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Fig. 6_SAF file offers us the ability to shape the morphology of individual pulpal systems in 3-D. 24 I I special _ advancements in endodontics important apical region.18–22 The device delivers the disinfectingsolutiontothecoronalaspectofthepul- palsystemanddrawsthesolutiontotheapicalregion of the pulpal system by way of evacuation. This tech- nique allows for a safe, comprehensive irrigation of the entire root-canal system.23–25 This technology overcomes the limitations of solution surface ten- sions and apical vapour locks that occur in deep, dif- ficult-to-reach areas of pulpal systems.26 In addition, the continuous movement of the solution increases microbial hydrolysis.27 Inthepursuittoincreasesuccessfuloutcomes,the progressiveclinicianmuststayattheforefrontofnew treatment modalities that may increase our efficacy in attaining higher levels of disinfection. Traditional endodontic techniques are based on the theory that files shape andirrigationsolutionsclean.28 Weknowthelimitationsofcur- rent rotary files in shaping the morphology of complex root- canalsystems.Onaverage,most file systems reach less than 50% of canal walls.29 Therefore, our inability to reach many surfaces of the root-canal system physically has dictated that disinfection rely mainly on the many techniques of irrigation. However, a new treatment modality challenges this method. The SelfAdjustingFileEndodonticSystem distributed by Henry Schein, Inc., spearheads this new direction into 3-Dshaping.TheSAFinstrument(Fig. 6) was designed to reach the major- ity of pulpal walls in a 3-D fash- ion.30–31 Thispotentialquantumleap inourabilitytoreachallpulpalwalls physically, significantly increases our efficacy in disinfection.32 This may set forth a paradigm shift in the way we approach our shap- ing and disinfecting techniques. _Higher success rates with the 3-D seal of the entire root-canal system— advances in the coronal seal Once the 3-D intricacies of a root-canal system have been evaluated, shaped and disinfected, then success ultimately lies in our ability to seal this com- plex and vulnerable system from the pathogenic source of endodontic disease, the oral cavity.33–34 Overall endodontic success rates would be higher if all clinicians placed the coronal seal immediately after the canals are sealed. This is the time when the isolated pulpal system is at its highest level of disin- fection. We know that endodontic disease emanates from the oral cavity and we strive to disinfect and seal the smallest of crevices within canal systems, but what about the main portal of entry for these pathogens? Figure 7 illustrates a lack of respect for this well-understood requirement for success. A relatively similar case treated in Figure 8 has a signif- icantly increased overall prognosis. In addition to common sense, the amount of quality research that supports this imperative final objectiveofsuccessfulendodontictreatmentisstag- gering.35–43 Arecent,impressivestudywasperformed by one of the largest insurance companies in the US in an effort to evaluate the success of endodontic outcomes. In assessing over 1.4 million endodontic casesoveraneight-yearperiod,theyfoundasuccess rate of 97%. Pretty impressive! However, it was also found that in the 3% of cases that failed, 85% did not have coronal coverage.44 Imagine the achievable success rate of modern endodontic therapy should an immediate seal of the entire root-canal system become the standard of practice. Endodontists should diligently educate those in their local dental community of the overwhelming importanceofthisimmediatefinalphaseofsuccess- fulroot-canaltherapy.Auniversalpracticeofplacing the coronal seal as a final phase of treatment will greatly enhance the success of our profession. The prudent endodontic practitioner should exclude any Fig. 5a_MacroCannula aids in the removal of gross debris during treatment, especially in the mid- root to coronal areas. Fig. 5b_MicroCannula facilitates the removal of microscopic debris at the apical 1mm of the root-canal system. Fig. 5a Fig. 5b Fig. 6 roots4_2010