Sciences Research |Vol. 4|Issue 2| March - April 2016

33. 33
3rd
4th
5th
Journal of Advanced Medical and Dental Sciences Research |Vol. 4|Issue 2| March - April 2016

34. 34
Design features of rotary root canal instruments
ENDO (Lond Engl) 2012;6(1):29–39

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ENDO (Lond Engl) 2012;6(1):29–39

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ENDO (Lond Engl) 2012;6(1):29–39

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ENDO (Lond Engl) 2012;6(1):29–39

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ENDO (Lond Engl) 2012;6(1):29–39

39. 39
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…”

40. 40
Salient Features of Various Nickel Titanium Instruments

41. 41
Salient Features of Various Nickel Titanium Instruments

42. 42
300 rpm/4-5.2 Ncm

43. 43
Revo-S
Sequence of 3 instruments with asymmetrical cross-section
The instrument works in a cyclic way (3C Concept):
1) Cutting
2) Clearance (debris elimination)
3) Cleaning
250 - 400 rpm
Snake like movement inside the canal

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45. 45

46. 46
ProFile Vortex
Technology Helical angle Speed Size Taper
M-Wire varying 500 #15 to #50 .04 and .06
Blue wire varying 500 #15 to #50 .04 and .06
Cohen 11th edition

47. 47
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

48. • 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%

49. 49
Speed - 350-500 rpm’s

50. 50
Coltene Whaledent
Controlled Memory NiTi
Proprietary Thermo mechanical Treatment
Retain 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

51. 51
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

52. 52
Self Adjusting File
•Unique Hollow Adaptive Design
Laser Milled NiTi Lattice
Cardiac stents

53. • 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

54. • Excellent adaptation to irregular canal anatomy
• Supplied with inbuilt irrigation System- The Vatea
System
• Poor cutting efficiency

55. 55
NiTi Instrument Complications
The most critical factors being-
•Operator experience
•Instrument geometry
•Root canal morphology
Torsional
Flexural Fatigue
Instruments Fracture Occurs By

56. 56
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

57. Single File Endodontics

58. WaveOne
Unique Reciprocating Single File system
M Wire Technology
3 files
Small #21, 6%
Primary #25, 8%
Large #40, 8%
Small file- fixed 6% taper

59. Primary and large File
8% taper in first 4mm
Decreasing taper from 4 to 16 mm
Cross section
Apical- modified Triangular
Coronal- convex Triangular
Reverse Helix, Safe Tip
Changing pitch and Helical angle
Single use Only

60. 60
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

61. Reciproc
The 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

63. • MicroMega
• Works in continuous Rotation
• Variable Pitch
• Continuously Changing Cross section
• Anti Breakage Control-File Unwinds on use
OneShape

64. 64
“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

65. • 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
65
TF Adaptive file system

66. 66
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 instruments
were associated favorably with the
lowest values of peak loads followed
by TF, PTN, and PTU.
NOTE
JOE — Volume 42, Number 12, December 2016

67. 67
Advantages of Reciprocation Instrumentation
Torsional 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

68. 68
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

69. 69
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 than
full-sequence rotary systems

70. 70
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

71. 71
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……..

72. 72
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…

73. 73
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…

74. 74

75. 75
Wave One Gold File
Modified dimensions and geometry
Off-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

76. 76
Constant helical angle of 24 degrees
Ogival, Roundly Tapered
150-degreeCCW direction and 30
degrees CW
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

77. 77
Primary
If primary does
not progress
Small Primary
If apex larger
than 025
Medium
If apex larger
than 035
Shaping finished
Large

78. 78
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

79. 79
Protaper Gold File
Progressively Changing Helical Angle and Pitch
Variable Tip Diameters
Shorter 11 mm Handle

80. 80

81. 81
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

82. 82
File name Price
Protaper universal (6) S- 2400 R- 2200
MTWO(6) S- 1900 R- 1900
Protaper next(3) S- 3900 R- 3450
K3XF(6) 1600
Twisted file(3) 1600
Hyflex CM 2400
Protaper gold 3000
Wave one gold 4000
Wave one 4500
One shape 4500
HERO SHAPER(6) 2150
REVO S 4500

83. At A Glance

85. Sterilization and Disinfection

86. 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

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

88. 88
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 than
cleansing with gauze

89. 89
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 cleaning
of the instruments

90. •Hand and ultrasonic cleaning of instruments
immediately after use
•Autoclave

91. • 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

92. 92

93. 93
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.

94. CONCLUSION

95. 95
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.

96. 96
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

97. 97
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

98. 98
Clinical Scenario
Rotary Reciprocation
Is Shaping Actually Possible..?
Life Span……..

99. 99
Clinical Scenario
Retreatment
Rotary Reciprocation
Cost

100. 100
Clinical Scenario
Rotary Reciprocation
Apical extrusion
Crack formation

101. 101
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???

102. 102
DISPROVED

103. 103

104. 104
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

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

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

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

108. 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
108
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 length
MAF X TAPER