An evidence-based update of rotary file systems by key ... · Fracture of rotary NiTi instruments...

by MedicNRG

NiTi - Traditional Rotary File Systems.

The Problem

Gentlefile – New Concept for 3D Cleaning and Shaping of Root Canals.

The Solution

An evidence-based update of rotary

file systems by key opinion leaders

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by MedicNRG

"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.“

Preserving the Future:

The New Approach to Endodontic Therapy

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

DENTSPLY Tulsa Dental Specialties

Dr. George Bruder

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by MedicNRG

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.

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by MedicNRG

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Dr. George Bruder: “Can we improve our effectiveness

without unnecessarily removing tooth structure that, if

left intact, might extend the life of the tooth? What is the next

generation of RCT technology that could enable clinicians to

properly irrigate and obturate to the apex, clean more of the

surface area of the infected dentinal canal wall and

simultaneously retain more tooth structure? This presentation

will present a new concept in NSRCT that is designed to

better conform to the natural tooth structure and provide the

ability to irrigate all the way to the apex”.

MedicNRG 2012

DENTSPLY 2014

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by MedicNRG

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by MedicNRG

Gentlefile – Proven By Science

The Ultimate Solution For Root

Canal Treatment For Every Dentist

• Gentlefile – The Promise

• File Structural Design – The Advantage

• File Concept – Maximum Safety

Innovative Approach to User-Friendly Root Canal Preparation

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by MedicNRG

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Gentlefile is for any dentist

who is concerned about:

• Mastering complex filing techniques

• Breaking engine-driven files

• Ledging or perforating curved canals,

transporting the foramen

• Using too many shaping files

• Spending too much money on endo products


by MedicNRG

• Gentlefile for optimal control without the NiTi file screwing-effect toward apex

• Super-flexible file adapts to any canal shape

• No need for expanded preparation of the coronal space

• Low entry cost of a highly sophisticated rotary file system

• Economical – Use of only 2-3 files in most cases

• Short learning curve and ease-of-use enables more complicated root

canal treatments

• Single-use files and disposable contra angles for prevention of

cross-contamination

The Ultimate Solution For Root Canal

Treatment For Every Dentist


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by MedicNRG

Gentlefile - The Promise

• Respecting the natural canal anatomy

• Symmetrical filing of the dentinal layer of the canal walls

• Preserving tooth structure rather than the drilling and

excessive cutting of dentin with NiTi file systems

• High-energy activation of irrigating solutions throughout the

entire root canal space

• Efficient cleaning and shaping of irregular canals geometries


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by MedicNRG

• Patented file design – wrapped layers of stainless steel wires on a cable core. The multi-layer structure provides unique elasticity throughout the entire length of the file

• Optimal balance between horizontal and vertical vectors protects the canal geometry and prevents file breakage

• The file’s surface roughness enables controlled filing with optimal conical shape, preserving the natural strength of the canal


File Structural Design – The Advantage

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by MedicNRG

The File Concept – Maximum Safety • Save & Forgiving – Gentlefile is a safe rotary file, even in complex

cases, for all dental practitioners.

• Automatic handpiece torque-limiting mechanism

• Friction-grip file holder for optimal load control

• File’s unique flexibility resists fatigue and prevents breakage

• Low-torque file movement provides tactile feedback

• No Screwing-in Effect. File is operated in a gentle, continuous pecking

motion allowing the dentist to control the file's progress towards the apex

• Be Safe! Gentlefile prevents iatrogenic damages like ledging,

perforations, and micro-crack formation

Innovative Approach to User-Friendly Root Canal Preparation 11

by MedicNRG Gentlefile

A New Dimension of Endo Performance


by MedicNRG

Patented Design – Wrapped Layers of

Stainless Steel Wires on a Cable Core


Built-in Abrasive Properties

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by MedicNRG

Unique flexibility

throughout the entire

file length


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by MedicNRG


The apical file section is a

bi-layer structure with even

greater flexibility for extremely

curved canals

The upper file section

is made of a 3-layer structure

that creates the vertical force

required for efficient file

progression in the canal

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by MedicNRG

• Respecting the natural canal anatomy • Symmetrical filing of the dentinal layer of the canal walls

• Preserving tooth structure rather than the drilling and

excessively cutting dentin with NiTi file systems

Superior root canal preparation

while preserving tooth structure

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by MedicNRG

Unique surface roughness enables

efficient shaping and controlled

filing of the dentinal walls

Rough surface structure is achieved by metal particle injection technology


by MedicNRG

The passive tip design has a smooth, polished

surface that follows the natural canal anatomy

without causing perforations or ledges

Passive Non-cutting Tip

Gentlefile’s apical 0.5 mm tip is shaped at a 45° angle for a trimmed, rounded end


by MedicNRG

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Scientific Comparison of the

Vertical Forces Applied by

Rotary Endodontic Files

An evaluation of the causes of potential

file separation and root canal damages


by MedicNRG

Measurement of

vertical forces applied

by endodontic files

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by MedicNRG

Gentlefile

Next File (DENTSPLY)

ProTaper File (DENTSPLY)

Revolutionary Approach to Innovative Root Canal Preparation

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by MedicNRG

NiTi File - Apical Ledge & formation

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by MedicNRG

Apical

Perforation

NiTi File.

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by MedicNRG

Vertical Root Fracture

NiTi File Over-instrumentation

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by MedicNRG

Gentlefile Prevents Ledge-Formation

By Dr.Tseiss

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by MedicNRG

Convenient Access to Posterior Teeth

Possible file pre-curve


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by MedicNRG


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by MedicNRG

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 of root canal treatment.

Superior Flexibility Bending Stiffness


by MedicNRG


Gentlefile - gray: initial start – 1x per canal

Gentlefile - red: for the remaining procedure.

Used in the all 4 canals

Obturation: Gutta percha 25 x 0.4 (all 4 canals)

Taper: 0.3-0.4

By Dr. Stone July 2015

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by MedicNRG


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by MedicNRG

Gentlefile – One Length for All Canals

Gentlefile’s motion is active

along its entire length


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by MedicNRG

High-energy activation of

irrigating solutions

Cleaning and shaping of

canals with irregular cross-

sections


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by MedicNRG

The Gentlefile technology uses a new concept of

cleaning root canals which removes a uniform layer of

dentin “dust”. NiTi rotary files instead remove large

dentin chips that are difficult to dislodge from the

canals. The significant higher RPM of Gentlefile

improves the removal of dentin debris, debridement,

and the disruption of the smear layer.

Gentlefile Promotes Deep Cleaning of

the Entire Root Canal System


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by MedicNRG

NiTi files try to revert to the

original straight state and

tend to create preparation

errors.

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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by MedicNRG

Optimal balance between horizontal and vertical vectors protects the canal geometry and prevents file breakage


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by MedicNRG

“Stiff file designs generates stress

concentrations in the apical root

dentin in curved canal…”

Potential relationship between design of

nickel-titanium rotary instruments and

vertical root fracture – Kim et al. J Endod 2010


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by MedicNRG NiTi files excessively remove dentin

which weakens the tooth structure

and may lead to root fractures

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by MedicNRG

• Shemesh et al. 2009

• Bier et al. 2009

• Adorno et al. 2011

• Bürkleinet al. 2013

• Liu et al. 2013

root fractures-Researches

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by MedicNRG

Fracture of rotary NiTi instruments may

occur 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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by MedicNRG

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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by MedicNRG

Cyclic Fatigue

Compression &

Torsional Tension

NiTi

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by MedicNRG

NiTi: 250 rpm

Gentlefile: 6,500 rpm


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by MedicNRG

NiTi – Breakage after 20 seconds

Gentlefile – NO breakage after 5 minutes

Cyclic Fatigue:

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by MedicNRG

Torsional Fracture

of NiTi File

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by MedicNRG

File Breakage Prevention

Mechanical file structure

Automatic load control

File friction-grip mechanism


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by MedicNRG

NiTi: Concentrated pressure imposed on one point

Gentlefile: Even load distribution along the entire file

Mechanical File Structure

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by MedicNRG

No-load Gentlefile = 25 mg NiTi = 267 mg

Active Stall Torque Load – measured when each file stopped:

Torsional Load Comparison


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by MedicNRG

Ergonomic Handpiece


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by MedicNRG

Automatic rotational speed of 6,500 rpm

Automatic maximal load and torque control

Friction-grip file for overload protection

Cordless, ergonomic, low-weight handpiece

Single On-Off button

Disposable, single-use contra angle heads


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by MedicNRG

Save & Forgiving – The file's unique

flexibility and torque-limiting mechanism

reduces iatrogenic damages to the natural

shape of the canal


by MedicNRG

Automatic Load Control


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by MedicNRG

File Friction-grip Mechanism


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by MedicNRG

The file is operated in a gentle, continuous

pecking motion allowing the dentist to control the

file's progress towards the apex

The file movement provides tactile feedback

versus the pulling-in effect of traditional NiTi files

and high-torque endo handpieces


Filing Technique

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by MedicNRG


S-shape

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by MedicNRG

Final File Position at Apical Constriction


By Dr. Stone

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by MedicNRG

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Gentlefile proprietary process avoid shape memory.

Super-flexible file adapts to all canal geometries, follows the

natural curvature of the root .

File stays centered in the canal, prevents ledging and

perforations .

Greater resistance to cyclic fatigue, the leading cause of file

breakage.

Increased torque strengths versus NiTi files .

Easy, fast, and efficient preparation with small number of file

(1-3 per case)


Gentlefile Advantages

by MedicNRG

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Gentlefile :

Shaping the Future of Endodontics

Gentlefile enable every dentist to

preform rotary root canal treatment


An evidence-based update of rotary file systems by key ... · Fracture of rotary NiTi instruments...

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Transcript of An evidence-based update of rotary file systems by key ... · Fracture of rotary NiTi instruments...