TF Adaptive:

simplicity meets performance

By Professor G. Gambarini

The aim of the nickel titanium instrumentation technique is to provide:

1. A simple, safe and efficient way to reach working length; and
2. An adequate tapered preparation for optimal irrigation and obturation, while mini-
mising iatrogenic errors.

Ideally, any new technique should be easy to understand and user-friendly, allowing for
excellent and predictable shaping.

In the last few years many new instrument designs, alloys and, most recently, sin-
gle-file reciprocation techniques have been introduced in an attempt to fulfil these re-
quirements. However, while all the changes offered some advantages there were also
disadvantages, when compared to traditional nickel titanium rotary instrumentation.

Why is TF Adaptive unique?

Gianluca Gambarini The idea behind TF Adaptive was to combine a twisted design, thermal treatment of
M.D., D.D.S. alloy, continuous rotation and reciprocation in an innovative new system to allow sim-
ple, predictable and safe instrumentation to be achieved in both complex and simple
cases.
Gianluca Gambarini is full-time
Professor of Endodontics at Sa- The concept is the provision of a motor that automatically detects the stress generated
pienza University of Rome, and during instrumentation (the more complex the case, the higher the stress) and then
Head of the Endodontic Depart- automatically chooses the best way of instrumenting the canal.
ment, as well as a researcher
and international lecturer. Prof. Millisecond by millisecond, it selects different types of reciprocating angles or contin-
Gambarini has a particular in- uous rotation. To meet this need, Adaptive has a smart motor that selects the best
terest in clinical endodontics individual parameters (including speed) for operating within each canal.
and related materials. He is
a consultant for a number of Until recently, such a high-tech device was beyond endodontic practice; however, it is
manufacturers, helping to de- now available in the form of the new TF Adaptive system and Elements Motor (Figure 1).
velop new technologies, oper-
ative procedures and materials
for root canal treatment. He is
a former scientific editor of the
Italian Journal of Endodontics,
the official Journal of the Italian
Society of Endodontists. An of-
ficial member of the American
National Standards Institute/
American Dental Association
and International Organisation
for Standardisation committees
for endodontic materials, Prof.
Gambarini is also an active
member of the International As-
sociation for Dental Research,
the Italian Society of Endodon-
tists and the European Society
of Endodontology (ESE), as well
as an associate member of the
American Association of En-
dodontists. He is currently the
country representative for Italy
within the ESE. Prof. Gambarini
maintains a private practice lim-
ited to endodontics in Rome,
Italy.

Clinical article 11
 The TF Adaptive motion
TF Adaptive performs in a patented, unique motion that auto-
matically adapts to instrumentation stress. When the TF Adap-
tive instrument is not or very lightly stressed, the movement
can be described as a continuous rotation, allowing better cut-
ting efficiency and removal of debris, since cross-sectional and
flute design are meant to perform at their best in a clockwise
(CW) motion. More precisely, it is an interrupted motion with the
following CW-CCW (counter clockwise) angles 600-0.
This interrupted motion is not only as effective as continuous
rotation in lateral cutting, thus allowing optimal brushing or cir-
cumferential filing for better debris removal in oval canals, but
it also minimises iatrogenic errors by reducing the tendency of
screwing-in of greater tapered nickel titanium instruments.
This adaptive motion is designed to reduce the risk of intra-ca-
nal failure without affecting performance. This is achieved by the
Adaptive motor, which automatically selects the best movement
for each clinical situation.
As for the general disadvantages of reciprocation, TF Adaptive
has a reciprocating motion with cutting angles (CW angles) that
are much greater than competitors (WaveOne/Reciproc) move-
ments. Consequently, the TF Adaptive instrument is working for
a longer period of time at a CW angle, which allows for improved
cutting efficiency and removal of debris and less tendency to
push debris apically and laterally because the flutes are de-
signed to remove debris in a CW rotation.

In addition, if there is increased instrumentation stress and metal

fatigue while negotiating the canal, the TF Adaptive instrument
adopts a reciprocation mode, with specifically designed CW and
CCW angles that vary from 600-0 to 370-50 (Figure 2).

These angles are not constant but vary according to anatomical

complexities and intra-canal stress.

12 Clinical article
The TF Adaptive sequences
The TF Adaptive technique is basically a 3-file technique, de-
signed for all canals. Whether working in a small, difficult canal
or a large, easy one, TF Adaptive enables clinicians to achieve
adequate taper and increased apical preparation.

TF Adaptive is an ergonomic, efficient and user-friendly tech-

nique, making use of an intuitive, colour-coded system based on
a traffic light sequence:
Start with green
Continue or stop with yellow
Stop with red (Figure 3).

Offering precision, the number of instruments within a sequence

can vary and adapt to canal anatomy. For example, when a
greater apical enlargement is needed due to larger original canal
dimensions and/or enhanced final irrigation techniques, there is
one final instrument that would not otherwise be used.

Interestingly, the two sequences (Figure 4) are based on differ-

ent concepts: a crown-down approach for the medium-large ca-
nals where an instrument of bigger taper can more easily reach
working length with minimal stress; and a contrasting approach,
moving from the smaller to the bigger sizes and tapers during
the small sequence. This second sequence is such because it
is easier and safer to perform a tapered funnel-form preparation
after an initial canal pre-enlargement has been performed using
a smaller tapered instrument.

Clinical article 13
 The instruments flexibility, which is a combi-
nation of small dimensions and proprietary TF
technology and design, allow SM1 to nego-
tiate complex canals easily and safely, since
TF Adaptives motion controls instrumentation
stress and optimises movements within the ca-
nal.

It is interesting to note that clinicians barely no-

tice the changing motion, thanks to a sophisti-
cated algorithm that facilitates a smooth transi-
tion between the different angles.

Following enlargement of the canal with SM1

(green band), the second instrument (yellow
band) is designed to prepare canals allowing
adequate sizes and taper (SM2 06 25). TF Adap-
tives motion and the flexibility of the instru-
ments allows for easy and predictable shaping
while respecting the original anatomy (Figure 7).

Case report
This case demonstrates how simple, easy and predictable shap- In complex cases, using SM3 (red band) to increase enlarge-
ing can be achieved using TF Adaptive in a complex canal. ment of the apical third is an option. In the great majority of cas-
es, it is very simple and safe to use the third instrument, which
Sequence selection is usually simple; having accomplished enlarges more of the root canal, creating a greater space for the
straight-line coronal access, apical patency and a glide path are Endovac cleaning device and obturation.
achieved using a #8 hand file, followed by a #10 hand file and
continued at least up to a #15 hand file. Using a tactile approach,
if clinicians struggle to get a #15 file to working length, the ca-
nal size is deemed to be small and the Small Pack (one-colour
band) and its instrument sequence are used (Figure 5).

The radiograph of an extracted tooth (Figure 6) shows the very

first hands-on use of TF Adaptive, demonstrating why the SM1
instrument (04 20) is needed in complex cases.

14 Clinical article