Cleaning & Disinfection (58)

Cleaning sign 200hThe scientific articles in this section examine the SAF System's ability to achieve a high level of cleanliness of the root canal, an ability attributed to the effective continuous simultaneous irrigation that flows through the lumen of the SAF to wash away the debris immediately upon its creation.

In a few of the articles, in which the SAF was not portrayed as the preferred choice for treatment, a “ReDent’s note” was added, to suggest how working with the system according to the manufacturer’s directions could help achieve better results.

 

  1. Additional Info

    • publisher publisher
    • View abstract on PubMed. PMID 29160396
  2. Additional Info

    • ReDent Nova’s note

      The Self-Adjusting File was not operated according to the clinical protocol. The canal was instrumented to size #40 by ProTaper, and then an SAF 1.5mm was used only sa a finisher, instead of the advised minimally-invasive protocol. In such canal size, SAF 2.0mm should have been used. In addition, the SAF was operated for 1.5 minutes instead of 4 minutes, with an irrigation rate of 2mL/min instead of 4mL/min.

      Had the clinical guidelines been followed, the results would most likely be better than the other irrigation techniques and not similar.

    • publisher publisher
    • View abstract on PubMed. PMID 28342477
  3. Additional Info

    • ReDent Nova’s note

      This research was not conducted according to the clinical protocol of the SAF System, and cannot be expected to provide the results anticipated when used correctly.

    • publisher publisher
    • View abstract on PubMed. PMID 28643935
  4. Additional Info

    • ReDent Nova’s note

      The "Materials and Methods" paragraph of this article demonstrates how the researchers were unfamiliar with the mode of operation of the Self-Adjusting File: "Shaping proceeded with a pecking motion in an apical direction until a working length was reached". The SAF System was only operated until it reached working length, and not for 4 minutes according to the manufacturer's instructions.

      It is also sad to note that the editors and reviewers of the Australian Endodontic Journal were just as unfamiliar with the SAF System as the authors, that they were not aware of how the researchers did not follow the recommended clinical protocol.

    • publisher publisher
    • View abstract on PubMed. PMID 27808450
  5. Additional Info

    • ReDent Nova’s note

      Measuring post-operative pain in endodontics is a delicate issue, relating not only to technical aspects (i.e. the instrumentation technique) but also to psychological aspects - the patients' expectations, the way their participation in the research was presented to them, the way that they are questioned, etc.

      This research, basically, showed that there is little to no post-operative pain after endodontic instrumentation. This contradicts many researches that showed that such pain exists to a significant extent and relate it to the mode of instrumentation. Some examples to such researches: Bürklein et al., Int Endod J 2014; Gambarini et al. Ann Stomatol 2013; Arias et al. J Dent 2014; Nekoofar et al, J Endod 2015.

      Since the SAF System was shown in several researches to extrude significantly less debris than rotary instrumentation systems, further research is required to investigate this topic.

    • publisher publisher
    • View abstract on PubMed. PMID 27662605
  6. Additional Info

    • publisher publisher
    • View abstract on PubMed. PMID 27623498
  7. Additional Info

    • ReDent Nova’s note

      This research failed to use the SAF according to the clinical guidelines, and the results demonstrate that.

      Operation of a Reciproc R40 instrument, with an apical dimensions of #40/.08, is an excessive preparation prior to instrumentation with the SAF, and is likely to pack a lot of debris that cannot be removed, especially due to the reciprocal motion.

      Additionally, the operation of the SAF did not include the use of a gutta-percha softener (chloroform or other), and the irrigation protocol during the SAF operation did not sequence the use of NaOCl with the use of EDTA. This led to remaining gutta-percha and debris that was created by the reciprocal instrument, that could not be removed by the SAF and continued to harbor bacteria.

    • publisher publisher
    • View abstract on PubMed. PMID 27400743
  8. Additional Info

    • ReDent Nova’s note

      The results of the postoperative pain scores for the SAF group, that are statistically similar to those of the other instruments, contradict the results of other researches that showed very little extrusion of debris by the Self-Adjusting File.

      This can be explained by the excessive glidepath preparation used in this research - the glidepath preparation for the SAF group was done with #25 hand files, while the other instruments received a #20 glidepath preparation, which should have also been the case for the SAF System. As hand-files have been shown to extrude more debris, this explains the post-operative pain scores.

    • publisher publisher
  9. Additional Info

    • ReDent Nova’s note

      Drawing any conclusion from this article about the SAF System would be very far fetched, as the protocol used here is not only far away from the one required for the SAF, but also irrelevant for clinical use for the other instruments that were examined.

      The researchers blocked the apical foramen, made an excessive glidepath preparation (Reciproc #25/.08) while avoiding the use of any irrigation, then dried the canals, and in the group of the Self-Adjusting File used the SAF for only 1 minute instead of 4 minutes. The only conclusion that can be reached is that the SAF System should not be used according to this malformed protocol.

    • publisher publisher
    • View abstract on PubMed. PMID 26992452
  10. Additional Info

    • ReDent Nova’s note

      The initial glidepath preparation was larger than advised (ISO #30 NiTi hand files in the first group and ProTaper Universal F3 in the second group), leading to significant accumulation of debris. The SAF was able to remove most of it, but due to the excessive preparation some of the debris remained inside, in contrary to previous researches conducted with the SAF System.

    • publisher publisher
  11. Additional Info

    • ReDent Nova’s note

      In this review paper, the authors have not found sufficient evidence to determine whether passive ultrasonic irrigation (PUI) is better than SAF System in removal of Ca(OH)2 or not. However, the two articles that this paper quotes clearly determined that the two techniques achieved similar results, which were superior to other techniques that were examined.

    • publisher publisher
    • View abstract on PubMed. PMID 26238527
  12. Additional Info

    • ReDent Nova’s note

       

      Regardless of the favorable results of the SAF System in this study, it was not operated according to its clinical protocol – the operation of the SAF System was for 1 minute only.

      Had the clinical protocol been implemented, it is expected that the results would have significantly improved.

    • publisher publisher
    • View abstract on PubMed. PMID 25747378
  13. Additional Info

    • ReDent Nova’s note

       

      The SAF showed superior results to other irrigation techniques in removal of calcium hydroxide despite the fact that it was only used for 1 minute. Had it been used for 4 minutes, as recommended in the Clinical Guidelines, the results would likely be even better.

    • publisher publisher
    • View abstract on PubMed. PMID 24860966
  14. Additional Info

    • ReDent Nova’s note

       

      Despite the favorable results, we have to note that the SAF System was not used according to the clinical guidelines. Operation of the SAF without activating it will not result in extrusion of debris, but will neither achieve the requested goal of cleaning and shaping the root canals.

       

      Several research papers in which the SAF System was operated according to the clinical protocol have also shown that the extrusion of debris was significantly lower than with other devices, and would serve as a better reference for this issue.

    • publisher publisher
    • View abstract on PubMed. PMID 24861152
  15. Additional Info

    • ReDent Nova’s note

       

      In this study, the canals were prepared up to ProTaper F3 and ProTaper F5 all the way to the
      major apical foramen, an action which is bound to destroy the apical constriction.

       

      The common and recommended practice is to prepare the canals up to the apical constriction, which would then result in more favorable results
      for the SAF System.

    • publisher publisher
    • View abstract on PubMed. PMID 25492488
  16. Additional Info

    • ReDent Nova’s note

       

      Two elements in this study contradict the authors' statement of conducting the experiment according to manufacturer's directions: Irrigation rate of only 1ml/min, and the use of 31mm files in root canals with an average length of 13mm (attained by personal communication, not detailed in the paper). Those elements led to escaping of the irrigation solution through the 8mm of mesh of the SAF which were out of the canal, and combined with the insufficient flow rate, this must have led to creation of "debris mud" that was likely to be extruded. Such "mud" is never created upon proper use.

       

      The authors had declined professional advice that was offered to them. Had they used adequate SAFs (21mm) with a 4ml/min irrigation rate, this would lead to different results, as already presented in previous studies of this kind. 

       

      Also, according to the acknowledgements of the paper, it was financed by the two other device manufacturers.

    • publisher publisher
    • View abstract on PubMed. PMID 25447504
  17. Additional Info

    • ReDent Nova’s note


      Despite the favorable results for the SAF System, it is important to note that the use of the system according to the clinical guidelines is likely to achieve even better results. In this study, irrigation was carried with distilled water at a rate of 2mL/min, while the recommendation is to use sodium hypochlorite at a rate of 4mL/min. As shown in previous studies (De-Deus, J Endod 2014) such a protocol would result in significantly lower levels of apically extruded debris.

    • publisher publisher
    • View abstract on PubMed. PMID 25202211
  18. Additional Info

    • ReDent Nova’s note

       

      The results of this study show the importance of following the SAF System clinical guidelines, as well as the importance of proper design of the study.

       

      One factor that affected the results is the use of saline as an irrigant, while the clinical protocol for the SAF recommends using NaOCl. The use of sodium hypochlorite, with its high surface tension, would have most likely resulted in better cleaning of these canals.

       

      The second factor is the use of mandibular central incisors sized #20. The rotary files used in this study were sized #40, eradicating the natural morphology of the canal, thus removing the medium inside of it, while the SAF is likely to have only expanded the canal to ISO #30.

    • publisher publisher
    • View abstract on PubMed. PMID 25202211
  19. Additional Info

    • publisher publisher
    • View abstract on PubMed. PMID 25576107
  20. Additional Info

    • publisher publisher
    • View abstract on PubMed. PMID 24666904
  21. Additional Info

    • publisher publisher
    • View abstract on PubMed. PMID 23829676
  22. Additional Info

    • ReDent Nova’s note

       

      The SAF was only operated after the canal was shaped by hand files, to a larger extent than the recommended glidepath, thus caused extrusion of debris prior to the operation of the SAF.

      Moreover, irrigation rate of 1mL/min, as used here, is insufficient and does not comply with the manufacturer's instructions.

    • publisher publisher
    • View abstract on PubMed. PMID 24041391
  23. Additional Info

    • ReDent Nova’s note

       

      Operating the SAF for only 2 minutes does not comply with the clinical guidelines of the SAF system and does not allow sufficient cleaning and irrigation.

    • publisher publisher
    • View abstract on PubMed. PMID 23441862
  24. Additional Info

    • ReDent Nova’s note

       

      The small sample size (n=10) and the variability within the sample (roots with and without an isthmus) may have not allowed to demonstrate the superiority of disinfection by the SAF system that was demonstrated in 3 previous studies by the same group. Additionally, SAF was operated for only 3 minutes with irrigation flow rate of 2mL/min – both factors non-compliant with the clinical guidelines of the system, and is likely to lead to insufficient cleaning.

    • publisher publisher
    • View abstract on PubMed. PMID 23880274
  25. Additional Info

    • ReDent Nova’s note

       

      In large long-oval canals such as used in this study, a 2.0mm SAF should have been used rather than a 1.5mm SAF.

      Decoronation of the teeth created artificial conditions that allowed the rotary instruments to reach buccal and lingual areas that in real clinical conditions would have been inaccessible. Above all, the canals were instrumented with extremely large rotary instruments (#55-#60) that were rigid enough to be applied to the buccal and lingual walls at the expense of a significant amount of sound dentin. With all that bias, these results could be expected.

    • publisher publisher
    • View abstract on PubMed. PMID 23880278
  26. Additional Info

    • ReDent Nova’s note

       

      The SAF was operated for only 30 seconds in each canal, instead of 4 minutes as recommended in the clinical guidelines of the system.

    • publisher publisher
    • View abstract on PubMed. PMID 24037074
  27. Additional Info

    • ReDent Nova’s note

       

      The canals were initially prepared to a large diameter of #35, yet cleaned with SAF 1.5mm. Following this research, the SAF 2.0mm was developed, to allow handling of such cases.

    • publisher publisher
    • View abstract on PubMed. PMID 22283697
  28. Additional Info

    • ReDent Nova’s note

       

      The canals were initially prepared to a large diameter, yet cleaned with SAF 1.5mm. Following this research, the SAF 2.0mm was developed, to allow handling of such cases.

      A similar protocol used by Siqueira et al (2010) demonstrated superiority of the SAF in disinfection of oval canals.

    • publisher publisher
    • View abstract on PubMed. PMID 22244642
  29. Additional Info

    • publisher publisher
    • View abstract on PubMed. PMID 21496675