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Coronal access and glide path 1. Place rubber dam. 2. Obtain straight line coronal access with slightly diverging axial walls adhering to the con- cept of Minmimally Invasive Endodontics.37 3. Achieve apical patency and es- tablish an apical glide path using #8 hand ﬁle, follow that with a #10 hand ﬁle and continue at least with a #15 hand ﬁle. Glide path may be facilitated with the M4 Safety Handpiece (Kerr Endodontics, Orange, CA) (Fig. 7). The pulp chamber should be ﬁlled brimful with NaOCl (So- dium Hypochlorite). Canal size and ﬁle sequence determination (Figs. 5 & 8) Small Canals (SM) Using tactile feel, if you strug- gle to get a #15 K-File to working length (WL) then the canal size is deemed to be ‘small’. Use the Small Pack (one colour band) and its instrument sequence. The small sequence may also be used in se- verely curved canals as well as roots that may be very thin and the risk of strip perforation is a possibility. Medium/ Large Canals (ML) Using tactile feel, if a #15 K-File feels loose at working length then the canal size is deemed to be ‘medium/large’. Use the Medium/ Large Pack (two colour bands) and its instrument sequence. Establish working length Working length should be es- tablished with a reliable apex locator. A radiograph may help the clinician as well. TF Adaptive canal shaping technique 1. Use the ‘TF Adaptive’ setting on your Elements Motor (Fig. 3). 2. Ensure the pulp chamber is ﬂooded with NaOCl or EDTA and make sure the ﬁle is rotating as you enter the canal. 3. Slowly advance the green (SM1 or ML1) with a single controlled motion until the ﬁle engages dentin then completely with- draw the ﬁle from the canal. Do not force apically. Do not peck. 4. Wipe off the ﬂutes. Deliver irrig- ant to the pulp chamber and conﬁrm canal patency with a #15 handﬁle K-File. 5. Repeat steps 3 and 4 using the ﬁle you started with until work- ing length is achieved. 6. Repeat steps 3 and 4 with the yellow SM2 or ML2 until the ﬁle reaches working length. If the desired apical size is achieved the sequence is complete. For larger apical sizes, repeat steps 3 and 4 with the red SM3 or ML3 until the ﬁle reaches working length. Note: All TFA ﬁles may be used in a brushing manner directed towards the external surface of the root away from the canal curvature when retrieving the ﬁle from the canals. Irrigate and dry When irrigating with EndoVac (apical negative pressure irrigation system),2 in small canals, you must take SM3 to working length. In me- dium/large canals, you must take at least ML2 to working length. Note that the Microcannula is .32mm in diameter (Fig. 9). TF Adaptive matching Paper Points may be used to dry the canals. Obturation TF Adaptive matching Gutta Percha in combination with the Elements Free Cordless Obturation system37 may be used to obturate the root canal system. Alternatively, TF Adaptive carriers may be used. Conclusions TFA employs Twisted File technology and Adaptive Motion Technology. The TF Adaptive ﬁle designisbasedonclinicallyproven Twisted File technology, which means the ﬁle is twisted to shape for improved ﬁle durability, fea- tures R-Phase Technology to im- prove ﬁle ﬂexibility and strength while maintaining the original canal curvature minimizing canal and apical transportation (Fig. 10). Adaptive Motion Technology is based on a patented, smart algo- rithm designed to work with the TF Adaptive ﬁle system. The authors have also found that Adaptive Motion Technology works well with other ground ﬁle rotary systems making their use safer especially in smaller and curved canals. This technology allows the TF Adaptive ﬁle to adjust to intra-canal tor- sional forces depending on the amount of pressure placed on the ﬁle. This means the ﬁle is in either a rotary or reciprocation motion depending on the situation and adjusts appropriately. This winning combination re- sults in exceptional debris removal with the tried and trusted classic rotary Twisted File design and less chance of ﬁle pull down and debris extrusion with Adaptive Motion Technology. Editorial Note: A complete list of ref- erences is available from the publisher. This article originally appeared in Oral Health dental journal MAY 2016. Disclaimer: Drs. Gambarini and Glassman are the inventors of Adap- tive Motion and receive a nominal royalty from Kerr. 19 Endo Tribune United Kingdom Edition | 9/2016 ENDO NEWS Dr Gary Glassman is the author of numerous publications. He lectures globally on endodontics, is on staff at the University of Toronto, Faculty of Dentistry in the graduate department of endodontics, and is Adjunct Profes- sor of Dentistry and Director of Endo- dontic Programming for the University ofTechnology,Kingston,Jamaica.Gary is a fellow of the Royal College of Den- tists of Canada, Fellow of the American College of Dentists and the endodontic editor for Oral Health dental journal. He maintains a private practice, Endo- dontic Specialists in Toronto, Ontario, Canada. His website is www.drgary glassman.com and his ofﬁce website is www.rootcanals.ca. He can be reached at drg@drgaryglassman.com. Gianluca Gambarini is a full-time Professor of Endodontics, University of Rome, La Sapienza, Dental School. He is head of the Endodontic Department International lecturer and researcher. He is author of more than 450 scien- tiﬁc articles, three books and chapters in other books. He has lectured all over the world (more than 350 pres- entations) and has been invited as a main speaker in the most important international (AAE, IFEA, ESE) and national endodontic congresses in Europe, North and South America, Asia, Middle East, Australia and South Africa. Prof. Gianluca Gambarini still maintains a private practice limited to Endodontics in Rome, Italy. Dr Sergio A. Rosler has been the As- sistant Clinical Teacher in numerous graduate and post-graduate Endo- dontic Programs and was Clinical Fellow Teacher at Warwick Dentistry University in the United Kingdom. Dr Rosler has lectured at conferences and several universities around the world. He maintains a private prac- tice limited to Endodontics in Buenos Aires, Argentine and can be reached at sergiorosler@gmail.com. AD Fig. 10: CBCT (Cone Beam Computerised Tomography) three dimensional visualis- ation of TFA preparation (SM sequence) in a complex molar, showing proper shape, tapered preparation and excellent maintenance of canal trajectories. (Courtesy of Dr Lucila Piasecki, Brazil and Prof. Gianluca Gambarini, Italy) 10

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