SAF Endo System Frequently Asked Questions (FAQ's)
Before Use
During Use
After Use
During Use
 What is the suggesting setting for the VATEA irrigation liquid flow rate?
For sodium hypochlorite, it is recommended to start with a VATEA flow rate setting of 5 ml/min until an effective technique is developed for suctioning away the liquid from the tooth. The flow rate may be adjusted depending on individual technique, but must be adequate for the intended procedure.
What suction tip should I use?
Any suction tip that can remove all of the irrigant during treatment can be used. In some cases, high volume suction tips (HVE tips) may be necessary to ensure efficient uptake of any excess irrigant while using the SAF.
Why is the SAF instrument slowly rotating before it engages the canal walls?
The SAF instrument and RDT3 head are specially designed to generate linear reciprocating cutting motion only. But the design also allows slow rotation of the instrument when not fully engaged in the canal. This slow rotation promotes the continuous repositioning of the SAF instrument so all sides of the instrument are eventually presented and adapted to all sides of the canal. The slow rotation will only occur when the instrument is not engaged in cutting. The rotation stops when the linear cutting action is fully engaged within the canal.
I am having a problem reaching working length. What should I do?
- Make sure the coronal third of the canal is adequately flared (Gates-Glidden 3 or equivalent)
- Use lubricant (e.g. Glide / RC-Prep) when first introducing the file into the canal
- Reestablish the glide path so a #20 file is free in the canal to the working length
- Make sure that the shaft of the SAF does not engage the access cavity walls; this might happen in incisors or premolars presenting exceptionally small pulp chambers. If so, use the longer 31mm SAF. There should be no need to enlarge the access cavity.
- Remove any gross pulp tissue remaining in the canal.
Clinical Recommendations for:
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When operating the SAF in root canals a certain coronal flaring is required. This can be done using either SS drills or nickel titanium (NiTi)flaring tools; the extent of flaring is dictated by(a) the shape of the canal and (b) the final shape desired.
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- Regular canals with a round cross section: Flaring may be done with either Gates Glidden (GG) drills or NiTi rotary instruments of choice. With GG use a # 4 or #5 GG in the orifice itself and smaller size (one size smaller than the first one, down to 2-3 mm apical to the orifice. NiTi rotary instruments which are designed for coronal flaring may also be used.
- Oval canals: In oval canals the coronal flaring should take into account the oval canal morphology. When flaring tools are used a slight buccal and lingual pressure should result in an oval flared canal orifice. This is done to allow the SAF file to spread freely buccaly and lingually when operated in the canal (see below).
Oval canals are likely to be found in distal roots of lower molars, in lower premolars canines and incisors and in upper second premolars.
- Oval-flat canals: When canals with exceptionally large bucco-lingual dimensions are recognized the coronal flaring should take this into account by preparing an oblong oval funneled orifice.
- Oval-flat canals with a narrow orifice: If such a condition is recognized the orifice funneling should be done in a way that the orifice will become the widest part of the canal. The SAF may expand to a certain extent into buccal and lingual recesses but should not be expected to solve this condition alone.
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- Establishment of the Glide Path
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Glide path should be established up to a size equivalent to a #20 K file. This may in many cases be limited to simply testing the canal dimensions with a # 20 hand file. In narrow canals the canal should be negotiated and prepared to the extent that # 20 K file may be inserted freely to working length.
This may be accomplished with either hand instruments or with rotary instruments designed for this stage, or a combination of both
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- Regular Round Canals: In regular canals with a round cross section simply insert the SAF file into the canal while vibrating and the VATEA irrigation turned on at ~ 5mL/min. Use a suction tip to aspirate the excess of irrigant, as the SAF should be operated with abundant and continuous irrigation. Always use the SAF system for root canal instrumentation with continuous irrigation! Do not push the SAF file to working length. Use delicate in-and-out motions to allow the file to find its way to working length. The file should always be operated with in-and-out motion. The out-bound motion should allow complete disengagement of the file to the extent that it rotates. Once engaged in dentin during the in-bound part of the motion it will stop rotating and the vibration alone will remain active. This is important in order to generate the smooth and uniform inner surface that is typically generated by the SAF file. Once you reached working length continue the in-and-out motion as before, with the inbound motion reaching working length. Continue this for a total of 4 min. The canal will be then ready, with uniform layer of dentin removed from all its surfaces. Irrigation was done simultaneously with instrumentation. No file exchange is needed with the SAF: The file is initially compressed in the canal and gradually expands while enlarging it.
- Oval Canals: When the root canal has an oval cross section (see above), the SAF file will be flattened when inserted into the canal and will vibrate as an oval-flat instrument. On every out-bound manual stroke it will regain its round shape, rotate and compress again to an oval-flat form when re-entering the canal in the in-bound part of the manual in-and-out movement. When fully compressed to a flat form the file will assume an oval-flat shape with dimensions of 0.2mm thickness and 2.4 mm width, as compared to a round cross section with 1.5 mm diameter when the file is relaxed (out of the canal). This means that in an oval canal with a bucco-lingual dimension of up to about 2.5 mm, no additional action is required other than that explained above for regular canals.
- Flat-Oval Canals: When the canal is flat with a bucco-lingual dimension greater than 2.5 mm, the file should be moved slightly buccaly and slightly lingually while moving it in-and-out in the canal. No "brushing" motion should be attempted: simple change in location will be enough. This will be also true in C-shaped flat canals.
- Curved Canals: The SAF file has an asymmetrical tip, which is flexed more easily to one direction, less to the other direction and does not flex easily in the directions diagonal to those mentioned above. When reaching a curve in the canal, the file will flex and go into the curve providing that the curve is in the direction to which the file flexes the easiest. It will not enter a curve easily when in all other directions. This is the second reason for the automatic rotation: when the file is allowed to freely rotate by going far enough in the out-bound manual motion, it will be re-inserted in a randomly different position every time that it goes in. When properly operated, it will find its way into the curved part of the canal within 20-30 seconds without any operator guidance. If pushed with attempt to force it around the curve, the file will stop rotating and the pushing action will fail to achieve the expected result. Rather, the operator should allow the file to freely rotate when disengaged from the dentin. By doing that, the file will be able to find its way into the curved part of the canal with no need for operator guidance. The operator has no need to control the direction of the file. The file will find its way by itself, providing that (a) it is allowed to rotate and (b) it is given the time to find its way randomly. Do not push the file and be patient! Sometimes, when starting with a new file, when still free of the canal, it will not start rotating immediately. This is due to slight friction that initially exists between the irrigation hub (the round plastic ring) and the file. Start it into the canal and it will soon start to rotate in the out-bound motion.
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Some operators desire a special apical shape in their endodontic preparations. The SAF file has no given shape to enforce on the root canal; it simply enlarges it by ~ 3 ISO sizes. If the apical part was round, it will be enlarged as round; if it was flat, it will be enlarged as flat. If a given shape is desired, it can be generated with other instruments that are used in this case as finishers. One may use hand files or rotary instruments of choice.
Nevertheless it should always be done after the canal is fully prepared with the SAF, thus ensuring that the main goal of cleaning and shaping was achieved by the SAF prior to this stage and the canal is clean of any remaining tissue or debris and a uniform layer of dentin has already been removed by the SAF from all its walls, longitudinally and circumferentially.
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After cleaning and shaping with the SAF system, what is the best way to obturate the root canal?
Select a master gutta percha (or Resilon™) cone that provides tugback from the apical third of the canal. Proceed with sealing the root canal with any conventional obturation technique, including lateral and/or vertical compaction.
What can happen if I operate the RDT3 Head and SAF instrument above 5000 rpm?
Operating the RDT3 Head at speeds exceeding 5000 rpm will cause rapid wear and eventual failure. The device is designed to operate within a specific set of operating conditions, and operation above this range may cause rapid deterioration.
Do's and Dont's
- Always use the SAF-System with continuous irrigation.
- Use the file gently: apply only minimal apical pressure.
- Make sure that the file is rotating when disengaged during the out-bound part of the manual in-and-out movement.
- Be patient: the file will find its way to working length.
- If you encounter difficulty in reaching working length, take the file out and check for a possible obstruction, using a #20 hand file.
- Do not allow the file to buckle: this may lead to mechanical damage. Buckling may occur when excessive pressure is applied on the file when not aligned with the long axis of the canal: the active (lattice-like) part of the file which is coronal to the canal orifice may buckle if not aligned and forced. Make sure to avoid such condition.
- Check the file for structural integrity before inserting/re-inserting it into the canal. Discard the file if damaged.
- After 2 min of operation remove the file from the canal and check for mechanical integrity, then resume instrumentation.
- Understanding of the mode of operation and some experience are required to achieve the excellent results of the SAF System.
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