JOURNAL OF ENDODONTICS
Copyright © 2002 by The American Association of Endodontists
CLINICAL ARTICLES
Effect of Early Coronal Flaring on Working Length
Change in Curved Canals Using Rotary Nickel-
Titanium Versus Stainless Steel Instruments
R. Dean Davis, DDS, J. Gordon Marshall, DMD, and J. Craig Baumgartner, DDS, PhD
This in vitro investigation examined pre- and
postinstrumentation working length (WL) measure-
ments in curved root canals. The conditions com-
pared were combinations of (a) stainless steel
hand files ⴙ Gates Glidden drills (SS) versus nickel-
titanium rotary files (Ni-Ti); and (b) early coronal
flaring (flaring completed before WL determina-
tion) versus late coronal flaring (flaring completed
after WL determination). Coronal flaring was ac-
complished for the SS group using Gates Glidden
drills and for the Ni-Ti group using rotary Ni-Ti files
(n ⴝ 15/group). WL was determined before coronal
flaring, immediately after coronal flaring, and again
after canal preparation. Results indicated that WL
decreased for all canals as a result of canal prep-
aration. The mean decrease in WL was significantly
greater for the SS group (ⴚ0.48 mm ⴞ 0.32) than for
the Ni-Ti group (ⴚ0.22 mm ⴞ 0.26). Less change in
WL occurred in both groups when initial WL was
determined after coronal flaring (SS: ⴚ0.12 mm ⴞ
0.13, Ni-Ti: ⴚ0.14 mm ⴞ 0.25).
Root canal working length (WL) may be defined as the distance
from a coronal reference point to the point at which canal prepa-
ration and obturation should terminate. The accurate determination
of WL and the use of this measurement when cleaning, shaping,
disinfecting, and obturating root canals may significantly influence
treatment success. A number of studies have reported a relation-
ship between long-term endodontic success and the location of
obturation materials with respect to the apical extent of the root
canal (1–3). Success has been found to be greatest in teeth in which
the obturation material extended to within 2 mm of the radio-
graphic apex but did not extend beyond the radiographic apex
(1–3).
438
Printed in U.S.A.
VOL. 28, NO. 6, JUNE 2002
A number of methods for determining WL have been described,
including the use of radiographs, electronic apex locators, and
tactile discrimination (4). Regardless of the method, once the
appropriate WL has been established, maintaining consistency of
that measurement throughout the course of endodontic treatment is
crucial to the clinician’s ability to instrument and obturate to the
desired apical location. Should the WL change over the course of
treatment, the depth of canal treatment becomes unpredictable.
This is particularly true in the instrumentation of curved canals.
Both in vitro (5) and in vivo (6) studies have shown that changes
in WL commonly occur during the cleaning and shaping of curved
root canals. Weine et al. (7) found that changes in WL were
produced by straightening of the canal during the course of treat-
ment. Stainless steel hand files were used in studies that showed
WL change occurring during canal instrumentation (5, 6). Nickel-
titanium rotary instruments have been shown to produce less
change in canal configuration than stainless steel files (8). The use
of nickel-titanium rotary instruments may decrease the amount of
WL change that occurs during cleaning and shaping procedures.
Commonly taught instrumentation techniques advocate the
coronal flaring of root canals (9). Flaring the coronal portion of the
root canal before instrumenting the apical region may provide a
number of benefits. Flaring of the coronal canal has been found to
facilitate the placement of files into the apical portion of curved
root canals (10). It is not known if determining WL after the initial
coronal flaring of the root canal has been completed, but before
apical preparation, will minimize the change in WL that occurs
during the instrumentation of curved canals.
The purpose of this in vitro investigation was to compare pre-
and postinstrumentation WL in curved root canals prepared by (a)
using early coronal flaring (flaring completed before WL determi-
nation) versus late coronal flaring (flaring completed after WL
determination); and (b) using either stainless steel or nickel-tita-
nium instruments.
METHODS AND MATERIALS
Extracted human maxillary and mandibular first and second
molar teeth were collected. Teeth with external defects or multiple
Vol. 28, No. 6, June 2002
root curvatures were excluded. The distal roots of mandibular
molars and the palatal and distobuccal roots of maxillary molars
were removed by using a tungsten carbide bur in a high-speed
handpiece, so that the mesial root and the associated crown were
separated from the remainder of the tooth. Radiographs of the
mesial roots were exposed from the buccal. Using the technique
described by Schneider, canal curvature of the mesial root was
determined and recorded (11). Roots with mesial-distal curvatures
between 20 and 45 degrees were selected.
A coronal access preparation was made in each specimen by
using a carbide bur in a high-speed air rotor handpiece. Air-water
spray was used at all times during access preparations. The orifice
of the mesiobuccal canal was exposed and penetrated to a depth of
1 to 2 mm using a #2 Gates Glidden drill (Moyco, Union Broach,
York, PA). The mesiobuccal cusp tip was flattened by using a
grinding/polishing wheel to provide a reproducible reference point
for WL determinations. Silicon markers (“stops”) were placed on
all rotary and hand files to use as a reference gauge in determining
the depth of canal penetration. A #10 K-type file (Flex-R file,
Moyco, Union Broach) was introduced into the mesiobuccal canal
of each specimen. The location on the root where the file first
appeared at the apical foramen when viewed through a clinical
microscope (Global Surgical Corp., St. Louis, MO) at ⫻12 mag-
nification was noted. Any specimen in which the canal could not
be negotiated with a #10 file was discarded. The root end was
resected at, or slightly coronal to, the level of the apical foramen
using a flat-sided diamond abrasive disk (Brasseler USA Inc.,
Savannah, GA). The flattened root end was placed against a flat
glass surface. A file was placed into the canal until it reached the
apical glass barrier. Penetration of the file to the apical area was
confirmed visually by using the clinical microscope. Using the
flattened coronal surface as a reference point, a WL measurement
was determined. With the aid of a digital micrometer (Mitutoyo
Corp., Tokyo, Japan), length was recorded to the nearest 0.01
millimeter. This measurement was designated the nonflared WL.
This measuring procedure was completed three times in succession
for each canal, and a mean value for WL was calculated and
recorded. All preparations and WL determinations were completed
by a single operator.
Thirty specimens were rank ordered by degree of maximum
canal curvature and divided into two groups (n ⫽ 15/group). The
root demonstrating the smallest curve was assigned to group 1, the
next smaller curve to group 2, etc. The mean canal curvature per
group was calculated and compared to verify similarities in
curvature.
Specimens in group 1 were instrumented using Gates Glidden
drills and hand-held 0.02 taper stainless steel K-type files. Speci-
mens in group 2 were instrumented using engine-driven rotary
nickel-titanium files.
Each specimen in group 1 was treated as follows: the root canal
was flooded with a solution of 2.6% sodium hypochlorite. A #15
stainless steel K-type file (Flex-R file, Moyco, Union Broach) was
introduced until moderate resistance was felt. None of the canals
permitted passage of the #15 file to the nonflared WL. The file was
rotated clockwise 1⁄4 turn without apical pressure and was then
removed from the canal. In the same manner, the next larger file
was placed, rotated, and withdrawn, again without attempt to
advance against resistance. This was continued until a #25 file size
had been used, penetrating no closer than 5 mm from the nonflared
WL, creating a path for a Gates Glidden drill to follow. Apical
patency was verified using a #10 file. The canal was irrigated with
1 ml of 2.6% sodium hypochlorite, and a #2 Gates Glidden drill
Coronal Flaring and Working Length Change 439
was introduced into the canal. While rotating at 4500 rpm, the #2
Gates Glidden drill was advanced until slight resistance was felt.
With slight pressure directed away from the inner canal curvature,
the #2 Gates Glidden drill was withdrawn. A #3 Gates Glidden drill
was used in the same fashion. The Gates Glidden drills were not
used to a predetermined depth. Canal diameter and location of the
curve, which varied among the canals, determined the depth at
which slight resistance was detected. After the use of the #3 Gates
Glidden drill, the canal was irrigated and the distance to the apical
glass barrier was determined as previously described. This length
was designated the group 1 flared WL.
Instrumentation was completed by using the balanced-force
technique as described by Roane et al. (12). Initial apical shaping
was completed at the full depth of the canal with #10, #15, and #20
K-type files. When the canal had been instrumented with a #20 file,
the apical portion of the canal was flared by using a step-back
technique, as described by Walton and Torabinejad (13). Step-back
instrumentation was initiated with a #30 file placed 0.5 mm short
of the flared WL. Each successively larger instrument was carried
to a depth 0.5 mm shorter than the previous file. Canal flaring was
considered complete when the hand instrumented portion of the
canal blended with the portion of the canal shaped using Gates
Glidden drills. A #30 file was then taken to the depth of the apical
glass barrier by using the balanced force technique, and the step-
back instrumentation procedures were repeated, beginning with a
#35 file placed 0.5 mm short of the flared WL. Recapitulation was
completed followed by irrigation with 1 ml of 2.6% sodium hy-
pochlorite after each change of file. For both groups, any file that
showed signs of distortion in the file flutes was replaced with a
new file. After the step-back procedure using the #30 file as the
master apical file (13), a group 1 final WL determination was
made.
Each specimen in group 2 was treated as follows: the root canal
was flooded with 2.6% sodium hypochlorite. GT files (Profile GT,
Tulsa Dental Products, Tulsa, OK) were used to enlarge the coro-
nal portion of the canal to a point 5 mm coronal to the previously
determined nonflared WL. A crown-down technique was used for
canal enlargement using an electric handpiece (Quantec E, Ana-
lytic Endodontics, Glendora, CA). All engine-driven rotary files
were operated at 150 rpm throughout the course of the study. The
force applied during canal instrumentation with rotary instruments
was the force recommended by the file manufacturer. The manu-
facturer describes this force as “gentle pressure” and defines it as
“the force that might be applied when writing with a sharpened
lead pencil.” Irrigation with 1 ml of 2.6% sodium hypochlorite was
completed each time a rotary file was removed from the canal.
While rotating at 150 rpm, the 0.10 GT file (tip size #20) was
placed into the canal until it no longer moved apically with the
application of gentle pressure. The file was removed, wiped free of
debris, and examined for signs of distortion using ⫻3.5 magnifi-
cation. The canal was irrigated with 1 ml of 2.6% sodium hypo-
chlorite, and the file was reintroduced into the canal. When the file
no longer moved apically but stopped short of the desired depth
(5-mm coronal to the nonflared WL), the 0.08 taper GT file was
used. As with the 0.10 GT file, the 0.08 taper GT file was used in
a crown-down approach until it reached a point 5 mm coronal to
the nonflared WL or until it no longer moved apically with the
application of gentle pressure. If the 0.08 taper GT file did not
reach the desired depth, the 0.06 taper GT file was used. This
sequence was repeated until the 0.08 taper GT file penetrated to a
point 5-mm coronal to the nonflared WL. At that point, an acces-
sory 0.12 taper GT #35 file was placed into the canal and rotated
440 Davis et al.
TABLE 1. Mean WL in millimeters
Mean Mean Mean
Group
Nonflared WL Flared WL Final WL
1 (n ⫽ 15) 18.19 (⫾ 1.00) 17.83 (⫾ 1.06) 17.71 (⫾ 1.03)
2 (n ⫽ 15) 18.32 (⫾ 1.05) 18.25 (⫾ 0.98) 18.10 (⫾ 1.00)
Group 1 ⫽ stainless steel hand files ⫹ Gates Glidden drills.
Group 2 ⫽ nickel-titanium rotary files.
at 150 rpm until light resistance was encountered. The file was
withdrawn, the flutes were cleaned, and the file was reintroduced
into the canal. This was repeated until the file no longer progressed
apically with light pressure. After irrigation, flaring was considered
complete. Canal patency was verified visually by placing a #10 file
to the complete depth of the canal. A length measurement was
made by using the technique previously described. This measure-
ment was designated the group 2 flared WL.
Canal instrumentation for group 2 was resumed using 0.06 taper
GT files with a crown-down technique. The 0.06 taper GT instru-
ment was placed into the canal and advanced until it either reached
the WL or until it no longer moved apically with the application of
gentle pressure. When the file no longer progressed apically but
was short of the glass apical barrier, it was removed, wiped free of
debris, and inspected for distortion. The canal was irrigated as
previously described, and the GT file was reinserted into the canal.
When the 0.06 taper GT file reached the glass apical barrier, the
canal was irrigated and a #25, 0.04 taper, rotary file (Profile, Tulsa
Dental Products) was taken to this depth. This process was re-
peated using a #30 Profile. After irrigation, canal preparation was
considered complete. Working length was measured as previously
described and was designated the group 2 final WL.
Data Analysis
Mean canal curvature and nonflared WL values were compared
between groups by using an independent t test. For each specimen,
differences between the nonflared WL, the flared WL, and the final
WL were calculated. Within each group, a repeated measures
analysis of variance (ANOVA) test and a posthoc paired t test with
Bonferroni correction were used to determine the presence of
statistically significant differences between (a) the nonflared WL
versus the flared WL; (b) the flared WL versus the final WL; and
(c) the nonflared WL versus the final WL. An independent t test
was used for a between-group comparison of WL change occurring
over the course of instrumentation (nonflared WL minus final
WL). All analyses were completed using p ⬍ 0.05.
RESULTS
The mean canal curvature for group 1 was 31.9 (⫾ 5.5) degrees
and for group 2 was 33.6 (⫾ 5.1) degrees. Comparison using an
independent t test found no significant difference between these
values (p ⫽ 0.40).
Working length measurements are depicted in Table 1, and
changes in WL that occurred during instrumentation are shown in
Table 2. Within-group analysis using the repeated measures
ANOVA revealed a significant difference among the mean WL
values for both groups 1 and 2 (p ⬍ .05). The change in length
occurring as a result of canal flaring is reflected in the difference
between the mean nonflared WL and the mean flared WL. For
group 1 this difference was ⫺0.36 mm (⫾ 0.26), and for group 2
Journal of Endodontics
TABLE 2. Mean WL change in millimeters
Nonflared WL Flared WL Nonflared WL
Group
to Flared WL to Final WL to Final WL
1 (n ⫽ 15) ⫺0.36 (⫾ 0.26)* ⫺0.12 (⫾ 0.13)*,# ⫺0.48 (⫾ 0.32)*
2 (n ⫽ 15) ⫺0.07 (⫾ 0.14) ⫺0.14 (⫾ 0.25)# ⫺0.22 (⫾ 0.26)*
Group 1 ⫽ stainless steel hand files ⫹ Gates Glidden drills.
Group 2 ⫽ nickel-titanium rotary files.
Statistical comparisons: * indicates statistically significant differences for within-group
comparisons (paired t test with Bonferroni correction, p ⬍ 0.017). For between-group
comparisons among vertically aligned boxes (group 1 versus group 2), values that are not
significantly different are annotated with the same symbol # (independent t test, p ⬍ 0.05).
the difference was ⫺0.07 mm (⫾ 0.14). The negative value indi-
cates a shortening of WL resulting from flaring. A comparison
within each group of nonflared WL minus flared WL using a
paired t test with Bonferroni correction indicated that the differ-
ence was significant for group 1 (p ⬍ 0.001) but not for group 2
(p ⫽ 0.07).
The difference between the flared WL and the final WL repre-
sents the length change that occurred as a result of preparation of
the apical portion of the canal. For group 1 this difference was
⫺0.12 mm (⫾ 0.13), and for group 2 the difference was ⫺0.14 mm
(⫾ 0.25). The negative values again indicate a shortening of WL.
A Bonferroni-corrected paired t test comparison indicated a sig-
nificant difference for group 1 (p ⬍ 0.01). For group 2, the
difference between the flared WL and the final WL was not
statistically significant. For the paired t test with Bonferroni cor-
rection to detect statistical significance when three groups are
compared in alternating pair-wise comparisons, the p value must
be less than 0.017. The p value for the group 2 flared WL versus
final WL comparison was 0.04.
The difference between the nonflared WL and the final WL
indicates the length change occurring as a result of complete canal
instrumentation. For group 1 this difference was ⫺0.48 mm (⫾
0.32), and for group 2 the difference was ⫺0.22 mm (⫾ 0.26). The
Bonferroni-corrected paired t test comparison indicated that the
difference between the nonflared WL and the final WL was sig-
nificant in both of these groups (p ⬍ 0.01).
A comparison between groups 1 and 2 of the WL changes that
occurred during complete canal instrumentation indicated that
samples in group 1 lost a mean of 0.26 mm more than those in
group 2. This difference was significant (independent t test, p ⬍
0.001).
No file separation occurred during canal instrumentation. Dis-
tortion of the flutes was seen in several files. The files most often
demonstrating distortion were the small stainless steel hand files
(#8 and #10 files) and the 0.06 taper GT files.
DISCUSSION
The results of this study indicate that shortening of WL consis-
tently occurs during the instrumentation of curved canals. The
amount of shortening found approximates the results reported by
Caldwell, who found that the use of stainless steel hand files
resulted in a mean length change of ⫺0.35 mm in the mesiobuccal
canals of maxillary molars and a decrease of ⫺0.29 mm in the
mesiobuccal canals of mandibular molars (5). In this study, the
mean loss of WL was significantly greater in the stainless steel
hand file ⫹ Gates Glidden drill group (⫺0.48 mm) than in the
rotary nickel-titanium file group (⫺0.22 mm).
In a clinical study, Farber and Bernstein evaluated WL change
that occurred during instrumentation (6). They found that 30% of
Vol. 28, No. 6, June 2002
the curved canals decreased in length by 1 mm or more and two
canals were shortened by 2 mm. In this study, the working lengths
in 13% of group 1 canals and 0% of group 2 canals were shortened
by approximately 1 mm, whereas 40% of group 1 canals and 20%
of group 2 canals decreased in length by approximately 0.5 mm.
Our finding that nickel-titanium rotary files caused small but
consistent changes in WL are in agreement with those of other
investigators who evaluated length change associated with the use
of nickel-titanium rotary files. Thompson and Dummer reported
that WL decreased by a mean of 0.5 mm in 33/40 canals when
instrumented using nickel-titanium rotary files (14). We speculate
that the differences found between stainless steel and nickel-
titanium instruments in our study are due to the superior ability of
nickel-titanium to remain centered within the canal during instru-
mentation, thus minimizing the straightening of the canal. This
supposition is supported by the findings of both Dummer and
Thompson (15) and Bryant et al. (16), who reported that nickel-
titanium rotary files caused minimal change in canal configuration.
It is also consistent with the results of Weine et al., who found that
stainless steel files tended to straighten curved canals (7).
Groups 1 and 2 differed in the relative amounts of WL change
that occurred as a result of coronal flaring. The Gates Glidden drills
used in the teeth of group 1 caused a significantly greater decrease
in length during initial canal flaring than did the nickel-titanium
Greater Taper files used in the teeth of group 2. In group 1, initial
coronal flaring was the factor with the greatest influence on length
change. Of the overall 0.48-mm mean length decrease that was
found in group 1, 0.36 mm occurred during initial canal flaring. Of
the overall 0.22-mm mean length decrease that was found in group
2, only 0.07 mm occurred during initial flaring. We speculate that
the relatively large length change produced by the Gates Glidden
drills in group 1 was due to the removal of the cervical bulge of
dentin. Coronal flaring with Gates Glidden drills tended to create
a straight-line access to the mid-root canal. Flaring in group 2 with
GT files tended to follow the original canal contour and did not
create the same type of straight-line access to the mid-root canal.
Once coronal flaring had been accomplished, little change in
length occurred for either group during the shaping of the apical
portion of the canals. The length change that occurred during apical
shaping in the stainless steel file group was ⫺0.12 mm versus
⫺0.14 mm for the nickel-titanium rotary file group. It is possible,
although not investigated in this study, that coronal flaring with
Gates Glidden drills could even further reduce the small WL
changes that resulted from apical instrumentation with nickel-
titanium rotary files. Although the length change in the apical
portion of the canal for group 1 was statistically significant, this
change seems too small to be clinically meaningful. The fact that
the paired t test found the difference between the flared WL and the
final WL to be statistically significant is indicative not of clinical
importance but of the consistency with which it occurred.
The ability of the clinician to establish WL and subsequently to
control the enlargement of the canal at this length may affect his or
her ability to confine the obturation material within the root canal
space. A number of studies have found success rates to be greater
in teeth in which the obturation material has been confined within
the root canal space, as opposed to instances in which the obtura-
tion material has extended beyond the radiographic apex. Sjogren
et al. (1) found the success rate of teeth with obturation material
extending beyond the radiographic apex to be 76%, whereas teeth
filled within 2 mm of the apex exhibited a success rate of 94%.
Teeth filled more than 2 mm short of the apex yielded a success
rate of 68%. Seltzer et al. (3) and Swartz et al. (2) reported similar
Coronal Flaring and Working Length Change 441
findings. In addition to the relationship of overfill to long-term
success, extrusion of obturation materials beyond the radiographic
apex has been associated with an increased incidence of postop-
erative pain (17).
The results of this study indicate that nickel-titanium rotary files
can be expected to consistently produce a small decrease in WL,
whereas the combination of Gates Glidden drills and stainless steel
files causes more than twice as much decrease in WL. The fact that
13% of the canals in group 1 lost at least 1 mm of length seems to
indicate significant potential for overinstrumentation and overfill-
ing of curved canals when Gates Glidden drills and stainless steel
files are used, when WL is determined before flaring. None of the
canals in group 2 lost 1 mm or more of length, indicating signif-
icantly less risk of overinstrumentation and overfilling when nick-
el-titanium rotary files are used, regardless of whether flaring is
completed before or after WL determination.
The clinical impact of length changes that occur during instru-
mentation may be reduced if WL is verified immediately before
obturation. Even if WL were shortened during cleaning and shap-
ing procedures, length verification completed just before obtura-
tion would permit adjustments to the obturation material and
reduce the risk of overfill. Use of an electronic apex locator can be
advantageous in this situation. It lends itself to rapid length deter-
mination, permitting repeated WL assessments throughout the pro-
cedure with little impact on treatment time. Although radiographic
estimates of WL have been found to be relatively inaccurate and to
consistently underestimate canal length (18), electronic apex loca-
tors have been found to correctly identify the apical foramen more
than 90% of the time (19). Importantly, Ibarrola et al. (20) found
that flaring of the canal before WL determination with an elec-
tronic apex locator significantly improved the accuracy with which
the apex locator was able to identify the apical constriction.
The findings of this study indicate that WL in curved canals is
consistently decreased during the course of instrumentation. Work-
ing length is decreased significantly more when a regimen of Gates
Glidden drills and stainless steel hand files is used versus nickel-
titanium rotary files. When Gates Glidden drills and stainless steel
hand files are used, the greatest WL decrease occurs as a result of
coronal flaring, and the most stable and predictable WL determi-
nation would be accomplished after coronal flaring has been com-
pleted. When nickel-titanium rotary files are used, there is little
difference in WL whether measurements are made before flaring or
after flaring has been completed.
Dr. Davis is a former resident, Department of Endodontology, OHSU
School of Dentistry, Portland, Oregon and is presently in private practice in
San Antonio, Texas. Dr. Marshall is associate professor, and Dr. Baumgartner
is professor and chairman, Department of Endodontology, OHSU School of
Dentistry, Portland, Oregon.
Address requests for reprints to Dr. J. Gordon Marshall, Department of
Endodontology, School of Dentistry, OHSU, 611 S.W. Campus Drive, Port-
land, OR 97201.
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