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Endodontic Hand and Rotary instruments

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Endodontic hand and rotary instruments.

1
CONTENTS

Sl no Topic Page no

1. Introduction 04

2. Classification of endodontic instruments 06

3. Standardization of endodontic instruments. 09

4. Metallurgy of endodontic instruments 12

5. Design features of an endodontic file 24

- Taper

- Tip design

- Flute

- Chip space

- Blade

- Land

- Pitch

- Rake angle

- Helix angle

6. Stainless steel endodontic instruments and its 31

modifications

- Hand driven ( broaches, files, reamers)

- Engine driven ( Gates glidden, peso reamers)

7.        

- Hand driven ( with greater taper)

- Mechanical

2
8. Instrumentation techniques 

9. Conclusion 

10. References 

3
Introduction.

The endodontic treatment requires proper cleaning and shaping of the root canal space, i.e.,

removing tissues whether vital or necrotic and reducing the bacterial load in the case of

infection, which is done through chemo-mechanical protocols.1 The epitome of an endodontic

treatment should satisfy the bio-mechanical principles of cleaning and shaping of the root

canal system which is influenced by type and efficiency of endodontic instruments used for

the procedure.2 Instrumentation has a key part in the course of treatment strategy to kill

microorganisms in the root canal framework. It evacuates an adequate number of organisms

from the open parts of the primary root canal by coordinate mechanical cleaning activity.

Instrumentation likewise shapes the waterway in such a way which encourages compelling

water system to expel the pulp tissue flotsam and jetsam and microorganisms in out of reach

regions of root canal system. The hand instruments were very effective however tedious

when contrasted with rotational instrumentation.3

The importance of chemo-mechanical preparation is extreme, that is why researchers have

focused on the fulfillment of technical and biological objectives of pulp therapy. In the last

two decades, the evolution of manual and mechanized instruments has contributed to improve

the success and predictability of the endodontic treatment.4 Endodontic instruments play a

significant role in the success of endodontic treatment starting from the preparation of the

access cavity to the final obturation of the root canal space. A continuously tapering funnel

shape with the smallest diameter at the end point and the largest at the orifice has been

deemed to be the most appropriate canal shape for filling with gutta-percha and sealer.5

Long before the advent of NiTi files into dentistry, endodontic instruments used to clean and

shape root canals were made up of carbon steel and stainless steel which were less flexible

and produced procedural errors which were overcome by the introduction of NiTi

4
instruments.2 NiTi alloy was first developed by W. F. Buehler, a metallurgist in 1960s, with

unique properties of super-elasticity and shape memory which did not confine to normal

metallurgic properties of alloys. It was Harmeet Walia who first fabricated an endodontic file

from a NiTi arch wire in 1988. Since then, NiTi alloy has become an inevitable part of

endodontics.2

History of Endodontic instruments

The manufacture of the first instruments for endodontic use dates to 1875. These early

instruments, which were made by hand from thin steel wires, performed more or less the

function of modern barbed broaches. In accordance with the lack of sophistication of the

time, more importance was given to obturation of the canal space than to cleaning of the root

canal system. With the advent of dental radiology, local anesthesia, and advances in

bacteriology at the turn of the last century, a new era opened in endodontic therapy.6

Nickel–titanium alloy was originally developed for the U.S. space program at the Naval

Ordnance Laboratory, in 1963, and was given the generic name “Nitinol”. In dentistry, it was

first used in 1971 by Andreasen and Hilleman, in the manufacture of orthodontic wires, due

to its low modulus of elasticity, shape-memory effect, and superflexibility. Specifically in

endodontics, Civjan et al. were the first to conceptualize the fabrication of endodontic

instruments from NiTi alloy, in 1975. Later, in 1988, Walia, Brantley and Gerstein introduced

the first handheld NiTi endodontic instruments, made by machining orthodontic wire.

Thereafter, technological advances in the production of NiTi instruments allowed them to be

manufactured by machining processes with significant changes in the configuration of the

active part, variations in the helical angle and cut angle, and different increases in taper

within the same instrument, no longer following the ISO standards published in 1958 for

manual instruments.7

5
Classification of Endodontic Shaping Instruments

Endodontic instruments can be classified

a. Based on their function(GROSSMANS CLASSIFICATION)

b. COHEN’S C LASS IFICATION
c. Based on the steps in endodontic treatment(HARTY’S CLASSIFICATION )
d. Based on ISO grouping(ISO CLASSFIC IATION)

BASED ON FUNCTION:

The endodontic instruments can be classified based on their function into

the following:

a. Exploring instruments:
These are instruments used to locate canal orifice and to assist in obtaining
patency of root canal.Eg: endodontic explorers, smooth broach.

b. Debriding / Extirpating instruments

These are instruments used to extirpate pulp and remove debris.

Eg. Barbed broach

c. Cleaning and shaping / Enlarging instruments:

These are instruments used to clean and shape the root canals laterall y
and apicall y.

Eg. Files, reamers

d. Obturating instruments:
These are instruments used to pack filling material into root ca nals.

Eg. Spreaders, pluggers

COHEN’S CLASSIFICATION

I. Hand-operated instruments for root canal space preparation.

II. Engine-driven and energized instruments for root canal space preparation.

6
III. Instruments for root canal obturation.

IV. Instruments for post space preparation.

BASED ON THE STEPS IN ENDODONTIC TREATMENT:

Endodontic instruments can be further classified based upon the steps in

endodontic treatment as

i. Instruments for access cavity preparation :

A) A basic instrument pack, cont aining endodontic explorer, long spoon

excavator, front surface mouth mirror, endodontic locking tweezers, briault
and periodontal probes, flat plastic instruments and amalgam pluggers,
endodontic millimeter ruler and irrigating syringe.

B) Burs – Burs are rotary cutting instruments required to accomplish good

access preparation. Friction grip tapered fissure burs, round burs, safe ended
burs, gates glidden burs are used.

C) Rubber Dam

ii. Instruments for root canal preparation:

These include various hand instruments, rotary root canal instruments and
instruments for retriving broken instruments and posts.

iii. Instruments for filling root canals:

These instruments include hand and finger spreaders and pluggers.

ISO GROUPING OF ENDODONTIC INSTRUMEN TS:

International Standards Organization and Federation Dentaire

Internationalle committee grouped root canal instruments into 4 groups.

• Group I: Hand-operated endodontic instruments

7
 1. Barbed broaches and rasps

2. K-type reamers and files

3. Hedstroem files

• Group II: Low-speed stainless steel endodontic instruments with latch-type attachments

1. Gates-Glidden drills.

2. Peeso reamers/ Largo drills.

• Group III: Ultrasonic and sonic instruments

• Group IV: Engine-driven nickel–titanium endodontic instruments (most commonly used)

1. Rotary instrumentation

2. Reciprocating instrumentation

3. Canal adaptive instrumentation

(a) Self-adjusting file (SAF)

(b) XP-Endo Shaper and Finisher

8
Standardization of Endodontic instruments.

Before the standardization proposed by Ingle and the agreements among the various

manufacturers, each company produced its own instruments without adhering to any pre-

established criteria. The numbering of instruments from 1 to 6 was purely arbitrary, there was

no uniformity governing the progression from one size to the next, and the instruments of one

manufacturer rarely matched similar instruments of another maker.6

9
Ingle and LeVine suggested a definite increment in diameter as the size progressed while

maintaining a constant taper of all blades regardless of size.7

• Instruments shall be numbered from 10 to 100, the numbers to advance by 5 units to size 60

and then by 10 units to size 100. This has been revised to include numbers from 6 to 140.

• Each number shall be representative of the diameter of the instrument in hundredths of a

millimeter at the tip; e.g., No. 10 is 10/100 or 0.1 mm at the tip, No. 25 is 25/100 or 0.25 mm

at the tip, and No. 90 is 90/100 or 0.9 mm at the tip.

• The working blade (flutes) shall begin at the tip, designated site D0, and shall extend

exactly 16 mm up the shaft, terminating at designated site D16.

• The diameter of D16 shall be 32/100 or 0.32 mm greater than that of D0; e.g., a No. 20

reamer shall have a diameter of 0.20 mm at D0 and a diameter of 0.20 plus 0.32 or 0.52 mm

at D16. This sizing ensures a constant increase in taper of 0.02 mm/mm for every instrument

regardless of size.

Following specifications were added later:

• The tip angle of an instrument should be 75 ± 15°.

10
• Instrument sizes should increase by 0.05 mm at D0, between Nos. 10 and 60, e.g., Nos. 10,

15, and 20, and they should increase by 0.1 mm from Nos. 60 to 150, e.g., Nos. 60, 70, and

80.

• Nos. 6 and 8 have been added for increased instrument

selection.

• In addition, instrument handles have been color coded

for easier recognition.7

At the 1989 Congress of the American Association of Specifications for the files
and reamers7
Endodontists, Schilder proposed a new criterion of

standardization for the instruments: rather than

increase by a fixed measurement (0.05 mm), he

suggested they increase by a fixed percentage

(29.17%) from one number to the next. This new

criterion is based on the observation that 5 hundredths

of a millimeter represents a significant increase of

50% when passing from a # 10 to a # 15 or of 33%

when passing from a # 15 to a # 20. In contrast, the

increment is minimal or very small between a # 40 and # 45 (13%) or between a # 50 and a #

55 (10%).6

11
Greater tapered instruments have been developed with 4, 6, 8, and even 10% taper. Tapered

instruments help in preparing canals of wider diameter without overenlarging the canal at

working length. Thus, a 30-size file with 2% taper, 30-size file with 4% taper, and 30-size file

with 6% taper all would have the same tip diameter of 0.30 mm. The diameter along the file

would be drastically enlarged with an increase in the taper.

Taper influencing on the diameter of the endodontic file

Metallurgy of Endodontic Instruments.

Regarding the material of which the instruments are made, carbon steel was widely used

years ago. This is a mixture of pure iron or ferrite (93.31%) and iron carbide or cementite

(6.69%). Today, stainless steel, a mixture of pure iron (74%), chromium (18%), which

prevents corrosion, and nickel (8%), which confers elasticity to the alloy, is preferred.

The characteristics of carbon steel instruments are:

– Rigidity increases with increased size

12
– The larger instruments are less resistant

than smaller ones to breakage by bending

or twisting

– The instruments are easily corroded

– Low cost.

The characteristics of stainless steel

instruments are:

– Greater flexibility than their carbon

steel counterparts, which can be

measured in one size instrument

– Greater resistance to fracturing by

twisting

– Reamers are more resistant to

fracturing by twisting than files. The clinical use of stainless steel instruments therefore has

more advantages over the use of carbon steel.6

Today, nickel-titanium instruments are also available commercially.6 According to Hooke’s

Law, most metal alloys can be elastically deformed by up to 0.1 or 0.2% beyond their elastic

limit, or yield strength. Any deformation above this limit, known as the yield point, will be

permanent. Nickel-titanium alloys, however, can be deformed up to 8% beyond their yield

strength without showing any residual deformation. Superflexibility, or pseudoelasticity, can

13
thus be defined as the ability of certain materials to recover their original shape after the load

is removed even when they are deformed beyond their yield strength.8

According to Thompson, the special properties of NiTi alloys are associated with a solid-state

phase change: the martensitic transformation (MT). The MT is induced by the application of

stress or by a temperature reduction, in which atoms move coordinately by a shear-type

mechanism and are rearranged into a new, more stable crystalline structure, with no change in

the chemical composition of the matrix, but with a macroscopic change in the shape of the

material. This transformation occurs between austenite (the parent phase) and martensite.8

When a material that undergoes MT is cooled below a certain temperature, the transformation

is initiated by a shear mechanism. The martensitic regions in A and B have the same crystal

structure, but the spatial orientations of the crystals

are different. In MT caused by the cooling of the

specimen, there is no change in shape, as the

transformation mechanism is one of reversible

ordered self accommodation.

If the material is heated while in the martensitic phase, the martensite becomes unstable, and

reverse transformation (RT) occurs. The martensite thus returns to the austenite phase, and

transformation follows the inverse path of MT.8

14
Another important point is the shape-memory effect (SME), which is the ability of the alloy

to completely recover its original shape when heated above the martensite-to-austenite

transformation temperature, a temperature that varies according to the chemical composition

of the alloy. Among the various metal alloys that exhibit superelasticity (SE) and the SME,

nickel-titanium has the best biocompatibility and corrosion resistance, due to its surface

coating of titanium oxide. The superelasticity of NiTi alloys is associated with substantial

recoverable deformation (up to 15%) when subjected to loading and unloading at an

appropriate temperature.8

Properties of NiTi It has two unique properties superelasticity and shapememory.

Other properties

x Greater strength

x Low modulus of elasticity

x Biocompatibility

x Resistance to corrosion

Due to these properties they have the advantage of minimal deformation therefore NiTi has

been used to manufacture endodontic instruments.

Composition

The alloy used for the manufacturing endodontic instruments contain

x Ni -56%

x Ti -44%

Advantages of endodontic NiTi instruments

15
Reduction in procedural errors-due to its superelastic property there was less instrumental

breakage Resistance to clockwise torsional stress.It is 3 times more flexible compared to

stainless steel so that it could be used for curved canals.

Canal preparation can be done with less transportation and ledge formation Engine driven

NiTi instruments reguire less chair time compared to stainless steel which is 6 times lesser

amount of time taken by stainless steel instruments

x Less loss of working length

x Reduced file fracture

x Reduced apical transportation due to its flexibility.9

Manufacturing of Endodontic Instruments.

They are manufactured in two ways:

Torsion

It occurs when the circular section wire, usually stainless steel, undergoes wear on its sides

resulting in flat surfaces that will produce the future section of the file. Usually these sections

can be quadrangular, triangular or rhomboid. After having achieved the section, the wire is

held at its ends and twisted to obtain the turns of the active part.4

Wear

The wear happens as follows: the circular section wire is introduced in two lathes that

generate wear of the wire, producing the desired sectional configuration. It is important to

note that files manufactured by wear tend to be less resistant than files manufactured by

torsion, as wear causes mass loss, which consequently reduces resistance.4

16
Manufacturing of NiTi instruments are more complex compared to manufacturing stainless

steel instruments, the superelasticity of this alloy does not allow spiral structure as they do

not undergo permanent deformation. So when the alloy is being manufactured the finished

NiTi wires go through various procedures before they are manufactured into endodontic

instruments. Initially the casting alloy is drawn into cylindrical shape before it is exposed to

under pressure to draw them into wires, then the formed wires are exposed to even pressure

to form a tapered shape by using a number of rollers. Other procedures such as drawing the

wire into cone shape, annealing was carried simultaneously which is followed by shaping the

wire into a required shape before cleaning and conditioning of the wire and then it is stored

in reels.9

Strategies in the alteration of NiTi alloy.10

In recent years, new forms of NiTi are developed by modifying the alloy by variations in

metal processing and file manufacturing or correcting the surface defects.

A) Plasma immersion ion implantation

Conrad et al. and Tendys et al. introduced Plasma immersion ion implantation (PIII) in the

late 1980s. The specimen is introduced in a chamber and immersed in the plasma, and a

highly negative pulsating voltage is then applied to the sample. Briefly, it is a line-of-sight

process in which ions are extracted from plasma, accelerated, and bombarded into a device.

Ionic implantation brought differences in surface characteristics, an increase in the cutting

efficiency, and improved wear resistance as shown by Rapisarda et al.

B) Oxide formation on NiTi/Titanium oxide coating

Titanium has a higher affinity with oxygen compared to Nickel. So, with increased exposure

time at moderate temperature, the oxide formation is composed mainly of TiO2 with slow

formation and growth. A study on the mechanical behaviour of the endodontic instruments

17
and its corrosion resistance in Sodium Hypochlorite (NaOCl) solution was carried out by Aun

DP et al.. They observed an improvement in cutting efficiency and high resistance to

corrosion on immersing in NaOCl solution. The coated instruments showed better

performance in fatigue life after corrosion, so they concluded that this characteristic should

be maintained since the TiO2 layer can support relatively large deformations. Coating the

endodontic instruments with a flexible TiO2 protective layer with the help of dip-coating sol-

gel method improves cutting efficiency, corrosion behaviour and resistance to fatigue failure.

C) Thermal nitridation

Powder Immersion Reaction Assisted Coating (PIRAC) is a nitriding method producing TiN

on NiTi. Such modified surface consists of an outer layer of TiN which is thin and a thicker

Ti2Ni layer underneath. By placing a TiN layer on commercial rotary NiTi instruments

corrosion resistance of files placed in contact with 5.25% NaOCl significantly increases.

D) Cryogenic treatment

Various metals are treated with deep dry cryogenic methods to enhance resistance to

corrosion and wear. These methods also improve strength and microhardness of metals. The

entire cross-section of the instrument is affected rather than no change in the elemental

crystalline composition on the surface of the alloy. There are two mechanisms involved. In

the first mechanism, the crystalline transformation from austenitic to complete martensitic

following CT occurs. In the second mechanism, finer carbide particles precipitate within the

crystalline structure. Kim et al. observed that cryogenically treated instruments had

significantly higher microhardness.

18
 Crystalline structure changes from the cryogenic
treatment. Where; a. Before treatment: Face-
centered cubic austenitic structure, and b. After
treatment - Cell-centered structure

E) Electropolishing / Reverse plating

Electropolishing (EP) is a typical surface treatment process for final finish during the

manufacturing of NiTi instruments. This process includes alteration of the surface chemistry

and morphology takes place as surface imperfections are removed as dissolved metal ions.

Once, the instrumentis immersed in a temperature -controlled bath of electrolyte it serves as

the anode when connected to the positive terminal of a direct current power supply, and the

negative terminal is attached to the cathode. The surface of a metal oxidises as the current

passes and dissolves in the electrolyte. A reduction reaction is observed at the cathode that

normally produces hydrogen. Most often the electrolytes used are mixtures of concentrated

solutions of sulfuric/phosphoric acid with a high viscosity. Bare NiTi surfaces are produced

from Ti oxides with Ni concentrations from 2% to 7% depending on the electrolytes and

regimes employed. In the process, the metal exhibits better corrosion resistance along with

improved surface characteristics. Anderson et al. reported that the instruments with

electropolishing show better resistance to cyclic fatigue loads and poor resistance to static

torsional loading. The benefits of electropolishing are likely caused by a reduction in surface

irregularities that serve as points for stress concentration and crack initiation. Lopes et al.

found significant increases in cyclic fatigue resistance and exhibiting fine surface cracks

19
which assumed an irregular or zig-zag path, that EP instruments demonstrated. In contrast,

the non-EP files had cracks running along the machining grooves.

Modifications in the microstructure of alloy by thermo-mechanical

treatment

Thermo-mechanical treatment, is a metallurgical process, which involves in combining both

the mechanical or plastic deformation process (compression or forging, rolling etc.,) and the

thermal processes (heat-treatment, water quenching, heating and cooling at various rates) into

a single process.

A) Thermal processing during the manufacturing of alloy

The mechanical behaviour of NiTi alloy is determined by the relative proportions and

characteristics of the microstructural phases. Heat-treatment (thermal processing) is a

fundamental approach towards regulating the transition temperatures of NiTi alloys and

affecting the fatigue resistance of NiTi endodontic files. More the martensitic NiTi alloy

more is the flexibility and fatigue resistance of an instrument as it produces a better

arrangement of the crystal structure and changes in the relative percentage of phases present

in the alloy as found by De Vasconcelos. Development of the next-generation endodontic

instruments is made on the enhancements in these areas of material management.

B) M-Wire

M-Wire was developed to produce superelastic NiTi wire blanks that contain substantial

stable martensite under clinical conditions M-Wire was developed. Martensite, stress-

induced martensite (SE), and austenite are three different forms of NiTi. Softness, ductility

and easy deformation are observed when the material is in its martensite form. The austenitic

20
NiTi is strong and hard, whereas SE NiTi is highly elastic. The martensitic phase

transformation has excellent fatigue resistance because of the energy absorption

characteristics of its twinned phase structure. In 2007, M-wire (Dentsply Tulsa- Dental

Specialties, Tulsa, OK, USA) introduced and it contains portions that are in both the

deformed and micro twinned martensitic, pre-martensitic R-phase, and austenite while

maintaining a pseudoelastic state. The austenite-finish temperature (Af) of M-Wire is in the

range of 450C–500C. This temperature range indicates that the instruments manufactured

from M-Wire would be necessary for the martensitic phase at room temperature.

C) R-Phase

R phase is formed during the forward transformation of martensite to austenite on heating

and reverse transformation from austenite to martensite on cooling. Upon heating, martensite

will start transforming to R-phase at Rs temperature, and this transformation will be finished

at the Rf temperature. On further heating, R-phase starts transforming to austenite at the As

temperature, and transformation is finished at Af temperature. If heated above Af

temperature, it will be converted entirely to austenite. Then, upon cooling to a sufficiently

lower temperature, the alloy starts transformation from austenite to R-phase at the Rs

temperature and this transformation will be finished at the Rf temperature. By further

cooling, the R-phase starts transforming to martensite at Ms temperature and finished at Mf.

The alloy obtains greater strength and a lower modulus of elasticity on comparison with

21
stainless steel. Therefore, instruments made with R-phase wire are more flexible than

stainless steel. Twisting of the wire can be performed once the R-phase is identified as it

optimises the grain structure in the metal. The grinding process weakens the metal’s structure

at the molecular level that results in creating microfractures on its surface, leading to fracture

of files. In 2008, SybronEndo (Orange, CA, USA) developed Twisted Files (TF) and K3XF

files by twisting the intermediate alloy followed by a heat-treatment process. R-phase

exhibits lower shear modulus compared to martensite and austenite phases. Further, the

transformation strain is also less than one-tenth to that of martensitic transformation.

Instruments made with R phase are fully austenitic at ambient and body temperatures and

also imparts greater flexibility and increased resistance to flexural fatigue as stated by recent

reports. On the contrary, Park et al.observed that this manufacturing method fails in

providing any beneficial effect with regard to torsional fracture.

D) Controlled memory NiTi alloys (CM Wire)

CM Wire (DS Dental, Johnson City, TN) was introduced in 2010. It is a novel NiTi alloy

with flexible properties. These CM wires are manufactured by a proprietary thermo-

mechanical process, which allows the instruments to be pre-curved before they are placed

into the root canals. In addition, this process also increases the flexibility, the transformation

temperatures (Af to about 50°C), reduces the shape memory, and also helps in obtaining

stable martensite at the body temperature. However, they revert to their original shape on

sterilization. During clinical use, the conventional NiTi files are in the austenite phase as

their Af temperature is at or below room temperature. However, the Af of CM files is

certainly above the body temperature, which results in the formation of both martensite and

R-Phases in addition to the austenite phase. Shen et al. reported that instruments made from

CM wires exhibited around 300% to 800% more resistance to fatigue failure compared to

instruments made from conventional NiTi wires. Longer fatigue life observed with the

22
square configuration of NiTi instruments made from CM Wire than the triangular

configuration.

E) Thermal processing after machining of files / Post-machining heat-treatment

Thermal processing used to overcome the defects occur during the machining process and

also to modify the crystalline structure of alloys. Thermocycling of NiTi alloys causes the

martensitic transformation to occur in two stages instead of in a single stage. The stage-1

transformation (A-M) takes place in Ni-rich NiTi alloys. Stage-2 transformation (A-R-M)

takes place after the additional heat-treatment, which precipitates finely dispersed Ti3Ni4

particles in the austenitic matrix. Accordingly, the R-phase is formed instead of martensite

due to the presence of fine dispersed Ti3Ni4 particles. Therefore, it necessitates additional

cooling of alloy to form martensite and hence, martensitic transformation occurs in 2 steps

(A-R-M).10

23
Design features of an endodontic file.

A. Tip design: Original stainless steel root canal instruments usually possess a sharp,

cutting tip. However, rotary instruments currently are manufactured with modified

noncutting tips as these noncutting tips cause less canal transportation and remove

debris better than traditional instruments having conventional cutting tips.7 According

to the ISO specification 3630-1, root canal instruments usually possess a sharp,

cutting tip. The ridges on the face of a cutting tip enable the tip to cut forward and

produce a file-tip shaped cavity, thus creating ledges. Studies indicate that the tip

configuration has a crucial

impact on the shaping ability of

root canal instruments.

Currently, there is clear

evidence, that independent of

the alloy, instruments with

modified non-cutting tips

perform better in maintaining

24
 the original canal curvature than those having a conventional cutting tip. These non-

cutting tips are characterized by a reduction of the tip, transition angle and the

incorporation of a guiding plane Instruments having non-cutting tips cause less canal

transportation and remove material more equally at the inner and outer aspects of the

curved canal compared to similar instruments having conventional tips.11

B. Flute: It is the groove or relief on the working surface of the file which collects the

debris as the file cuts through the substrate.7

C. Chip space: The chip space denotes the cleaning effectiveness of an instrument as an

increase in chip space denotes improved ability to remove debris out of the root

canal.7 This is the difference between the area of the canal lumen and the area of the

cross-section of the particular instrument used. The chip space is directly related to

the cutting efficiency of any root canal instrument and its cleaning effectiveness.

Simply stated, the greater the chip space the more efficient is the instrument in

transporting dentin and debris out of the canal. The greater the chip space, the smaller

the cross-section of any instrument and the smaller the cross-section the greater the

flexibility of the instrument.11

D. Blade (cutting edge): It is the working area of the file and is the surface with the

greatest diameter that follows the flute as it rotates.7

E. Land: In certain file designs, a surface projects axially from the central core to the

cutting edge between the flutes. This feature is incorporated to reduce canal

25
 transportation and supports the cutting edge. It is defined as the surface projecting

axially from the central axis as far as the cutting edge between flutes.

Functions:

• Reduces the tendency of the file to screw

into the canal

• Reduces transportation of the canal

• Supports the cutting-edge

• Limits the depth of cut.

Full radial land – ProFile, GT.

Recessed land – Quantec.

Modified radial land – K3.

No radial land – ProTaper, Race, Endowave, Hero 642.5

F. Pitch: It is the distance from one cutting edge to the next. A file with a short pitch will

have more spirals than a file with a longer pitch.7 This is the distance between the

edges of two cutting blades measured along the working part of an instrument The

smaller the pitch, the greater the contact area between the instrument and the root

canal walls, thereby increasing the torsional stress of the instrument. The pitch may be

regressive, continuous, or progressive. Normally, hand instruments possess a

continuous pitch. Only some Hedstrom files (e.g., those manufactured by VDW,

Munich, Germany) have a progressive pitch length.11

26
G. Rake angle: On perpendicular sectioning of a file, the angle which the leading edge

forms with the radius of the file is known as the rake angle. If it forms an obtuse

angle, then the rake angle is considered to be positive. An acute angle is termed

negative rake angle.7 The rake angle is the angle formed by the cutting edge and a

cross-section taken perpendicular to the cutting edge

• The cutting angle is the angle formed by the cutting edge and the radius when the

file is sectioned perpendicular to the cutting edge

• It can either be positive, negative or neutral.

Positive rake angle: If the angle formed by the leading edge and the surface to be cut

is obtuse, the rake angle is said to be “positive or cutting.” E.g. K3, Quantec systems.

Negative rake angle: If the angle formed by the leading edge and the surface to be cut

is acute, the rake angle is said to be “negative or scraping.” E.g. Profile, ProTaper, M

two, etc. Neutral or zero rake angle: When the face of the blade coincides with the

radial line it is said to be neutral or zero rake angle (planing). E.g. LightSpeed,

Greater taper (GT) file systems.5

27
 Rake Angle

Configuration of cutting edges: The cross-section of any root canal instrument

determines the relevant cutting. angles that are wedge angle, angle of cutting,

clearance angle, and rake angle.

Cross sectional parameters

illustrating the configuration of
cutting edges.

Very small modifications of the cross-sectional shape may have serious

consequences on instrumentation behavior. The wedge angle determines the strength

28
 of the cutting blades of the instrument. The greater the wedge angle the stronger the

blade. The clearance angle has an impact on the amount of the frictional force arising

during the cutting process. The smaller the clearance angle the less is the cutting

efficiency. The sum of the wedge and clearance angle build the angle of cutting. The

rake angle is the angle between the cutting edge of the instrument and a perpendicular

to the root canal surface at the point the cutting edge touches the canal wall. The rake

angle may be positive, negative, or neutral (nearly equal to the perpendicular).

Instruments with a positive rake angle cut dentin very effectively by creating dentin

chips. A positive rake angle reduces the cutting forces. In general, Hedstrom files are

characterized by a positive rake angle. However, nearly all root canal instruments

requiring a rotary reaming working motion have a negative rake angle, such as

reamers, K-file, and rotary NiTi instruments. Although a negative rake angle makes

these instruments less effective they can be better controlled inside the root canal as

their tendency to penetrate deeper into the root canal dentin is reduced (aka screw-in

effect) compared to instruments having positive rake angles. Moreover, a negative

rake angle increases the strength and the wear resistance (longevity) of the cutting

edges.11

H. Helix angle/ cutting angle: It is the angle the cutting edge forms with the long axis of

the file.7 This angle, also called helical angle, is the angle between the instrument long

axis and the tangent to the cutting edge, The helical angle of instruments used for

hand preparation indicates the most efficient working motion of the instrument.

Instruments having a helical angle of less than 45° (reamers and K-files) require a

rotary reaming working motion to effectively cut dentin, while those having an angle

greater than 45° (e.g. Hedstrom files) require a linear filing motion.11

29
I. Core diameter: The core diameter of any root canal instrument affects its flexibility as

well as its resistance to fracture. A greater core diameter is associated with an

increased resistance to fracture but at the same time with a decreased flexibility. The

core diameter depends on the cross-sectional shape of the instrument. For hand

instruments, the core diameter decreases from square, to triangular and further to S-

shaped cross-sections. Usually, reamers, K-files and S-files are symmetrical in cross-

section, while Hedstrom files are characterized by an asymmetrical cross-section.11

J. Taper (conicity): The taper of ISO-sized hand instruments is .02 (or 2%). From the tip

to the end of the working part, the diameter of the instruments increases by 0.02 mm

every millimeter. The taper may be regressive, continuous, or progressive. The more

tapered the instrument is, the faster the core diameter increases resulting in reduced

flexibility.11

Comparison of 2, 4,
and 6% tapered

30
Stainless steel endodontic instruments and its modifications.

GROUP I - HAND-OPERATED ENDODONTIC

INSTRUMENTS

Barbed Broaches

Barbed broaches are produced in a variety of sizes and color codes. They are manufactured

by cutting sharp, coronally angulated barbs into metal wire blanks. Broaches are intended to

remove vital pulp from root canals, and in cases of mild inflammation and a large canal

space, they work well for severing pulp at the constriction level in toto. The use of broaches

has declined since the advent of NiTi rotary instruments, but broaching occasionally may be

useful for expediting emergency procedures and removing materials (e.g., cotton pellets or

absorbent points) from root canals.12

Barbed broaches were the earliest endodontic instruments used to extirpate the pulp and

enlarge the canal. It is manufactured from a tapered, round, soft iron wire in which angled

cuts are made into the surface to produce barbs. Barbed broaches are available in a variety of

sizes, from triple extrafine (XXXF) to extracoarse (XC).

The selection of a suitably sized broach for the removal of the pulp and gross debridement is

important. A barbed broach that is too wide does not permit removal of all the pulp tissue, or

31
it may force the pulp apically as it is inserted in the canal. It may also bind in the canal as it is

rotated and may thereby break, or the barbs may become embedded in the dentin as the

broach is withdrawn. On the other hand, if the broach is too narrow, it will not engage the

pulp tissue sufficiently to allow its removal.

By comparing the size of the broach with the size of the last instrument used in the root canal

or an estimated size of the image in a radiograph, one should select a barbed broach that fits

loosely into the apical third of the root canal. The root canal is irrigated with a 5.2% solution

of sodium hypochlorite, and the barbed broach is introduced until one notes unforced contact

with root canal walls. The broach is withdrawn about 1 mm and is rotated 360° to engage the

pulp tissue; it is withdrawn again to remove the pulp tissue.7

Reamers

Reamers are made from square or triangular blanks depending on

manufacturer and ISO size.61 In general, smaller sizes are made

from square blanks to increase their core diameter thereby

increasing the resistance to fracture. On the other hand, reamers of

greater sizes are made from triangular blanks to increase their

flexibility as the core diameter of a triangular blank is smaller than

that of a square bank.

Reamers made from stainless steel are twisted to give the working part of the instrument a

spiral form. This is of clinical relevance as twisted instruments are per se more resistant to

fracture than milled instruments, as the integrity of the blanks will not be damaged.61

Reamers have ½ to 1 cutting blades per millimeter in their working part, thus the number of

cutting blades is less in the reamer than in the K-file This spiral form of the working part

results in blade angles of 10° to 30° relative to the long axis. Due to this angle configuration,

32
reamers are primarily designed to be used in a reaming working motion. They cut dentin by

being inserted into the canal, twisted about one-quarter turn clockwise to engage their blades

into the dentin, and then withdrawn.11

The cutting action takes place during the withdrawal phase. This movement is repeated a

number of times without ever forcing the instruments during their insertion but engaging the

dentine during rotation and removal from the canal. A rotation exceeding half a turn is not

advisable as it could cause engagement and fracture inside the canal. To be certain of

imparting the correct movement to the instrument one need only remember not to remove

one’s fingers from the handle of the instrument as would be necessary to rotate it 360° or

more. The necessity for rotation in the canal contra-indicates the use of reamers for initial

exploration (fracture risk) and in the preparation of curved canals (risk of lacerating the apical

foramen).

The Reamers, due to the reduced number of spirals and the large spaces between the blades,

do not tend to accumulate debris but on the contrary, represent an optimum solution for

removing the smear layer produced by the file.6

Scanning electron microscopy image of a reamer

(left) and K-file (right) showing that the K-file has
more cutting blades per millimeter of the working
part.

33
Modifications of Reamers

K-Reamers

The K-Reamers are traditional reamers, only available in steel with ISO diameters from 08 to

140 and lengths 21, 25, 28 and 31 mm. Their cross-section is quadrangular up to size 40 and

triangular from size 45 to 140.

K-Flexoreamers

The K-Flexoreamers are reamers obtained by twisting a steel wire with a triangular cross-

section having a pitch (number of spirals) and helical angle (cutting angles of the blades)

analogous to the classic Reamers. The triangular cross-section even in the smaller diameters

gives the Flexoreamers an increased flexibility compared to the traditional reamers, while the

rounded tip (identical to the Flexofiles) reduces the risk of ledging or apical transportation

when preparing curved canals. The Flexoreamers are only available in ISO diameters from 15

to 40 and lengths 21, 25 and 31 mm.

K-Flexoreamer Golden Mediums

The K-Flexoreamer Golden Mediums are identical to the Flexoreamers except that the tip

diameters have intermediate values compared to the ISO ones. The K-Flexoreamer Golden

Mediums are infact available in ISO diameters 12, 17, 22, 27, 32 and 37. They are indicated

for use in long and calcified canals or with curves where a more gradual increase in

instrument diameter could be particularly useful.

34
Farside

The Farside are reamers in steel with a quadrangular cross-section particularly useful for the

initial penetration of calcified canals or in the presence of coronal interferences. They are

available in ISO diameters 06, 08, 10 and 15 with lengths from 15 to 18 mm, characterized by

a particularly short shaft that increases the resistance against deformation during the initial

exploration.

Deepstar

The Deepstar are reamers with a quadrangular cross-section identical to Farside as regards

length and blade design, with the difference that the Deepstar are only available is ISO

diameters 20 to 60. The Deepstar are indicated in retreatments to accelerate the removal of

old obturating materials; their short shaft and square section allow the application of

considerable pressure

during insertion without

deformation, while the

ample space between the

blades favours the

elimination of debris.

ProFile Series 29.02 Reamers

The ProFile Series 29 Reamers are obtained by microgrinding a round steel or NiTi wire.

Like all the ProFile 29 instruments, this reamer follows the ProFile diameter standardization

35
with a fixed percentage increase of 29.17%. The ProFile Series 29 Reamers are available in

diameters from 2 to 9 (steel) and 2 to 11 (Nickel-Titanium).6

Senseus FlexoReamers

The Senseus FlexoReamers have the same characteristics as the Standard FlexoReamers, just

like these they are obtained by torsion of a triangular steel wire, they have a bevelled Batt

type tip of 55° and are available in three lengths, (21, 25 and 31 mm) and with ISO diameters

from 06 to 140.

K files.

Files were first mass produced by the Kerr Manufacturing Co. of

Romulus, Michigan, in the early 1900s—hence the name K-type file

(or K-file). K-files and K-reamers were manufactured by the same

process (i.e., by twisting square or triangular metal blanks along their

long axis.12

K-files made from stainless steel are twisted instruments just like

reamers. They are also made from square or triangular blanks,

depending on their ISO size and manufacturer. Compared to reamers, K-files show 1½ to 2½

cutting blades per millimeter of their working part, thus there are about twice the number of

spirals on a K-file as on a reamer of a corresponding size.61 The tighter spirals of a K-file

establish cutting angles, greater than those of reamers. The cutting angle of K-files is about

25° to 40°, hence these instruments are, like reamers, primarily designed to be used in a

rotary reaming motion.

36
It is worth mentioning that although the term “K-files” implies that these instruments should

be used in a filing working motion, however, they are by far more efficient when used

according to their cutting angle in a rotary reaming motion. The term “file” denotes a cutting

instrument that removes substrate by back-and-forth (linear) motions along the surface of the

substrate. Thus, the term “file” is incorrectly coined for this type of instruments.11

The quadrangular design which increases its resistance to torsion and flexion making it

particularly useful in the initial negotiation of the canal; the four points of contact by the

blades against the canal walls improve the tactile perception of the operator, making the K-

File the ideal instrument for exploring (scouting) endodontic anatomy. The tip of the K-File

is cutting and has an aggressive transition angle with the first spiral capable of causing

ledging especially when using the less flexible instruments in curved canals. The K-Files

produce large amounts of dentinal debris, which can block the spirals of the files making

them less efficient at cutting and the push and pull action can push debris apically, causing a

plug and blocking the foramen. To prevent this inconvenience, the file should principally

work on withdrawal, the debris must be frequently rinsed away and their use must be

alternated with frequent and abundant irrigation. The filing movement of the K-Files inside

the canal must be quite gentle to prevent the instrument from being a plunger of dentin

mud.31 The K-Files are available in ISO diameters from .06 to .140 mm and lengths from 21,

25, 28, 30 and 31 mm (depending on the manufacturer).6

37
Root canal instrumentation with hand files

38
Modifications of K – file.

K-Flex

The K-Flex file represents the first attempt to make a “hybrid” instrument, able to integrate

the force and versatility of a K-File with the cutting aggression of a Hedstroem file. The K-

Flex has a romboidal cross-section, which increases the flexibi lity of the larger diameters,

alternating depths of spirals capable of removing more debris and a reduction of 37,5% of the

cross section area. It is only

available in stainless steel with

the same diameters and lengths

as K-Files 10,11,21.

A. Tip of a # 70 K-Flex (Kerr) (x25). B.

Photograph of the body of the same
instrument (x25).

K-FlexoFiles

The K-Flexofiles are files in steel obtained by twisting a wire with a triangular cross-section

and is available from a diameter of 15. Compared to the classic K-Files, the K FlexoFiles

differ regarding the tip and cross-section. The FlexoFiles tip is rounded and has a transitional

angle that is blunted making this instrument safer during the shaping of curved canals and

particularly suited for the balanced force technique. The triangular section is less bulky than

K-Files, increasing the flexibility of the FlexoFiles, while the three angles of contact that the

blades have with the dentinal walls reduce the friction and favour penetration in an apical

direction. Furthermore, the increased space for the removal of debris (due to the triangular

39
design in cross-section) explains why there is less tendency with respect to K-Files to build

dentin mud and to cause dangerous apical plugging with debris. The FlexoFiles are only

available in ISO diameters of 0.15 to 0.40 mm and lengths 21, 25 and 31 mm. Practically

identical to the FlexoFiles are the Flexicut Files. They are available in the same diameters and

lengths as the FlexoFile.

A. Tip of a # 40 K-Flexofile (Dentsply

Maillefer) (x64). B. Photograph of the
body of the same instrument (x64).

K-FlexoFiles Golden Mediums

The K-FlexoFiles Golden Mediums are identical to the K-FlexoFiles except that the

diameters have intermediate values compared to those of the ISO standard. The K-FlexoFiles

Golden Mediums infact are only available in ISO diameters 12, 17, 22, 27, 32 and 37; the

lengths remain those of the classic Maillefer 21, 25 and 31 mm. Their use is recommended

for long and calcified or curved canals where the passage from a 10 file to a 15 file or from a

15 to a 20 may be difficult; the use of intermediate diameters enable the operator to reach the

working length earlier and with less risk of complications.

40
Unifile

The Unifile has a cross-section in the shape of an S obtained by machining a double helix on

the long axis of a round wire. The structure of the spirals show that Unifiles are not obtained

by torsion but by micromachining like the Hedstroem files; the depth of the spirals is

however less than that of the H-File with consequently higher strength. The Unifiles are

available in the ISO diameters from 15 to 80 and with lengths 21, 25 and 31 mm. There is

also a rotary version in stainless steel, available though only with lengths 21 and 25 mm.

Unifile # 5 (Ransom-
Randolph). A. Tip (x25). B.
Body (x25)

S-File

The S-File is obtained by micromachining a nickel titanium wire with ISO .02 taper having a

S configuration in cross-section similar to a Unifile that however differs, due to a constant

angle of the spirals throughout its working length and a spiral depth which increases from the

tip to the handle. Apart from the manual version, available in the ISO diameters from 15 to

80 and lengths 21, 25 and 28 mm, there is also a rotary version only available in lengths 21

and 25 mm.

41
 S-File # 40. A. Tip (x64). B.
Body (x64).

Flex-R

The Flex-R file designed by Roane, was developed by Moyco Union Broach®. It is

characterized by a tip design that is completely modified. According to Roane the tendency

by conventional files to cause transportation of canals, ledges and perforations depends on

their lack of flexibility, their cutting tip and their use with unbalanced forces.40 Removing a

section of the tip and eliminating all the cutting angles, it was possible to reduce the angle of

the tip from 75° to 35° creating a type of collar that guides the penetration of the file.

Furthermore the spirals of the Flex-R files are obtained by micromachining and not by torsion

and varies in depth according to the size of the instrument: less depth in the smaller sizes to

give more strength and more depth in the bigger sizes to give more flexibility.

42
 Flex – R file # 40. A. Tip
(x64). B. Body (x64).

Nitiflex

The Nitiflex are files in nickel titanium with a rounded non-cutting tip, obtained by

micromachining a round wire. The Nitiflex are available in ISO diameters 15 to 60 and

lengths of 21 and 25 mm. They have a cross-section design that varies progressively with the

size of the instruments with the aim of maintaining constant flexibility and torsional strength.

Infact the Niti with the smaller size are more fragile, have a core design that is triangular with

convex sides to increase the mass of metal and thus the torsional strength while the bigger

sizes are more robust but more rigid and have a triangular design with concave sides to

increase flexibility.

A. Tip of a # 30 Nitiflex
(Dentsply-Maillefer) (x64). B.
Photograph of the body of
the same instrument (x64).

43
ProFile Series 29.02

Hand Files the ProFile Series 29.02 Hand Files are files manufactured by micromachining a

steel or nickel titanium wire with .02 taper and is characterized by a tip with a rounded

transition angle that reduces the risk of creating ledges in curved canals. The ProFile Series

29 does not follow the standardization of the ISO diameters, but those of the ProFile 29

devised by Schilder in 1989: their diameter at the tip does not increase in a linear and fixed

way but by 29.17%, enabling the operator to have more instruments in the range of maximum

utility, (from size 10 to size 40). Even the numbering of the ProFiles 29 does not follow the

standard ISO system: infact they are numbered from 2 (with a tip diameter of 0.129 mm) to

number 11 (with tip diameter 1.293 mm). Furthermore there are ProFile 29 Hand files in steel

number 00, 0 and 1 corresponding respectively to ISO files 06, 08 and 10. It is important to

emphasize once again that the term ProFile 29 does not refer to a type of instrument but to a

type of standardization that can be applied to all the instruments: infact there are ProFile 29

reamers and ProFile 29 Hedstroem etc.

C+Files

The C+Files are files devised to facilitate the location of the

canal orifices and the initial exploration of calcified canals.

Available in ISO diameters 8, 10 and 15 with lengths of 18,

21 and 25 mm, the C+Files show a characteristic resistance to

deformation, derived from the robust quadrangular cross-

section, which allows the operator to exert 143% more

pressure during insertion into a canal than would deform a K-File of corresponding size. The

C+Files have depth gauge black markings along their shaft, which indicate 18, 19, 20, 22 and

24 mm from the tip, aiding the positioning of the silicone stop and allowing an accurate

44
check of the insertion depth of the instrument. Ultimately the pyramidal tip of the C+Files

favours the penetration in calcified canals, while their metallic surface has been subjected to

an electropolishing process, which makes them particularly smooth, thereby reducing the

friction against the canal walls and the accumulation of debris in the spaces between the

blades.

Ergoflex

The Ergoflex K-Files are files obtained by microgrinding that are characterized by a

particular flexibility, depending on the depth of the blades, by the blunted tips for security

and an ergonomic handle that prevents undesired intra-canal rotation of the instruments.

Available in steel and nickel titanium with ISO diameters from 8 to 70 and lengths 21 and 25

mm, the Ergoflex K-Files are particularly efficient in cutting by filing but must not be rotated

in the canal as they do not have a high torsional strength.

Tip of a # 40 Ergoflex (FKG)

(x64). B. Photograph of the
body of the same

Triple-Flex
The Triple-Flex file is obtained by twisting a steel wire with a triangular crosssection, has a

cutting tip and is characterized by high flexibility, torsional strength and debris removal

45
capability. The Triple-Flex file is available in ISO diameters from 08 to 80 and lengths of 21,

25 and 30 mm.

Ultrasonic Files

The ultrasonic files (www.satelec.com) are practically K-Files

without handles, which can be mounted using appropriate inserts on

the ultrasonic handpiece. They are available for various ultrasonic

units namely Satelec, Spartan and EMS. Until a few years ago they

were recommended for root canal shaping, currently they are used to

passively activate the irrigating solution before canal obturation. The use of the ultrasonic

files for canal shaping is not recommended due to their tendency to make ledges in the canal

walls and their structural fragility.

Hedstroem files

The Hedstroem Files or H Files are obtained by microgrinding a conical steel or NiTi wire

with a round cross-section.

A # 20 Hedstroem file
(Dentsply Maillefer). A. Tip
(x64). B. Body (x64)

46
The cutting angle of the blades (helical angle) against the dentine is, for the Hedstroem, close

to 90° making this instrument particularly aggressive when using the push and pull (filing)

action. The design of the blades is however also responsible for the structural weakness of the

Hedstroem files, when used in a rotational manner. This is due to the fact that the deep

grinding of the surface has reduced the central mass of metal which determines the torsional

strength of the instrument. The efficient cutting action of the H-Files seems to be superior of

that of K-Files and this explains the popularity of this instrument especially for

circumferential filing of canals with oval or elliptical cross-section. The Hedstroem files are

distributed by most manufacturers of endodontic instruments with diameters and lengths

provided by the ISO standard.

Modifications of H-file.

Profile Series 29.02 Hedstroem

The Profile Series 29.02 Hedstroem are obtained by machining a blank wire with round

cross-section in steel or NiTi. Like all the instruments of Profile Series 29, these H-Files

follow the standardization of the Profile diameters with increment fixed at 29.17%. The

Profile Series 29 Hedstroem are available with diameters from 2 to 9 (steel) and 2 to 11

(Nichel-Titanium).

Ergoflex H-Files

The Ergoflex H-Files (or Flextroem) are Hedstroem files that are characterized by a particular

flexibility that depends on the depth of the machining of the shaft, the rounded tip for safety

and an ergonomic grip that prevents undesired rotation of the instrument inside the canal.

Available in steel and NiTi, in ISO diameters of 8 to 50 with lengths 21 to 25; the Ergoflex

prove to be very efficient when cutting by filing but must not be rotated in the canal because

they are not very resistant to rotational loading.

47
 A # 20 Ergoflex H file (FKG).
A. Tip (x64). B. Body (x64).

Micro-Debriders

The Micro-Debriders (www.dentsply-maillefer.com) are Hedstroem Files with a taper of .02

characterized by a short shaft bent at an angle of 200° and a long grip in plastic. It is ideal for

working under the microscope without interference of the fingers in the operative field. They

can also be useful for teeth with difficult access such as some upper and lower molars or in

patients with limited opening. The MicroDebriders are to be used only with a circumferential

filing movement and are availabe in ISO diameters 20 and 30. The MC Instruments are

almost identical to the Micro-Debriders but are available in diameters 08 to 30.6

48
 Micro-Debriders (Dentsply
Maillefer).

A-File
It’s a variant of H-file. Its cutting edges are at an acute angle to long axis of the file When

used in curved canals, flutes on the inner edge collapse, so no dentin is removed. On the outer

edge, flutes open, filling the

dentin on outer curvature.13

Schematic representation of
H and A- file.

49
HAND INSTRUMENTS WITH GREATER TAPER

Profiles .04 hand files

Profiles .04 Hand Files are NiTi hand instruments obtained by machining; available in ISO

diameters from 15 to 80, the Profile .04 Hand Files have a taper that is twice that of

traditional hand files with a diameter that increases from the tip to the handle by 0.04 mm per

mm of length. The design of the blades and tip of the hand Profiles is identical to the rotary

Profile; the blades infact are flat radial lands type and the tip is rounded and non cutting. The

correct method of using the ProFiles manually is rotation in the canal with light pressure

without forcing the instrument. Complete rotation of 360° or more is permissible but it is also

possible to use the balanced force technique. The Profile Hand instruments can be used as

finishing instruments in complex cases where the use of rotary instruments could be

hazardous (confluent canals, sharp apical curvatures) or also as the only instrument for root

canal shaping.

Hand GT Files

The Hand GT Files devised by Dr. L.S. Buchanan, are instruments in NiTi with greater taper

obtained by machining;

The hand GT files (Courtesy

of Dr. L.S. Buchanan).

50
contrary to the Rotary GT Files and Profiles which have radial lands type blades, the Hand

GT Files have sharpened blades

A. Hand GT files have a

triangular cross section. B.
Rotary GT files have radial
lands type blades (Courtesy
of Dr. L.S. Buchanan).

which are machined in an counter-clockwise direction with a pitch (number of spirals per

mm) and helical angle (blade inclination) that is variable from the tip towards the handle. In

particular, the number of spirals are higher and the cutting angle wider near the apical part of

the instrument, while coronally the spiral number is reduced and the angle becomes narrower.

Clinically the apical part functions like a K-File with good torsional strength and tactile

perception of the canal, while the coronal part functions like a reamer reducing the tendency

to screw in and favouring the elimination of debris. The Hand GT Files also have the blade

direction counter-clockwise, that is opposite to other hand instruments and therefore to be

51
able to cut they must be rotated in a counter-clockwise direction. It is possible to use the

Hand GT Files with the watch winding movement but in the opposite direction or using the

balanced force technique inverted, while their filing efficiency is modest (push and pull). The

GT Hand Files consist of four instruments with a fixed diameter at the tip of 0,20 mm, a

maximum diameter of the blades of 1.00 mm and a taper respectively of .06, .08, .10 and .12;

as a consequence of this characteristic, the length of the cutting part of the GT Files reduces

from 13.5 mm for the .06 taper to 6.7 mm for the .12 taper. The GT Hand Files have a non-

cutting tip, ergonomic pear shaped handle with a diameter of 6 mm and depth gauges that is

dark markings placed along the shank at 18, 19, 20, 22 and 24 mm from the tip, that

facilitates the positioning of the silicone stop and allows accurate control of the insertion

depth of the instrument. The colours of the handle (white for GT .06, yellow for GT .08, red

for GT .10 and blue for GT .12) do not follow the ISO system but are for indicating the

progression of the taper of the instruments. The GT Hand Files can be used on their own as

the only instruments for shaping or sequentially with hybrid instrumentation together with

hand instruments or following rotary instruments such as GT Rotary Files, Profiles or the

ProTapers. They are particularly useful to bypass the ledges and in the presence of canals

with a severe apical curvature due to the possibility of precurvature with the appropriate

instruments such as the Endobender.

Micro-Openers

Micro-Openers are K-Files with a greater taper characterized by a shank that is bent at an

angle of about 200° and a long handle in plastic. Ideal for using under the microscope, they

prevent interference in the operative field by the fingers. The Micro-Openers can be useful in

teeth with difficult access such as some maxillary and mandibular molars or in patients with

limited opening of the mouth. The Micro-Opener series comprises three instruments with a

52
tip diameter respectively of 0.10, 0.15 and 0.10 mm and a taper respectively of .04, .04 and

.06.6

Micro-Openers (Dentsply
Maillefer).

STEEL ROTARY INSTRUMENTS

GROUP – II - LOW-SPEED STAINLESS STEEL
ENDODONTIC INSTRUMENTS WITH LATCH-TYPE
ATTACHMENTS

Gates-Glidden drills

The Gates-Glidden drill has a long, thin shaft ending in

a flame-shaped head, with a safe tip to guard against

perforations. The flame head cuts laterally and is used

with gentle, apically directed pressure. The long shaft

is designed to break at the neck, the narrowest

diameter that lies adjacent to the handpiece. If the drill

binds during use, it will fracture at the neck of the shaft

Gates-Glidden drill. Note the flame-
shaped head with a safe tip

53
and will extrude from the tooth. The fractured segment is easily removed by grasping the

broken shaft with pliers and pulling it out of the tooth.

Peeso reamers
The Peeso reamer has long, sharp flutes connected to a thick shaft. It cuts laterally and is

primarily used for the preparation of post space when gutta-percha has to be removed from

the obturated root canal.

Both Gates-Glidden drills and Peeso reamers are made of stainless steel and are used with an

electric slow-speed handpiece in a rotational speed range of 800–1200 rpm.

These aggressive cutting instruments are inflexible and should be used at slow speed in a

contra-angled engine-driven handpiece and with extreme caution to prevent

overinstrumentation and perforations.

The diameters of Gates-Glidden drills and Peeso reamers are:

Diameter of Slow-Speed Rotary

Stainless Steel Instruments

Endo-Eze A.E.T. files

The Endo-Eze A.E.T. Files (Anatonical Endodontic Technology) consist of two types of

instruments, the Shaping Files and the Apical Files, both in steel and designed by F. Riitano.

The Shaping Files are 4 rotary instruments to be used in an appropriate contra angled

54
handpiece having alternate clockwise/ counter-clockwise movement of 30°. The Shaping

Files are available in 4 lengths (19, 23, 27 and 30 mm) and are:

Shaping 1 with tip diameter of 0.10 mm and .025 taper

Shaping 2 with tip diameter of 0.13 mm and .045 taper

Shaping 3 with tip diameter 0.13 mm and .06 taper

Shaper C with tip diameter 0.25 mm and taper .035.

The Shaping Files have blades that cut even with a lateral brushing movement and are

particularly indicated for the cleaning of canals with an irregular anatomy such as canals with

an elliptical cross-section, C-Shaped etc. The Apical Files are hand instruments in steel

characterized by a working part with limited length to allow a better tactile perception during

the apical shaping. The Apical Files are available in lengths of 19, 23, 27 and 30 mm and ISO

diameters of 15 to 50. The taper of the working part is .02 up to diameter 25 and then

increases to .025.6

G
A. The A.E.T. Shaping files are particularly indicated for the cleaning of canals
with an irregular
GROUP III: anatomy such as canalsAND
ULTRASONIC with anSONIC
elliptical cross-section
INSTRUMENTS (Courtesy
of Ultradent). B, C. The apical files are available in length of 19, 23, 27, and 30 mm

55
GROUP III: ULTRASONIC AND SONIC INSTRUMENTS

Ultrasonic and sonic instruments have been developed mainly for cleaning the root canals

and have a limited role in shaping of the root canals. The ultrasonic

instrument consists of a piezoelectric or a magnetostrictive unit that

generates ultrasonic waves. The piezoelectric units are better in that they

are more powerful and generate lesser heat than the magnetostrictive

systems. The handpiece holds a K-file or a specially designed diamond

file that, when activated, produces movements of the shaft of the file

between 0.001 and 0.004 inch at a frequency of 25–30 kHz.

This oscillating movement produces the cutting action of the file and

creates an ultrasonic wave of irrigant solution, which is delivered along the side of the file

into the root canal. The ultrasonic vibration produces heat that increases the chemical

effectiveness of the irrigating solution.

Ultrasonic files and tips.

It also produces two significant physical processes:

1. Cavitation: This is the growth and collapse of bubbles, with a resulting increase in the

mechanical cleansing activity of the solution. Because of this increase in thermal and

mechanical activity of the irrigating solution delivered into the root canal, removal of debris

and tissue from the isthmus and removal of the smear layer are more efficient. The

bactericidal action of the irrigating solution also increases. However, the root canal diameter

does not permit cavitation significantly.

56
2. Acoustic streaming: This is the formation of small but intense eddy currents or fluid

movements around the oscillating instrument. This improves the cleaning ability of the

irrigant through hydrodynamic stresses.

Before ultrasonic instrumentation, the apical third of the root canal should be instrumented to

at least the size of a No. 30 to No. 40 file. This is because both acoustic streaming and

cavitation are totally dependent on the free oscillation of the instrument. Hence, ultrasonic

devices have very limited application in the shaping of the root canal. They do improve the

cleaning ability of the irrigant and help in debriding regions that are difficult to access, such

as the isthmus of a canal.6

Sonic handpieces operate at 2–3 kHz when used inside root canals.

They are similar in shape and weight to dental handpieces and are attached to existing air and

water lines. These instruments are used in a manner similar to the ultrasonic system in

instrumentation of the root canals.7 The only difference is that the sonic system uses water as

an irrigant and requires special instruments known as follows:

• Rispi Sonic

• Shaper sonic

• Trio sonic (or Helio sonic)6

57
GROUP – IV - ENGINE-DRIVEN NICKEL–TITANIUM
ENDODONTIC INSTRUMENTS

MECHANICAL INSTRUMENTS IN NICKEL TITANIUM

Generations of NiTi Systems According to Haapasalo and Chen

FIRST GENERATION SYSTEMS

They are mechanized instruments manufactured with NiTi Alloy, that is, they have the

special properties of super elasticity and shape memory. This generation of files offers

superior quality in terms of flexibility and strength. The most used are: Quantec System

(Tycon/Analytic Endod/Kerr-United States), ProFile System 04/.06 (Dentsply/Maillefer-

Switzerland), K3 Endo System (SDS Kerr-Sybron Endo-United States), Mtwo® System

(VDW Dental-Industry), ProTaper® Original (Dentsply/MailleferSwitzerland), ProTaper

Universal (Dentsply/Maillefer-Switzerland) .

• Advantages: Optimum flexibility is the ability of the instrument to accompany the curvature

of a root canal avoiding the formation of steps, perforations along the root canal or at the

58
apical level; cutting efficiency; reduced working time for the operator, greater comfort for the

patient and a lower incidence of post operative pain.

• Disadvantages: They generate costs for the operator since they must be used only once;

possibility of instrument fracture; poor cleaning in flattened root canals.4

LightSpeed, LightSpeed LX (LightSpeed Technology, San Antonio, Tx, U.S.A.)

Originally, LightSpeed was designed similarly to a Gates Glidden with a small non-cutting

tip, radial lands and a long shaft. Manufactured from NiTi, LightSpeed instruments were the

most flexible instruments at the time. Each working tip showed an individual shape with a

slow increase in tip length (0.25 mm – 2 mm), diameter and conicity from one instrument to

the next. The instruments were initially used at 1,000 r.p.m. – 2,000 r.p.m. Later, the

manufacturer has recommended a slower speed. The principal of the LightSpeed technique

was to minimize, as much as possible, the contact between instrument and dentin.

Consequently, intermediate sizes were included, that further reduced the work load for each

file. This philosophy resulted in a high number of instruments (more than 20), with an

extremely short working time for each file. Due to its unique design, larger apical preparation

could be achieved, even in severely curved canals. Following apical preparation, a step-back

procedure had to be performed in order to create sufficient conicity along the complete length

of the canal allowing proper obturation. It has been recommended to obturate the apical part

of root canals prepared with LightSpeed with a tapered 5 mm long gutta-percha cone attached

to a metal carrier (SimpliFill). In a later version, called LightSpeed Xtra, the tip design was

changed and the number of intermediate size instruments was reduced, making the file set

considerably smaller. LightSpeed Xtra can be regarded as the first system of the fifth

generation with an asymmetrical geometry.

59
Each LightSpeed file shows a unique tip with tip size, conicity and length increasing slightly from one
instrument to the next.

Root canal instrumentation using LightSpeed instruments

60
ProFile .04 and .06 (Dentsply/Maillefer, Ballaigues, Switzerland)

ProFiles have been among the first systems to use crowndown preparation with rotary NiTi

systems.149,153 All instruments show a constant taper of 4% or 6%, respectively, and are

used in a crown-down sequence at 300 r.p.m.

ProFile .04 showing radial lands and a noncutting tip

61
K3 (Kerr/SybronEndo, Orange, CA, U.S.A.)

K3 instruments mark the transition from first to second generation. The file presents with

radial lands as well as with actively cutting blades and a positive rake angle, a noncutting

safety-tip and variable helical flute angle preventing a screw-in-effect.11

SECOND GENERATION SYSTEMS

Instruments manufactured with NiTi Phase R Alloy (Rombiodal), appear with the objective

of improving the properties of the first generation alloys files, increasing their flexibility and

reducing the risk of fracture, being manufactured by different thermal processes and also by

torsion. The intermediate phase (R) enable the instrument to be twisted by creating stretch

marks and cutting teeth without causing microfractures, giving the instrument greater

flexibility and resistance to torsional fracture. Within the most used systems we have: K3 XF

(Sybron EndoKavo/Kerr) Phase R/Wear, Twisted File (League R-Twisted), Easy Shaper

(Phase R-Easy Dental Equipment-Belo Horizonte, MG, Brazil)

• Advantages: High resistance to cyclic and torsional fatigue, lower fracture index, greater

cutting efficiency, offers a shorter working time providing a reduction of stress for the

professional, lower incidence of post-operative pain, therefore in greater comfort for the

patient

• Disadvantages: They generate costs to the operator since they must only be used once,

possibility of fracture but with a lower incidence than with the first generation instruments.4

62
Mtwo (VDW Antaeos, Munich, Germany)

Mtwo was one of the first NiTi systems with instruments designed as Hedstrom files. The

instruments show two actively cutting flutes making the system very effective for dentin

removal. All files of the set (04/10, 05/15, .06/20, .05/30, .04/35, .04/40) are used to working

length with the largest instrument in size being .04/40. Two additional sets .04/45, .04/50,

.04/60 and .06/30, .06/35, and .06/40 are completing the system. If thermoplastic obturation is

used, a final .07/25 instrument is also available.

A. The set of Mtwo instruments. B. The design of Mtwo is similar to a Hedstrom file. C. Cross-
section of Mtwo-files with two actively cutting blades.

63
RaCe and BioRaCe (FKG, La Chaux-de-Fonds, Switzerland)

The design of RaCe, an acronymon for Reamers with alternating Cutting edges, shows

alternating conical and parallel sections along the axis of the instrument, a convex triangle

cross-section, sharp cutting edges and a chemically treated surface. The system was followed

by the more popular BioRace system. All instruments, except an orifice shaper, are used to

working length: .05/15 (non-cutting tip) and .04/25 (cutting tip) working in the most apical

area; .06/25 (non-cutting tip) working in the middle and coronal third, 04/30 and .04/40

(cutting tips), working apically. In severely curved root canals, following size .06/25, two

flexible instruments sizes .02/35 and .02/40 can be used. For large preparations additional

sizes .04/50 and .02/60 are available.

Regular sequence of BioRaCe instruments (ns: non-cutting tip). The red color marks the regions
inside the root canal where the respective file is most active.

64
BT RaCe (FKG, La Chaux-de-Fonds, Switzerland)

Booster Tip (BT) RaCe is a modified tip with a low taper. Three files with an atypical

sequence of instruments are used for preparation: first a .06/10, followed by a non-tapered

.00/35 and finally a .04/35 instrument. For larger root canals, .04/40 and .04/50 instruments

are also available.

Sequence of the BT system. Note that the second instrument has a 0% taper

FlexMaster (VDW Antaeos, Munich, Germany)

The FlexMaster system comprises of instruments with three different tapers: 2%, 4%, or 6%,

non-cutting tips and a triangle, slightly convex cross-section and instrument sizes from 15 to

70, making it one of the systems with the largest variety of instruments.

The instruments are used in a crown-down-sequence starting with an Intro-File (9 mm cutting

length, 11% taper) followed by instruments with a 6% conicity. Following each instrument,

size or taper are decreased allowing a stepwise deeper penetration of the root canal. Size .02/

65
20 has to reach working length, followed by 2% instruments with increasing diameter for

apical enlargement. The instruments are used at approximately 300 r.p.m.

A. Basic box of FlexMaster with 10 instruments. More than 10 additional sizes (up to .02/70) are
available. B. The instrument shows a non-cutting tip and a triangular, slightly convex cross-
section.

ProTaper and ProTaper Universal (Dentsply/ Maillefer, Ballaigues, Switzerland)

ProTaper instruments were the first to show different conicities along the shaft in one

instrument. The system consists of six instruments:

• An Orifice shaper with a high conicity and a short cutting part;

• Two Shaping Files with small taper and small size at the tip and a high conicity (9%) near

the shaft;

• Three Finishing Files with increasing sizes (20, 25, and 30) and tapers up to 9% at the tip

and 5% towards the handle. This design results in limited contact areas between instrument

and root canal dentin. In a later version, called ProTaper Universal, the design was changed.

The cross-section was altered, making the file more flexible, the tip was rounded, making the

instrument tip non-cutting, and additional sizes (35, 40, and 50, all with a 5% taper) were

offered.11

66
A. Sequence of ProTaper instruments. Shaping files have small tips, but a large taper and size at
the upper shaft. B. Finishing files show increasing size and taper at the tip, with a smaller shaft.
Instrument no. 6 is an orifice opener with a great taper and reduced working part.

67
 Instrumentation of root canals with ProTaper instruments

THIRD GENERATION SYSTEMS

Third generation NiTi systems present modifications in the composition of the alloys that are

thermally pretreatment, making the files more.11

Advantages: High resistance to cyclic and torsional fatigue, lower fracture index when used

more than once, greater cutting efficiency, greater flexibility compared to first generation

(15% more flexible), less working time for the professional, greater comfort for the patient,

lower incidence of post operative pain.

Disadvantages: They generate higher costs, because according to the manufacturer they must

be used only once; possibility of fracture, but with a lower incidence compared to the

instruments of the previous generation.4

68
ProTaper Gold (Dentsply/Maillefer, Ballaigues, Switzerland)

The manufacturer's latest development, ProTaper Gold, shows increased flexibility due to

undeclared alterations in the metallurgy of the alloy. The file design is the same as the PT

Universal.11

Twisted files (Kerr/SybronEndo, Orange, CA, U.S.A.)

Twisted files are manufactured by twisting pretreated M-wire NiTi alloy. The system

includes five instruments with varying taper (.04 to .12) and a uniform tip size of 25. TF

adaptive are also manufactured from M-wire NiTi and produced by twisting thermically

pretreated alloy.

Typhoon (TYP, Clinicians’s Choice Dental Products, New Milford, CT, USA)

These instruments are fabricated from Controlled Memory (CM) wire, a thermally pretreated

NiTi alloy that significantly increase the resistance to torsional failure.

F 360 (Komet, Lemgo, Germany)

This system consists of two files sizes: .04/25 and .04/35, with two additional sizes for larger

root canals (.04/45 and .04/55). The design is of double helix, similar to Mtwoinstruments

(F360). The instruments, manufactured from conventional NiTi alloy, are used in a single-

length technique with 300 r.p.m. A root canal can usually be prepared with two or three

instruments.

F6 Sky Taper (Komet, Lemgo, Germany)

The company has introduced a corresponding One File System: F6 Sky Taper. The file has a

taper of 6%, two blades, a Hedstrom file design and is used in full rotation. 11

69
 F6 Sky Taper-instrument.

FOURTH GENERATION SYSTEMS

The fourth generation systems have nickel MC titanium alloys (memory control).

• Advantages: Is indicated for root canals with severe anatomical complexity. High resistance

to cyclic fatigue, lower fracture index. (300% more resistant), greater cutting efficiency,

greater flexibility, 80% more flexible than conventional instruments, offers less working

time, lower incidence of post-operative pain, greater patient comfort.

• Disadvantages: Contraindicated for wide or relatively wide and straight ducts

70
 TF adaptive (Kerr/SybronEndo, Orange, CA, U.S.A.)

The system includes two sets of instruments made from R-phase NiTi alloy: for small canals

instrument sizes .04/20, .06/25 and .04/35, for larger root canals .06/25, .06/35, and .04/50 are

available. Unfortunately, the color code does not keep to the ISO-code: green for the smallest

file, yellow for the middle, and red for the largest one, resembling a traffic-light sequence.

The instruments rotate in a clockwise direction up to 600°. In case of resistance, the forward

rotation is reduced to 370°, followed by a 50° backward motion.

TF Adaptive instruments work with a full rotation of maximum 600 degrees if no friction is present. Under
friction, the rotation is changed into a 370° clockwise and 50° counter-clockwise motion.

FIFTH GENERATION SYSTEMS

These instruments show a modified cross-section.

Revo-S (MicroMega, Besancon France)

These instruments show different cross-sections along the length of the instrument with three

cutting blades at the tip and two blades towards the shaft. Files are available in sizes .04/25,

.06/25, .06/30, .06/35, and .06/40.

71
One Shape (MicroMega, Besancon France)

One Shape instruments also show different cross-sections along the length of the instrument

with three cutting blades at the tip and two blades towards the shaft. The main instrument for

preparing of the majority of root canals is a size .06/25. Additional two larger instruments

(One Shape Apical) with sizes .06/30 and .06/37 are available for preparation of larger root

canals.

ProTaper Next (Dentsply/Maillefer, Ballaigues, Switzerland)

ProTaper Next (PTN)

presents with a rectangular

cross-section and a non-

cutting tip. The irregular

cross-section increases

space for dentinal debris

and reduces contact of the

instrument with the root

canal wall (only a three-

point contact is possible).

72
The rectangular cross section directs the file into its optimal position in the root canal. The

movement resembles a snake`s movement (“swaggering movement”). PTN is fabricated from

M-wire. Instrument sizes are .04/17, .06/25, and for optional use .07/30, .06/40, .06/50. For

glide path preparation, the manufacturer recommends PathFiles .03/13 and .02/15.

Mani Silk (Mani, Tohichi, Japan)

The Mani Silk system consists of three size instrument with an asymmetrical teardrop-shaped

cross-section, fabricated from thermally pretreated NiTi. Three different sequences can be

selected: .08/25, .06/25, and .06/30 for straight root canals; .08/25, .06/20, and .06/25 for

moderately curved; and .08/25, .04/20, and .04/25 for severely curved canals. The selection

of the systems presented does not cover the entire range of available systems. Development

of new systems with improved designs and metallurgy still continues.

SINGLE-FILE SYSTEMS

The latest generation of engine-driven root canal instruments are single-file systems. These

systems can be subdivided into those using a full clockwise rotary motion (F360 and F6 Sky

Taper [both Brasseler, Lemgo, Germany] and OneShape [Micro Méga, Besançon, France])

and those using a reciprocation working motion (Reciproc [VDW] and WaveOne [Dentsply

Maillefer]).

73
 Different single-file instruments. From above: Reciproc, WaveOne, OneShape and F360

These single-file systems are claimed to be able to completely prepare and clean root canals

with only one instrument. All single-file instruments have a non-cutting tip.

Tip configuration of different single-file instruments. From above: Reciproc, WaveOne, OneS

74
Reciprocating Single-File Systems

Two instruments, both made from M-wire alloy, belong to this group: Reciproc (VDW) and

WaveOne (Dentsply Maillefer). Reciproc instruments are available in different sizes 25.08

(R25), 40.06 (R40), 50.05 (R50), and WaveOne are available in the sizes 21.06 (small), 25.08

(primary), and 40.08 (large).

Characteristics of Single-File Systems

Out of these instruments, only the WaveOne size 21.06 has a constant taper while all other

instruments are characterized by a regressive taper. Only the first three millimetres of the

working part from the tip of the instrument have a constant taper of .08 followed by a

continuously decreasing taper. The final tapers near the shaft are .055 for the WaveOne

primary, .045 for the WaveOne large, .043 for Reciproc R25 and .04 for Reciproc R40 and

R50, respectively.

Reciproc instruments have an S-shaped cross-section along the entire working part of the

instruments This cross-sectional design results in sharp cutting edges and a small core

diameter with a comparable great chip space. In contrast, WaveOne instruments are

characterized by different cross-sectional designs. Near the tip, the cross section shows radial

75
lands, while in the middle part of the working length and near the shaft the cross-sectional

design changes from a modified triangular convex cross section with radial lands to a neutral

rake angle with a triangular convex cross section.

Cross-sectional designs of reciprocating and full rotary single-file instruments.

The reciprocating working motion consists of a counterclockwise (cutting direction) and a

clockwise motion (release of the instrument), whereby the angle of the counter-clockwise

direction is greater than the angle of the reverse direction.

Schematic illustration of the reciprocating working

motion. The angle of the counter-clockwise
direction (cutting action) is greater than the angle
of the reverse direction (release of the instrument).

76
The actual angle of counter-clockwise rotation is 158.68° for Reciproc and 159.85° for

WaveOne, while the angle in clockwise direction is 34.65° for Reciproc and 41.44° for

WaveOne. The actual cycle rotational speed is 282.92 r.p.m for Reciproc and 343.36 r.p.m

for WaveOne. However, these values strongly depend on the type of motor used. It should be

noted that the actual values may differ from those set by the manufacturer. Due to the fact

that the angle of the counter-clockwise motion is greater than the angle in clockwise

direction, the instrument progresses continuously towards the apical end of the root canal. It

is important to note that the angles of reciprocation are specific to the design of WaveOne

and Reciproc instruments and are programmed in special electronic motors. It is therefore

mandatory to use a motor that is able to generate the required counter and clockwise angles.

Reciproc and WaveOne instruments are not suited for sterilization processes since they do

not fit into the handpiece again. Therefore, these instruments can only be used for one patient.

Clinically, it is important to consider that these instruments should not be used in a single

straightforward motion up to the apical end of the root canal. Instead, the instruments should

be used in a slow in-and-out pecking motion with amplitude of less than 3 mm. One in-and-

out movement is defined as one peck. Following three pecks, the instruments should be

removed, the canal copiously irrigated, the flutes of the instrument cleaned and the canal

scouted with a small hand instrument, to avoid canal blockage with debris or dentin chips.

Thus, the handling of these reciprocating instruments should be based on a sequence of three

pecks where with every peck the instrument progresses deeper into the canal.

Some studies suggest that the use of reciprocating single-file systems is associated with little

to nearly no canal transportation, even when preparing severely curved canals. A micro-

computed tomographic evaluation found that the use of Twisted Files Adaptive in severely

curved root canal of extracted human mandibular molars resulted in less canal transportation

and better centering ability than Reciproc and WaveOne. It appears that these systems

77
considerably reduce the working time for canal preparation compared to other engine driven

NiTi systems. The use of these reciprocating instruments was safe, and fractures were not

noticed. Data about the cleaning efficiency of reciprocating instruments is controversial.

Regarding cyclic fatigue of reciprocating single-files, several studies suggested that the

reciprocating single-file instruments displayed greater flexural fatigue resistance than full-

sequence rotary systems. In general, Reciproc showed better torsional resistance and less

bending resistance than WaveOne. The superior behavior of Reciproc might be attributed to

the smaller core diameter of these instruments compared to WaveOne and the fact that for

Reciproc, the angles of reciprocation are smaller than those of WaveOne. Similarly, the speed

of reciprocation is lower for Reciproc than for WaveOne. However, the damage that these

instruments may cause to dentin is still controversial.

Full Rotary Single-File Systems

The single-file systems F360 and F6 Sky Taper (both Brasseler, Lemgo, Germany) and

OneShape (Micro Méga, Besançon, France) operate in a full clockwise rotational motion and

can be used in every torque-controlled motor and handpiece . Currently, no data are available

regarding the F6 Sky Taper instruments, since these instruments were launched only recently.

All F360 instruments possess a constant taper of .04 and the following sizes are available: 25,

35, 45, and 55.179 A modified S-shaped cross-sectional design is used for the entire working

part of the instruments and the instruments are made of a conventional austenite NiTi alloy.

OneShape instruments are available in sizes 25, 30, and 37 with a constant taper of .06. The

instruments are made of conventional austenite NiTi and are characterised by different cross-

sectional designs over the entire length of the working part. In the tip region, the cross section

represents three cutting edges while in the middle, the cross-sectional design progressively

78
changes from a three-cutting-edge design to two cutting edges. Near the shaft, the

instruments possess an S-shaped cross section with two cutting edges.

OneShape instruments have variable pitch lengths along the working part. It is claimed that

this design minimizes threading and binding of the instrument in continuous rotation.

According to comparative investigations, F360 and OneShape single-file instruments

prepared curved canals equally well compared to reciprocating single-file systems and full-

sequence rotary NiTi instruments. The original canal curvature was well maintained and

hardly any procedural errors were noted. The instruments were found to be safe.

One study found that the use of OneShape instruments required less time to prepare curved

canals in extracted teeth compared with Reciproc and WaveOne, while another study found

no difference. However, preparation of severely curved canals was significantly faster with

F360 and OneShape compared to the full-sequence Mtwo system (VDW). Two investigations

evaluated the shaping ability of F360 and OneShape instruments compared with the two

reciprocating single-file systems Reciproc and WaveOne in simulated S-shaped canals.Both

studies agreed that the lower tapered rotary single-file systems (F360 and OneShape)

maintained both original canal curvatures better than the reciprocating instruments having

greater tapers. OneShape prepared these S-shaped canals significantly faster compared to

WaveOne and F360 instruments.

79
Regarding the tendency of rotary single-file systems to extrude debris apically and to cause

dentinal damages, the available data is inconclusive.

Canal transportation using different full rotary and reciprocating single-file instruments in simulated
S-shaped canals. Preparation was performed to an apical size 25. The full rotary single-file
instruments maintained both canal curvatures better than the reciprocating instruments.

SELF ADJUSTING FILE (SAF)

The SAF shows a new conceptual approach to instrument design. It is constructed of two

broad lattices of NiTi that are connected by several small wires forming a connective mesh.

This principle of construction allows the file to be compressed in small and narrow canals

and to extend in root canals with large diameters. If the correct file size is selected, the

instrument is designed to touch as much root canal surface as possible. The instrument

operates in a special hand piece with slight vibrations in a frequency of 5,000 Hz.

Since the inner part of the instrument is hollow, an irrigant of choice can be introduced via

this empty space resulting in continuous irrigation during preparation. The irrigant can be

delivered at a maximum rate of 1–10 mL per minute. The two lattices show a rough surface

without blades. The file does not cut dentin like conventional instruments that are equipped

80
with cutting blades, but rather removes dentinal hard tissue by brushing or scrubbing and

immediately irrigating the shavings and tissue remnants out of the root canal. The tip of the

file is asymmetrically designed, allowing the instrument to vibrate itself into the best

position, hence the term Self Adjusting File. The compressibility of the instrument enables a

good adaption to the cross-sectional shape of the canal. When inserted into an oval canal with

a 0.2 mm mesio-distal diameter, a 1.5 mm SAF will be compressed mesio-distally and thus

spread bucco-lingually as far as 2.4 mm .

The manufacturer recommends using the SAF for four minutes per canal with a 4 mL per

minute flow rate of irrigant in small up and down movements. Ideally, the canal will be

uniformly enlarged along its entire circumference, resulting in an undefined, non-ISO shape,

magnification of the original canal shape.

Regarding obturation, lateral compaction does not seem to be suitable for the SAF technique

since the prepared root canal does not show a specific geometry. Thermoplastic obturation

techniques may be difficult since the apical taper is not clearly defined. The SAF represents

an interesting and novel approach of root canal preparation. It is able to save dentin by

maintaining the original root canal cross-sectional shape and provides good canal cleaning.

However, the SAF system is not widely used. Further studies are still necessary.

Self Adjusting File (note the mesh like pattern)

81
Instrumentation Techniques.

Manual Preparation Techniques

Ingle described the first formal root canal preparation technique known as the “standardized

technique.” In this technique, each instrument is introduced to working length resulting in a

canal shape that matches the taper and size of the final instrument. This technique was

designed for singlecone filling techniques using gutta-percha or silver cones.

Standardized Technique

This technique was first described by Ingle in 1961. Starting with small instruments, all

following instruments are inserted to working length. Preparation results in a root canal with

low conicity that theoretically reproduces the shape of the last instrument used (Master

Apical File [MAF]). The final shape of the preparation is suited, theoretically, for single cone

obturation techniques as a high congruence between the MAF, the shape of the root canal and

a matching gutta-percha cone is expected. Studies have shown that this congruence is rather

conceptual than real.

Step-Back Technique :The step-back technique or similar techniques such as the telescopic

technique or the serial technique aim at a higher conicity by stepwise reduction of working

length, once apical preparation has been finished with the MAF .

Sequence of instruments in the step-back procedure

82
Each step back is followed by irrigation and recapitulation with a small file. The step-back

technique has been for many years one of the traditional preparation techniques in

endodontics. In some studies it produced cleaner root canals than standardized techniques.

Circumferential Filing

Circumferential filing aims at reducing the percentage of unprepared root canal walls by

intentionally pressing the instruments against the walls. The instrument is inserted to working

length, pressed against the canal dentin, and withdrawn. After the next insertion of the

instrument to working length, it is pressed against the root dentin in some minor distance

from the first file and again withdrawn in a shaping movement. Repetition results in

circumferential preparation of the root canal dentin, theoretically touching the entire canal

walls. This preparation results in a higher conicity than the techniques described above.

Anticurvature Filing

This technique is designed to keep files away from the furcational zone of curved root canals

thus preventing excessive removal of dentin and strip perforations at this critical zone. This

goal should be achieved by use of precurved instruments (files) at the outer side of the

curvature.

Crown-Down Technique

This technique, first presented by Goerig et al., has gained new popularity with the

introduction of rotary NiTi instruments. Following coronal flaring, large instruments are used

to enter and enlarge the root canal a few millimeters apically each time. The instrument is

followed by a smaller file, preparing only a few millimeters deeper than the previous

instrument. This is repeated until working length is reached. As the final step, enlargement of

the apical diameter completes the preparation.

83
The advantages of the crown-down techniques are:

• Less friction and stress on the instrument thereby reducing risk of instrument fracture

• Less canal straightening since reduced friction allows a more controlled preparation

• Less contamination of the apical zone of the root canal by reducing transportation of

infected debris.

• Early coronal and mid-root enlargement allowing early disinfection of the coronal parts of

the root canal system.

• Reduction of extruded debris beyond the apical foramen.

A slightly modified technique, termed as crown-down pressureless, has been also suggested.

Sequence of instruments in the Crown-down procedure

Step-Down Technique

With this technique the coronal part of the root canal is prepared first, resulting in more

straight access to the middle and apical part of the root canal by early elimination of coronal

interferences. Early disinfection of the coronal space is expected to reduce apical

transportation of microorganisms, apical extrusion of debris and irrigant, and better control of

apical preparation.

84
Balanced Force Technique

The Balanced Force (BF) technique, described by Roane and Sabala in 1985,uses specially

designed instruments (Flex-R-Files) with non-cutting tips. The concept is to reduce the stress

on the instruments thereby reducing the risk of straightening the canal and fracturing the

instrument. The instruments are introduced until resistance is felt. The file is rotated at 180°

in a clockwise direction (placement phase) with a slight but constant apical pressure,

followed by a 120° rotation (cutting phase) in counterclockwise direction with maintained

apical pressure, to prevent coronal displacement of the file.

Principles of the Balanced Force technique. Instruments with

a symmetrical triangular cross-section and pilot tips

Finally the file is withdrawn in a clockwise motion (removal phase). The instrument is

worked to working length in 1-2 mm steps with repeated constant clockwise and

counterclockwise partial rotation, assisted by copious irrigation. It has been claimed that BF

preparation can achieve preparation sizes of 45 in curved canals and 80 in straight canals. The

main advantages of the BF technique are good apical control of the file tip since the

instrument does not cut over the complete length, and good centering of the instrument due to

the non-cutting safety tip. Good results for the preparation of curved canals without, or with

only minimal, straightening have been reported. However, incidence of procedural mishaps

85
such as root perforations or instrument fracture have been described as well. The amount of

apically extruded debris was lower than with stepback or ultrasonic techniques. However,

some earlier reports have indicated significantly more displacement of the root canal center

axes, suggesting straightening.

Hybrid Techniques

For some time, combining various NiTi preparation systems have been suggested to address

certain shortcomings of current instruments. Although many combinations are possible, the

most popular and useful ones involve coronal preenlargement followed by different

additional apical preparation sequences. However, clinicians must keep in mind that anatomic

variations in each canal must be addressed individually with specific instrument sequences.

Most important, oval canals extend deep into the apical area, and apical foramina may in fact

be oval in most cases. Naturally, a rotating file can produce a round canal at best; therefore a

strategy must be devised for adequately shaping oval canals without overly weakening

radicular structure.

86
Hybrid technique using Light
speed Instruments

87
Conclusion
The current literature reflects a trend towards the use of NiTi alloys with heat treatment and

controlled memory, designed to increase the flexibility and reduce the shape-memory

properties of instruments. In clinical practice, these instruments can be pre-bent and maintain

this flexed shape, facilitating penetration at the entrance of the root canal, which is in keeping

with more conservative approaches to access surgery. CM instruments also have a higher

deformation capacity before fracture than conventional instruments, due to their greater

flexibility and cyclic fatigue resistance. To date, there is still no endodontic instrument

capable of meeting all of the requirements of an optimal root canal preparation. New

materials and studies must be developed in the continued search for a system that can

combine efficiency and safety in endodontic instrumentation.

88
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92
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