NICKEL-TITANIUM ENDODONTIC

INSTRUMENTS
A new generation of endodontic instruments, made from a remarkable alloy,
nickel titanium, has added a striking new dimension to the practice of
endodontics.
The superelasticity of nickel titanium, the property that allows it to return to
its original shape following signifcant deformation, diferentiates it from
other metals, such as stainless steel, that sustain deformation and retain
permanent shape change. These properties make nickel-titanium endodontic
fles more fexible and better able to conform to canal curature, resist
fracture, and wear less than stainless steel fles.
History. !n the early "#$%s, the superelastic property of nickel-titanium
alloy, also known as Nitinol, was discoered by &uehler and 'ang at the
() *aal +rdnance ,aboratory."-$ The name *itinol was deried from the
elements that make up the alloy, nickel and titanium, and .nol/ for the *aal
+rdnance ,aboratory.
The trademark *itinol refers specifcally to the frst nickel-titanium wire
marketed for orthodontics.
As early as "#01, 2i3an and associates"-0 reported on potential
applications of nickel-titanium alloys containing nickel 114 by weight 511-
*itinol6 and nickel $%4 by weight 5$%-*itinol6. They found that the
characteristics of $%-*itinol suggested its use in the fabrication of tough
corrosion-resistant hand or rotary cutting instruments or fles for operatie
dentistry, surgery, periodontics, and endodontics. 7urther, it was suggested
that 11- or $%-*itinol could be used for the manufacture of corrosion-
resistant root canal points to replace siler points.
A frst potential use of nickel titanium in endodontics was reported in "#88
by 'alia and associates."-8 *umber "1 fles fabricated from nickel-titanium
orthodontic alloy were shown to hae two or three times the elastic fexibility
in bending and torsion, as well as superior resistance to torsional fractures,
compared with *o. "1 stainless steel fles manufactured by the same
process. The results suggested that *itinol fles might be promising for the
instrumentation of cured canals. !n "##-, a collaboratie group made a
decision to examine and study the possibility of producing *ickel titanium
instruments. The nickel-titanium reolution
in endodontics followed, and in 9ay "##-, )erene introduced these new fles
to students in the 2ollege of :ental 9edicine at the 9edical (niersity of
)outh 2arolina. ,ater these and other similar fles became aailable to the
profession generally.
Superelasticity Alloys such as nickel titanium, that show
superelasticity, undergo a stress-induced artensitic transformation from a
"
parent structure, which is austenite. +n release of the stress, the structure
reerts back to austenite, recoering its original shape in the process.
:eformations inoling as much as a "%4 strain can be completely
recoered in these materials, as compared with a maximum of "4 in
conentional alloys.
!n a study comparing piano wire and a nickel-titanium wire, )toeckel and ;u
found that a stress of -1%% 9<a was re=uired to stretch a piano wire to >4
strain,
as compared with only 1%% 9<a for a nickel-titanium wire."-# At >4 strain,
the music wire breaks. +n the other hand, the nickel-titanium wire can be
stretched much beyond >4 and can recoer most of this deformation on the
release of stress.
The superelastic behaior of nickel titanium also occurs oer a limited
temperature window. 9inimum residual deformation occurs at approximately
room temperature.
A composition consisting of 1% atomic percent nickel and 1% atomic percent
titanium seems ideal, both for instrumentation and manufacture.
Manufacture. Today, nickel-titanium instruments are precision ground into
diferent designs 5? style, @edstrom, 7lex-A, B-double futed, )-double futed, ( fles,
and drills6 and are made in diferent siCes and tapers. !n addition, spreaders and
pluggers are also aailable. *ickel-titanium instruments are as efectie or better
than comparable stainless steel instruments in machining dentin, and nickel-
titanium instruments are more wear resistant.">% ( and drill designs make it
possible to use mechanical 5ie, rotary handpiece6 instrumentation.
9oreoer, new prototype rotary motors now ofer the potential for improed
tor=ue control with automatic reersal that may ultimately decrease rotary
instrument breakage.
Finally, nickel-titanium fles are biocompatible and appear to hae excellent
anticorrosie properties.">" !n addition, implantation studies hae erifed that
nickel titanium is biocompatible and acceptable as a surgical implant.">- !n a "##0
AAD =uestionnaire, the endodontic membership answered the following =uestion,
.:o you think nickel-titanium instruments are here to stay and will become basic
armamentaria for endodontic treatmentE/ The responses were =uite positieF .yes,/
0-4G .maybe,/ -"4G and .no,/ H4.">>
'ith the ability to machine futes, many new designs such as radial lands hae
become aailable. Aadial lands allow nickel-titanium fles to be used as reamers in a
>$%- degree motion as opposed to the traditional reamers with more acute rake
angles. Although the most common use
-
of this new design has been as a rotary fle, the identical instrument is aailable as
a hand instrument. !n addition, a conerter handle is aailable that allows the
operator to use the rotary fle as a hand instrument.
Torsional )trength and )eparation. The clinician switching from stainless to nickel-
titanium hand instruments should not confuse nickel titaniumIs superelastic
characteristics with its torsional strength and so assume that it has super strength.
This misconception has led to unnecessary fle breakage when frst using this new
metal. )tudies indicate that instruments, whether stainless steel or nickel titanium,
meet or exceed A*)!JA:A )pecifcation *o. -8. @oweer, when reiewing the
literatureon this sub3ect the results seem to be mixed.2analda and &eraste=ui found
nickel-titanium fles5*itifex and *aifex6 5:entsplyG Tulsa, +kla.6 to bemore fexible
than the stainless fle stested 57lexofle and7lex-A6. @oweer, the stainless steel
fles were foundto be more resistant to fracture. &oth types of metalexceeded all
A*)!JA:A specifcations. 2analda et al., inanother study, compared identical
instrumentsF2anal9aster 5aka ,!K@T)<DD:6 stainless steel and 2anal9aster nickel
titanium. 'ithin these designs, thenickel-titanium alues were superior in all
aspects to those of stainless steel of the same design.
LTepel et al. looked at bending and torsional properties of -H diferent types of
nickel-titanium, titaniumaluminum,and stainless steel instruments.">$ Theyfound
the nickel-titanium ? fles to be the most fexible, followed in descending order by
titanium aluminum,fexible stainless steel, and conentional stainlesssteel.'hen
testing for resistance to fracture for -"brands, howeer, they found that *o. -1
stainless steel fles had a higher resistance to fracture than their nickel-titanium
counterpart.
L'olcott and @imel, at the (niersity of Tennessee,compared the torsional
properties of stainless steel ?type and nickel-titanium (-type instruments. As in
preious studies, all of the stainless steel instruments showed no signifcant
diference between maximumtor=ue and tor=ue at failure, whereas the nickel-
titanium instruments showed a signifcant diference between maximum tor=ue and
tor=ue at failure.
LDssentially, this means that the time between .windup/and fracture in nickel-
titanium instruments isextended, which could lead to a false sense of security.
'hile studying cyclic fatigue using nickel-titanium ,!K@T)<DD: instruments, <ruett
et al. determined that canal curature and the number of rotations determined fle
breakage. )eparation occurred at the point of maximum curature of the shaft.
L 2yclic fatigue should be considered a alid term, een for hand instrumentation,
in light of the fact that many manufacturers are placing handles on fles designed
for rotational use.
7rom these studies, it seems that if the clinician is changing from a high-tor=ue
instrument, such asstainless steel, to a low-tor=ue instrument, such as nickel
titanium, it would be wise to know that nickeltitanium instruments are more eMcient
and safer when used passiely.
>
LAlthough instrument breakage should be rare, any instrument, hand or rotary, can
break. !t is the clinicianIs knowledge and experience, along with the manufacturerIs
=uality control, that will ultimately minimiCe breakage.
At both the (niersity of Tennessee and (niersity of 2alifornia at ,os Angeles,
breakage has not increased with the routine use of nickel-titanium instruments. !f
breakage occurs, the fractured piece can occasionally be remoed or bypassed
using ultrasonics and hand instruments in con3unction with magnifcation.
LThe dentist haing problems with fle breakage should seek help in ealuating his
techni=ue. +ne should practice on extracted teeth until a leel of confdence is
reached that will help ensure safe and eMcientpatient care.
The following is a list of situations that place nickeltitanium hand instruments at risk
along with suggestions for aoiding problemsF
Nickel-Titanium Precautions and
Prevention:
1. +ften too much pressure is applied to the fle.*eerforce a fleN These
instruments re=uire a passie techni=ue. !f resistance is encountered, stop
immediately, and before continuing, increase the coronal taper and negotiate
additional length, using a smaller,
%.%- taper stainless steel hand fle. )tainless steel fles should be used in siCes
smaller than a *o. "1. !f one is using more fnger pressure than that re=uired to
break a *o. - pencil lead, too much pressure is being used. &reak a sharp *o. -
pencil lead and see how little pressure is re=uiredN
2. 2anals that 3oin abruptly at sharp angles are oftenfound in roots such as the
mesiobuccal root of maxillary molars, all premolars, and mandibular incisors and the
mesial roots of mandibular molars. The straighter of the two canals should frst be
enlarged to working length and then the other canal, only to where they 3oin. !f not,
a nickel-titanium fle may reerse its direction at this 3uncture, bending back on
itself and damaging the instrument.
3. 2ured canals that hae a high degree and small radius of curature are
dangerous.">8 )uch curatures 5oer $% degrees and found > to H mm from
working length6 are often seen in the distal canals of mandibular molars and the
palatal roots of maxillary frst molars.
4. 7iles should not be oerusedN All clinicians hae experienced more fracture after
fles hae been used a number of times. Aemember that all uses of a fle are not
e=ual. A calcifed canal stresses the fle more than an uncalcifed canal. A cured
canal stresses the fle more than a straight canal. +ne must also bear in mind
operator ariability and the use of lubricants, which will afect stress.
H
2onsider discarding a fle after abusie use in calcifed or seerely cured canals
een though it has been used only in one tooth. (se new fles in hard cases and
older fles in easier cases. *o one knows the maximum or ideal number of times a
fle can be used. 7ollow manufacturersI instructions and the rule of being .better
safe than sorry./ +nceonly is the safest number.
5. !nstrument fatigue occurs more often during the initial stages of the learning
cure. The clinician changing from stainless steel to nickel titanium should take
continuing education courses with experienced clinicians and educators, followed by
in itro practice on plastic blocks and extracted teeth. &reak fles in extracted teethN
:eeloping a leel of skill and confdence
allows one to use the techni=ue clinically.
6. ,edges that deelop in a canal allow space for defection of a fle. The nickel-
titanium instrument can then cure back on itself. A nickel-titanium instrument
should not be used to bypass ledges.
+nly a small cured stainless steel fle should be used, as described, in another
section of this text.
. Teeth with .)/-type cures should be approached with cautionN Ade=uate faring
of the coronal third to half of the canal, howeer, will decrease problems in these
cases. !t may also be necessary to go through a series of instruments an additional
time or two in more diMcult cases.
!. !f the instrument is progressing easily in a canal and then feels as if it hits
bottom, :+ *+T A<<,; A::!T!+*A, <AD))(ADN This will cause the instrument tip to
bind. Additional pressure applied at this point may cause weakening or een
breakage of the instrument. !n this situation, remoe the instrument and try a
smaller, %.%- taper hand instrument, either stainless steel or nickel-titanium,
carefully faring and enlarging the uninstrumented apical portion of the canal.
". Aoid creating a canal the same siCe and taper of the instrument being used. The
only exception is in the use of the &uchanan KT fle concept 5to be discussed later6.
+n remoal from the canal, the debris pattern on the fle should be examined.
:ebris should appear on the middle portion of the fle.
Dxcept for negotiating calcifed canals and enlarging the apical portion of the canal,
the tip and coronalsection of the fle should not carry debris.
Aoid cutting with the entire length of the fle blade. This total or frictional ft of the
fle in the canal will cause the instrument to lock. !f this occurs, rotate the
instrument in a counterclockwise direction and remoe it from the canal. The
greater the distance a single fle is adanced into the canal, the greater will be the
chance of fles .locking up./ 'hen the fle feels tight throughout the length of blade,
it is an indication that the orifce and coronal one-third to two-thirds of the canal
need increased taper. !nstruments of arying design
1
andJor taper can be used to aoid frictional ft. *ickel-titanium instruments with
tapers from %.%H, %.%$, and greater, as well as Kates-Klidden drills and
sonicJultrasonic instruments, sere this purpose well.
1#. )udden changes in the direction of an instrument caused by the operator 5ie,
3erky or 3abbing moements6 must be aoided. A smooth gentle reaming or rotary
motion is most eMcient.
11. As with any type of instrument, poor access preparation will lead to procedural
errors.
12. Adancing or pushing an instrument into a canal in too large an increment
causes it to act as a drill or piston and greatly increases stress on the metal. Dxcept
for the most diMcult cases and the necessity of using small instruments, the tip
should not be used to cut into or drill into the canalG it should act only as a guide.
Aegardless of the techni=ue being used, nickel-titanium instruments should be
adanced in small increments with a more passie pressure than that used with
stainless steel.
13. :o not get in a hurryN :o not get in a hurryN :o not get greedy and try to make
nickel titanium do more than it is designed to do.
14. !nspection of instruments, particularly used instruments, by staf and doctor is
critical. <rior to insertion and on remoal, look at the blade.Aotate the fle, looking
for defections of light. This indicates a damaged instrument. Also remember that,
unlike stainless steel, nickel titanium has an excellent memory. The fle should be
straight. !f any bend is present, theinstrument is fatigued and should be replaced.
15. :o not assume that the length of fles is always accurateGmeasure each fle.
)ome fles are longer fromhandle to tip than others. 7iles may also become longer
or shorter if they are unraeled or twisted.
2omparatie )tudies
*ickel-titanium instruments function diferently than those made of stainless steel,
een when the cross-sectional design, taper, futes, and tip are identical. !n an efort
to compare hand nickel-titanium to stainless steel fles, a series of studies were
initiated at The (niersity of Tennessee. Dighty-two second-year dentalstudents
were re=uired to instrument two epoxy blocks containing cured canals. The only
ariable was the use of stainless steel fles in one block and nickel-titanium fles in
the second block. )tandardiCed photographs were taken of the blocks before and
after instrumentation.
+erlay tracings were made of these photographs, and diferences in the shapes of
the before and after drawings were measured. The nickel-titanium blocks receied a
higher grade $0.#4 of the time and the stainless steel blocks "H.84 of the time.
'orking length was maintained signifcantly more often 5p O .%16 in the nickel-
titanium group than in the stainless steel group. There was no ledging of canals
$
using the more fexible nickel-titanium fles compared with >%.H4 ledging when
stainless steel fles were used. 'hen using nickel-titanium fles, the students were
short of working length in only >4 of the canals compared with H$4 of the canals
when using stainless steel fles. Although the canals were instrumented beyond the
intended working length in -14 of the nickel-titanium blocks, the students were
able to deelop an apical stop within " mm between working length and the end of
the canal. !n the stainless
steel group, $4 of canals fell into this category. The degree of destruction around
the foramen was signifcantly diferent 5p O .%16. Apical Cipping occurred >".04 less
often with the *itinol fles.
)tripping of the canal walls was less with the nickel-titanium fles. A second study in
which the blocks were instrumented by a member of the faculty had similar
fndings.
LAn obseration from these studies was the creation of a smooth belly shape on the
outer aspect of the apical third of the canals instrumented with nickel-titanium
instruments. This seemed to replace the ledging
that occurred with stainless steel. +ther studies hae shown that this may be
attributable to the techni=ue in which the fles were used.Are nickel-titanium hand
instruments best used with a push-pull fling motion or with a reaming or rotary
motionE !n one study, nickel-titanium fles used in a fling motion caused a
signifcantly greater amount of the outer canal wall to be remoed, between > and $
mm short of working length. The stainless steel fles, howeer, remoed
signifcantly more of the outer canal wall, at working length and in the danger Cone,
than did the rotary or hand nickel-titanium fles.
The rotary nickeltitanium fles were signifcantly faster and maintained better canal
shape than the other groups. The results of this study indicate that nickel-titanium
instruments
should be used with a rotational or reaming motion and are efectie in shaping root
canal systems.
L(sing computed tomography, Kambill et al. reamed extracted teeth with either
stainless steel or nickel-titanium fles and reported that the nickel-titanium fles
caused less canal transportation, remoed less dentin, were more eMcient, and
produced more centered canals.
L+n the other hand, not all studies are in agreement concerning cutting eMciency.
Tepel et al. tested -H brands of hand instruments specifcally for cutting eMciency.
They found that fexible stainless steel fles were more eMcient than nickel titanium.
@oweer, they did not address the =uality of the completed canal.
LDlliot et al., at KuyIs @ospital in ,ondon, used resin blocks to compare stainless
steel 57lexofles6 and nickel- titanium 5*itifex6 instruments used with either a
balanced force or stepback techni=ue.
0
LThe authors concluded that it is preferable to use nickel-titanium instruments in a
balanced force techni=ue and stainless steel in a fling techni=ue because stainless
steel fles can be precured. 2onsidering the results from Tennessee and ,ondon,
nickel-titanium instruments should be used as reamers, not fles.
7igure "%--8 Puantec .fles/ are more like a reamer, a drill as it
appears, and are used in a rotary motion, not push-pull A, Puantec
safe-cutting tip fle. &, Puantec noncutting tip fle. The fles are
produced in three diferent tapersF %.%-, %.%H, and %.%$ mmJmm.
52ourtesy of )ybron-DndoJ?err6
QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ
7igure "%--$ The unusual ,ight)peed instrument. .(/ shaped in
8
design with a noncutting tip, the ,ight)peed cutting head terminates
a "$ mm noncutting shaft.9ade only in nickel titanium in !)+
siCes -% to "%% and in half siCes as well, they are used in rotary preparations
at -,%%% rpm. 52ourtesy of ,ight)peed Technology !nc.6
Cleaning protocol for rotary nickel-titanium
endodontic instruments:
Background: The cleaning of endodontic and all dental instruments prior to
sterilization is a prerequisite for their processing for re-use. This study aimed to
deelop a clinically practical cleaning protocol for rotary nickel-titanium 5*iTi6
endodontic fles prior to steriliCation.
Met$o%s& 2leaning experiments were conducted onsix diferent types of fles
that had been used on human teeth. The experiments inoled three components of
mechanical and chemical remoal of root canal debris from the flesF the use of
sponges soaked with chlorhexidine to remoe gross debris, pre-soaking, and
ultrasonication. After cleaning, the fles were immersed in Ran KiesonIs solution and
examined under magnifcation for stained debris. *ew unused fles were also
examined.
'esultsF 9acroscopically, there were no instances of isible debris and all fles
appeared clean after all cleaning se=uences. 9icroscopically, new fles showed both
stained and unstained debris, and seeral experimental cleaning regimens
produced fles that were free of stained debris. 2ombining elements of the most
efectie cleaning se=uences resulted in a cleaning protocol that predictably
produced clean fles.
(oncnslusio& The results do not support the recommendation for the single
use of endodontic fles based on inability to clean fles between uses. (nder
experimental conditions the cleaning protocol deeloped rendered rotary *iTi fles
"%% per cent free of stained debris. The protocol comprises "% igorous strokes in a
scouring sponge soaked in %.- per cent chlorhexidine solution, a >% minute pre-soak
in an enCymatic cleaning solution, "1 minutes ultrasonication in the same solution,
and a -% second rinse in running tap water.
The protocol can be applied to all endodontic fles.
Some stu%ies con)rm t$e
e*ecti+eness of Ni,i instruments&-
#
1- .+aluation of Sin/le-use 'otary Nic0el-titanium
1nstruments
The purpose of this study was to document the number and types of defects
obsered in a single brand of *i-Ti engine-drien rotary instruments discarded after
one clinical use in a specialiCed endodontic practice. Dery <ro7ile )eries -# .%H
taper nickel-titanium rotary instrument that was used clinically during a H-week
period was collected from an endodontic oMce in &loomfeld @ills, 9!. All
instruments were new and were used by experienced clinicians during a single
patient isit. After teeth were accessed, gates gliddens were used to coronally fare
the orif, )) hand fles were used to a siCe "1 to working length. The canals were
then instrumented to working length with the .%H taper <ro7ile from large to small
5S0 to S-6. A2 prep and copious irrigation were used. A 9icro9ega >-H air motor
with contra-angle 5$F"6 reduction, set at >>> rpm was also used. The instruments
were then collected, ultrasonically cleaned, steriliCed and inspected with a Klobal
:ental 9icroscope at B"$ magnifcation. The types and numbers of defects were
recorded and statistical analyCed. A total of 08$ fles were ealuated and the
instrument groups diided into three diferent groups consisting of torsional fatigue,
fexural fatigue, and fracture. A total of ""1 5"146 of these instruments showed
some type of defect after one clinical use. The siCe > had the highest defect rate
5->46. The -, H, and 1 fles had defect rates from "$ T "04 and the $ and 0 fles
showed minimal defects of -.H and H.84 respectiely. Torsional fatigue accounted
for the ma3ority of the defects 5"-.846, whereas fexural fatigue only occurred ".$4
of the time. +nly seen of the 08$ fles fractured 5.#46. There was no statistical
signifcance in the oerall rate of failure based on fle siCe, in the rate of specifc
failure between fle siCes, or within the type of failure seen within each fle siCe.
*ote that in this study, no control was used for the amount of force applied to the
teeth and regardless of the number of canals, they still considered the fle as being
used once. 08$ new fles were used for a H-week period and 8$4 showed no isible
signs of defect or distortion after one use. Therefore, it can be assumed that these
fles may be used safely for a second procedure but the fles should be inspected
with magnifcation prior to a second use and those used in calcifed or sharply
cured canals should not be reused. 7or maximum safety, the authors recommend
a single use.
2- Failure of 2roFile instruments use% 3it$ $i/$
an% lo3 tor4ue motors.
A1M& The purpose of this study was to ealuate the failure incidence of <ro7ile
nickel-titanium rotary instruments when used in con3unction with diferent motors
and a specifc instrumentation techni=ue.
M.,H5657589F <ro7ile *i-Ti rotary instruments 5<A!6 with %.%$ taper were used
in a crown-down techni=ue. !n groups ", - and >, an air, a high tor=ue and a low
tor=ue motor were used, respectiely. Dach group included >% canals in extracted
human molars. +ne set of <A! siCes H%-"1 was used for each canalG they were
steriliCed before each case. A -.14 *a+2l solution was used as an irrigant. The
number of deformed and separated instruments was recorded for the arious
"%
experimental groups.
'.S:7,SF !nstrument separation did not occur in any of the three groups. +ne and
two instruments were deformed when using the air and high tor=ue motors,
respectiely.
(5N(7:S15NSF The results indicated no diference between the three motors
with respect to the incidence of instrument failure. The results suggest that the use
of <A! in a crown-down manner with air control motors was safe.
3. 2reparation of se+erely cur+e% simulate% root
canals usin/ en/ine-%ri+en rotary an% con+entional
$an% instruments.
This in +itro study ealuated the eMcacy and safety of six diferent nickel-titanium
engine-drien instruments used with a tor=ue-controlled engine deice and nickel-
titanium hand and stainless steel hand instruments in preparation of cured canals.
A total of 8% cured 5>$ degrees6 simulated root canals were prepared. !mages
before and after were superimposed, and instrumentation areas were obsered.
Time of instrumentation, instrument failure, change in working length and weight
loss were also recorded. Aesults show that stainless steel hand instruments cause
signifcantly less transportation towards the inner wall of the canal than do nickel-
titanium hand instruments. *o instrument fracture occurred with hand instruments,
but >%-$%4 breakage of instruments was recorded during instrumentation with the
engine-drien deices. The working length was maintained by all types of
instruments. *ewly deeloped nickel-titanium rotary fles were not able to preent
straightening of the seerely cured canals when a tor=ue-controlled engine-drien
deice was used.
4. (anal s$apes pro%uce% se4uentially %urin/
instrumentation 3it$ ;uantec S( rotary nic0el-
titanium instruments& a stu%y in simulate% canals.
A1MF The aim of this study was to determine the shaping ability of Puantec )2
nickel-titanium rotary instruments in simulated root canals.
M.,H5657589F 7orty simulated canals consisting of four diferent shapes in
terms of angle and position of curature were prepared with Puantec )2
instruments. )e=uential still images were taken of the canals using a ideo camera
attached to a computer with image analysis software. !mages were taken
preoperatiely, and then after instrument 0 5)iCe -1, %.%1 taper6, instrument 8 5siCe
-1, %.%$ taper6, and instrument "% 5siCe H1, %.%- taper6 were taken to length. Dach
se=uential postoperatie image was superimposed indiidually oer the
preoperatie image in order to highlight the amount and position of material
remoed during preparation.
'.S:7,S& +erall, the mean preparation time to siCe "% was >.$ min with "- mm
canals taking on aerage less time than 8 mm canals. There was a highly signifcant
diference between the canal types 5< O %.%%%"6. *o instruments fractured within
the canal or deformed, although one instrument separated from the latch grip. All
canals remained patent. 7ollowing preparation to siCe "%, "# canals 5H846 retained
their length, eight 5-%46 lost length, and "> 5>-46 gained lengthG the magnitude of
the change in length was always %.1 mm or below. 7ollowing preparation to siCe 0
""
instruments all canals showed aberrant shapes. Dxcess remoal of material along
the outer aspect of the cure between the beginning of the cure and the end-point
5outer widening6 was found in -$ canals 5$146 after instrument 0. At the same
stage of preparation six canals 5"146 had Cips, three 5846 had ledges and fe
5">46 had perforations. 7ollowing preparation to siCe "%, -0 5$846 canals were
perforated.
(5N(7:S15NSF (nder the conditions of the study, Puantec )2 instruments
consistently produced aberrations when canals were enlarged to siCe 0 5siCe -1,
%.%1 taper6 or aboe. 2are should be exercised when using these instruments in real
teeth.
5. A reconstructe% computeri<e% tomo/rap$ic
comparison of Ni-,i rotary 8, )les +ersus
tra%itional instruments in canals s$ape% =y no+ice
operators.
A1MF The aim of this study was to compare the efects of preparation with
conentional stainless steel 7lexofles and Kates Klidden burs ersus nickel-titanium
KT rotary fles in the shaping of mesial root canals of extracted mandibular molars.
M.,H5657589F A total of 1H canals from -0 mesial roots of mandibular molar
teeth were prepared using one of two methods by noice dental students. +ne
canal in each root was prepared by a crown-down approach. utiliCing stainless steel
7lexofles and Kates Klidden burs. The other canal was prepared using nickel-
titanium KT rotary fles in a crown-down fashion as recommended by the
manufacturer. <reoperatie 2T scans of each root were recorded and 1% canal
specimens were aailable for postoperatie comparisons. 7ollowing canal shaping,
postoperatie scans were superimposed on the original images. 2hanges in canal
area, canal transportation and thickness of remaining root structure at strategic
leels of the root were analyCed. The time taken for each method was also noted.
'.S:7,SF At the coronal and mid-root coronal one-third sections, the rotary KT
fles produced a signifcantly smaller postoperatie canal area 5< O %.%16. !n the
mid-root sections there was signifcantly less transportation of the root canal toward
the furcation, and less thinning of the root structure with KT fles compared to the
stainless steel fles 5< O %.%16. +erall, there was greater conseration of structure
coronally and more ade=uate shape in the mid-root leel. The KT rotary techni=ue
was signifcantly faster than the stainless steel hand-held fle techni=ue 5< O
%.%%%"6. Two KT instruments fractured during the study.
(5N(7:S15NSF (nder the conditions of this study, noice dental students were
able to prepare cured root canals with *i-Ti KT rotary fles with less transportation
and greater conseration of tooth structure, compared to canals prepared with hand
instruments. The rotary techni=ue was signifcantly faster.
6. ,$e use of compute% tomo/ra$y 3$en
comparin/ nic0el-titanium an% stainless steel )les
%urin/ preparation of simulate% cur+e% canals.
A1MF The aim of this study was to compare canal preparations completed with
@edstrom and ?-fles of !)+ siCe "1 - H%, made of nickel-titanium 5*i-Ti6 and stainless
"-
steel 5))6.
M.,H5657589& Dighty simulated canals with -%% and >% degrees 2 curatures
were prepared using the step-back techni=ue and =uarter turnJpull instrument
manipulation. 9iddle and apical leel canal sections were taken using computed
tomography.
'.S:7,SF *o signifcant diference was found between any of the fle types at
either leel with respect to canal curature 5-% degrees or >% degrees6. At the
middle leel, the stainless steel fles caused more enlargement toward the inner
part, compared to nickel-titanium fles. At the apical leel, nickel-titanium canal fles
caused more enlargement toward the inner part, whereas more outward
enlargement was caused by stainless steel instruments. *o signifcant diference
could be obsered at the middle leel 5< U %.%16 related to the enlargement toward
the outer side of the canal curature. Transportation at both leels was signifcantly
less 5< O %.%%"6 for the *i-Ti fles than the )) ones. 2entring ratios of the fle types
at the middle leel were low, but not signifcantly diferent 5< U %.%16, whereas at
the apical leel the centring ratios were signifcantly higher for the *i-Ti fles 5< O
%.%%"6.
(5N(7:S15NSF *i-Ti instruments produced preparations with ade=uate
enlargement, less transportation, and a better centring ratio.
. (yclic fati/ue of 2roFile rotary instruments after
prolon/e% clinical use.
A1MF The purpose of the present study was to ealuate resistance to cyclic fatigue
of new and used <ro7ile *i-Ti rotary instruments.
M.,H5657589F (sed instruments were operated in "% clinical cases using
passie instrumentation and a crown-down preparation techni=ue. 2yclic fatigue
testing of new and used engine-drien instruments was then performed with a
specifc deice which allowed the instruments to rotate freely inside a stainless steel
artifcial canal, whilst maintaining conditions close to the clinical situation.
!nstruments were rotated until fracture occurred and time to fracture was isually
recorded with a chronometer.
'.S:7,S& A signifcant reduction of rotation time to breakage 5life span6 was noted
between new and used instruments. !n all siCes new instruments were signifcantly
more resistant than used ones 5two-sample t-test, < O %.%"6. *o instrument
underwent intracanal failure during clinical use.
(5N(7:S15NSF <rolonged clinical use of *i-Ti engine-drien instruments
signifcantly reduced their cyclic fatigue resistance. *eertheless, each rotary
instrument was successfully operated in up to "% clinical cases without any
intracanal failure.
!. Apical e>trusion of %e=ris an% irri/ants usin/
t3o $an% an% t$ree en/ine-%ri+en instrumentation
tec$ni4ues.
A1MF To ealuate the weight of debris and irrigant olume extruded apically from
extracted teeth in itro after endodontic instrumentation using the balanced force
techni=ue, a hybrid hand instrumentation techni=ue, and three engine-drien
">
techni=ues utiliCing nickel-titanium instruments 5<ro7ile .%H, Puantec -%%% and <ow-
A6.
M.,H5657589F 7ie groups of -% extracted human teeth with single canals
were instrumented using one or other of fe techni=uesF balanced force, hybrid,
Puantec -%%%, <ro7ile .%H, or <ow-A. :ebris extruded from the apical foramen
during instrumentation were collected into preweighed ".1 m, tubes. 7ollowing
instrumentation, the olume of extruded irrigant fuid was determined by isual
comparison to control centrifuge tubes flled with %.-1 m, increments of distilled
water. The weight of dry extruded dentine debris was also established.
'.S:7,S& +erall, the engine-drien techni=ues extruded less debris than the
manual ones. @oweer, there was no statistical diference between the balanced
force techni=ue and the engine-drien methods. The olume of irrigant extruded
through the apex was directly associated with the weight of extruded debris, except
within the <ro7ile group. The hybrid techni=ue was associated with the greatest
extrusion of both debris and irrigant.
(5N(7:S15NSF +erall, the engine-drien nickel-titanium systems were
associated with less apical extrusion.
"-Mo%elin/ capacity of .N65?as$ )les in simulate%
root canals.
'ith the deelopment of rotary nickel-titanium fles and their applications in
Dndodontics, the concepts of root canal preparation hae changed. The ob3ectie of
this research is to ealuate the transportation of simulated root canals caused by
stainless steel D*:+fash rotary fles compared to nickel-titanium <ro7ile fles 5.%H, .
%$ and +rifce )hapers6. Twenty-four simulated root canals with a >% degrees
curature were randomly diided into - groups and prepared with D*:+fash or
<ro7ile fles according to manufacturersV instructions. 2omparison between the
simulated root canals before and after instrumentation showed signifcant
diferences 5p O %.%%"6 between the groups, with greater transportation obsered
with D*:+fash fles. +ne case of deformation was obsered with a <ro7ile
instrument 5S-%J.%H6 and there were no fractures.
1#. (yclic fati/ue of 2roFile rotary instruments
after clinical use.
A1MF The purpose of this study was to ealuate cyclic fatigue of .%$ <ro7ile *i-Ti
rotary instruments after clinical use in molar teeth.
M.,H5657589F !n group ", instruments siCe H%-"1 were used in a crown-down
techni=ue using -.14 *a+2l as an irrigant. 7ifty-two molars were included and ">
sets of <rofle *i-Ti rotary instruments were used. Dach set of instruments was used
in four molars, and was steam autoclaed before each use. Kroup - 5"% sets of new
<ro7ile *i-Ti rotary instruments6 was the control group. 2yclic fatigue was tested by
rotating the instruments in a #% degrees metallic tube until they broke.
'.S:7,SF +ne-way analysis of ariance did not show any statistically signifcant
diferences amongst the fles from both groups regarding cyclic fatigue.
(5N(7:S15NSF !t was concluded that steriliCation and clinical use in the presence
of *a+2l did not lead to a decrease in the number of rotations to breakage of the
fles.
"H
11. S$apin/ a=ility of Hero 642 rotary nic0el-
titanium instruments in simulate% root canals.
A1MF To determine the shaping ability of @ero $H- nickel-titanium rotary
instruments during the preparation of simulated canals.
M.,H5657589F A total of H% simulated root canals made up of four diferent
shapes, in terms of angle and position of curature, were prepared by @ero $H-
instruments using a crown-down preparation se=uence. <re- and postoperatie
images of the canals were taken using a ideo camera attached to a computer with
image analysis software. The pre- and postoperatie iews were superimposed to
highlight the amount and position of material remoed during preparation. This
report describes the eMcacy of the instruments in terms of prealence of canal
aberrations, the amount and direction of canal transportation and oerall
postoperatie shape.
'.S:7,SF 7our Cips and four elbows were created during preparation, all in canals
with H% degrees, "- mm cures. *o perforations or danger Cones were created.
@ighly signifcant diferences 5< O %.%%"6 were apparent between the canal shapes
in total canal width at the apex and beginning of the cure, and in the amount of
resin remoed from the inner and outer aspects of the cure at the orifce. 2anal
transportation was most fre=uently directed toward the outer aspect of the cure at
specifc points along the canal, except at the orifce, where it was apparent that
canals with -% degrees cures transported toward the inner. +erall, mean absolute
transportation was always less than %."1 mmG howeer, signifcant diferences
occurred between canal shapes at the end-point 5< O %.%"6, apex of the cure 5< O
%.%"6 and at the orifce 5< O %.%"6.
(5N(7:S15NS& (nder the conditions of this study, @ero $H- rotary nickel-
titanium instruments created canals with few aberrations and no perforations. The
relatiely high proportion of aberrations in canals with short, acute cures may
indicate that instruments with increased taper should be used with caution at or
near the full working distance. 7urther research in real teeth is necessary to
elucidate the full potential of these new rotary instruments for use in root canal
preparation.
12. S$apin/ a=ility of Hero 642 rotary nic0el-
titanium instruments in simulate% root canals&
A1M& To determine the general eMcacy and shaping ability of @ero $H- nickel-
titanium rotary instruments during the preparation of simulated canals. <art " of
this two-part report describes the eMcacy of the instruments in terms of three-
dimensional canal form.
M.,H5657589F A total of H% simulated root canals made up of four diferent
shapes in terms of angle and position of curature were prepared by @ero $H-
instruments using a crown-down preparation se=uence. The eMcacy of the
instruments was assessed in terms of preparation time, instrument failure, canal
blockages and loss of canal length. !ntra-canal impressions were taken of the
prepared canals in order to assess three-dimensional canal form.
'.S:7,SF The mean time for canal preparation was 8.$ min and was infuenced
signifcantly 5< O %.%16 by canal shape. Two instruments fractured and eight
instruments deformedG signifcant diferences were obsered between canal shapes
5< O %.%16. All of the canals remained patent. 7ifteen canals 5>#.146 maintained the
"1
correct working distance, "1 lost distance and eight canals gained length.
Dxamination of intracanal impressions demonstrated that the ma3ority of canals
50#46 had apical stopsG canal shape had a signifcant infuence 5< O %.%%"6 on the
=uality of apical stops. 'ith one exception all canals had smooth canal walls and all
of the canals showed good fow characteristics. Taper was poor in >% canals 50#46
and good in eight canals 5-"46.
(5N(7:S15NSF @ero $H- rotary nickel-titanium instruments prepared simulated
canals rapidly but with a three-dimensional form that lacked ade=uate taper.
13. 'e%uction of intracanal =acteria usin/ nic0el-
titanium rotary instrumentation an% +arious
me%ications.
The purpose of this study was to ealuate the extent of bacterial reduction with
nickel-titanium rotary instrumentation and ".-14 *a+2l irrigation. Also, the
additional antibacterial efect of calcium hydroxide for U" wk was tested. 7orty-two
sub3ects with radiographic and clinical signs of chronic apical periodontitis were
recruited. The canals were sampled before treatment, during and after
instrumentation, and after treatment with calcium hydroxide and the samples
incubated anaerobically for 0 days at >0 degrees 2. The bacteria from each sample
were =uantifed and the log"% alues were used for calculations and comparisons.
The initial sample confrmed infection of the canals. There was a signifcantly
greater pattern of reduction of bacteria when *a+2l was used as an irrigant,
compared with sterile saline 5p O %.%16. After instrumentation with *a+2l irrigation,
$".#4 of canals were rendered bacteria-free. The placement of calcium hydroxide
for at least " wk rendered #-.14 of the canals bacteria free. This was a signifcant
reduction, compared with *a+2l irrigation alone 5p W %.%%%"6. The results of this
study indicate that *a+2l irrigation with rotary instrumentation is an important step
in the reduction of canal bacteria during endodontic treatment. @oweer this
method could not consistently render canals bacteria-free. The addition of calcium
hydroxide intracanal medication should be used to more predictably attain this goal.
14. ,or4ue %urin/ canal instrumentation usin/
rotary nic0el-titanium )les.
*ickel-titanium engine-drien rotary instruments are used increasingly in
endodontic practice. +ne fre=uently mentioned problem is fracture of an instrument
in the root canal. Rery few studies hae been conducted on torsional characteristics
of these instruments, and none has been done under dynamic conditions. The
purposes of this study were to measure the tor=ue generated and the apical force
applied during instrumentation with a commercial engine-drien nickel-titanium fle
system, and to relate tor=ue generated during simulated clinical use to torsional
failure of the instruments. Ten extracted human teeth 5fe with small-siCed and fe
with medium-siCed straight root canals6 were instrumented with Puantec )eries
-%%% fles, and the tor=ue and apical force generated were measured. The applied
apical force was generally low, not exceeding "1% g in either small or medium
canals. The tor=ue depended on the tip siCe and taper of each instrument, and on
canal siCe. !nstruments with %.%1 and %.%$ taper generated the highest tor=ue,
which was greater in small than in medium canals. The tor=ue at failure was
"$
signifcantly 5p O %.%%"6 higher than tor=ue during instrumentation, but with
considerable ariation in the extent of the diference.
15.A comparison of t3o nic0el-titanium
instrumentation tec$ni4ues in teet$ usin/
microcompute% tomo/rap$y.
A1MF The aim of the study was to compare the shaping of root canals by two nickel-
titanium instrumentation techni=ues using microcomputed tomography 592T6.
M.,H5657589& Ten mandibular frst molar teeth 5>% canals6 that had intact
crowns and fully formed roots were scanned using 92T. 7ifteen canals were
instrumented using *iTi7lex hand fles 59aillefer6 using balanced force. The
remainder were instrumented using prototype <ro7ile %.%H Taper instruments
5:entsply6 in a crown-down manner to an apical siCe !)+ -1. The teeth were
scanned again following instrumentation. The two instrumentation techni=ues were
compared in a total of -0 canals. The area of dentine remoed at predetermined
leels 5-.%, >.%, H.1, $.%, 0.1 mm6 from the apex was measured. Transportation and
centring were recorded. !mages constructed at these leels were compared with
ideo images of e=uialent physical sections created after the second scan. The
olume of dentine remoed in the apical 0.1 mm of the root canals of each tooth
was calculated and the diferent techni=ues compared. Aendered three-dimensional
images were used to assess the preparations =ualitatiely. The time taken for
preparation was recorded.
'.S:7,S& There was no signifcant diference between hand instrumentation with
*iti7lex fles and machine instrumentation with prototype <ro7ile %.%H Taper
instruments for any of the ariables tested.
(5N(7:S15NS& &oth techni=ues produced well centred and tapered
preparations.
16. S$apin/ a=ility of t$ree 2roFile rotary
instrumentation tec$ni4ues in simulate% resin root
canals
The aim of this study was to compare the shaping ability of three <ro7ile rotary
instrumentation techni=ues and a conentional step-back method in simulated root
canals. <realence of canal aberrations, change in working length, and preparation
time were measured. A total of H8 composite images were made from pre- and
postcanal scanned images using 2orel <hotopaint 8.% and then the amount of
coronal substance the instruments remoed was also calculated two-dimensionally
on digitiCed images with the &rain 2 software to compare the enlarging eMciency.
There were no signifcant diferences between the three rotary groups in
preparation time, change in working length, and the incidence of aberrations 5p U
%.%16. The amount of coronal substance the instruments remoed in the <ro7ile .%H
taper group was signifcantly smaller than the other three groups 5p O %.%16.
1. A comparison of stainless steel an% nic0el-
titanium H-type instruments of i%entical %esi/n&
"0
torsional an% =en%in/ tests.
5@A.(,1B.F 7or a true comparison of clinically releant =ualities of instruments
manufactured from diferent alloys, the instrument must be identical in design. The
purpose of this study was to perform mechanical tests on stainless steel and nickel-
titanium instruments of identical design. )T(:; :D)!K*F !dentical experimental
endodontic fles of @-type with double helix were fabricated from stainless steel and
nickel-titanium alloys. Torsional and bending tests were carried out according to
American *ational )tandards !nstituteJAmerican :ental Association specifcation *o.
18 and !nternational )tandards +rganiCation *o. >$>%J". 2hanges in instruments
during the testing were also analyCed with scanning electron microscope techni=ue.
'.S:7,SF The results indicated that the torsional moment of the stainless steel
fles was signifcantly higher than for the nickel-titanium fles 5< O.%%"6, whereas the
mean angular defection for the nickel-titanium fles was signifcantly higher. The
mean bending moment for the nickel-titanium fles was signifcantly lower 5< O.%%"6
than the mean alue for the stainless steel fles. The scanning electron microscope
demonstrated that the fracture surfaces of the stainless steel fles were brittle,
whereas the nickel-titanium fles had a ductile fracture.
(5N(7:S15NSF 'hen the design of endodontic instruments of diferent alloys is
identical, the nickel-titanium fles are more fexible in bending. @oweer, nickel-
titanium fles re=uire less force to deform to fracture.
1!. An in +itro comparison of canal preparation
usin/ t3o automate% rotary nic0el-titanium
instrumentation tec$ni4ues.
A1M& The aim of this study was to compare the eMcacy of root canal preparation
using two automated rotary nickel-titanium instrumentation techni=ues with a
double fared balanced forces hand preparation techni=ue, using stainless steel fles
in extracted human teeth.
M.,H5657589& )ixty root canals in extracted human teeth were matched for
curature, length and diameter and diided eenly between three groups 5group "
W double fare using 7lexofles, group - W rotary nickel-titanium using 9cB!9
instruments and group > W rotary nickel-titanium using <rofle .%H Taper )eries -#
instruments6. The instruments were used according to the manufacturerVs
instructions in a tor=ue controlled motor and handpiece 5groups - and >6 and
according to a predetermined procedure in group ". A standardiCed radiographic
techni=ue using mercury as a contrast medium was used to ealuate the canal
shape before and after preparation in the plane of maximum curature. The pre-
and postoperatie radiographic images were compared against each other and with
a predicted Videal preparationV calculated from a pro3ection of the fnal instrument
dimensions. The outcome measures were changes in canal dimensions as =uantifed
by measuring the changes in the position of the inner and outer wall at " mm
interals. Alteration in canal curature could be inferred by comparison with the
ideal preparation.
'.S:7,S& The degree of canal curature did not infuence the efectieness of any
of the techni=ues. The results showed no statistically signifcant diferences in the
outcome measures between the groups 5two-way A*+RA6. There were no signifcant
diferences in canal wall position changes at any leel except the apical three,
"8
where signifcantly less change occurred in all groups 5< W "46. !nstruments
fractured in three canals, with acute cures in groups - and >.
(5N(7:S15NS& 2anal curatures were e=ually and well maintained following
preparation in all the groups, as long as the instrument did not fracture.
1". 6entine c$ips pro%uce% =y nic0el-titanium
rotary instruments. This study aime% to compare the cross-sectional
shape of two nickel-titanium rotary instruments, namely <ro7ile and Puantec fles,
both !)+ -1, %.%$ taper, and sought to relate this to the chips produced by cutting
dentine. A limited comparison was made with stainless steel engine reamers. 7irst,
fe fles of each type were sectioned transersely at "- mm, 8 mm and H mm from
the tip and examined by scanning electron microscopy. The cutting angles were
assessed by a direct measurement techni=ue which allowed for the inclination of a
cutting edge to the root canal. )econd, eight samples of cutting debris were
collected from instrumentation by each type of nickel-titanium fle and four samples
from the engine reamers. The ma3or and minor axis, area and roundness of the
dentine chips in each sample were measured using computeriCed particle analysis.
The results demonstrated that all fles had a negatie cutting angle which aried at
the diferent leels 5<ro7iles range $#.H degrees to 18.H degrees and Puantec range
0H.8 degrees to 1$.8 degrees6. The consistency within fles of the same type was
good as demonstrated by low standard deiations, except for Puantec fles at the H
mm leel where higher standard deiations of H." degrees and 1.1 degrees for the
two blades were found. The chip analysis showed signifcant diferences between
chips produced by <ro7ile and Puantec fles 5< O %.%16. The latter were larger and
rounder. The chips from the <ro7ile and the engine reamer chips were similar in
dimension 5< U %.%16. *o simple relationship existed between fle geometry and the
dentine chips produced during instrumentation.
2#. 6ummer, (anal s$apes pro%uce% se4uentially
%urin/ instrumentation 3it$ ;uantec 7C rotary
nic0el-titanium instruments&
A1MF The aim of this study was to determine the shaping ability of Puantec ,B
nickel-titanium rotary instruments in simulated root canals.
M.,H5657589& 7orty simulated canals consisting of four diferent shapes in
terms of angle and position of curature were prepared with Puantec ,B
instruments. )e=uential still images were taken of the canals using a ideo camera
attached to a computer with image analysis software. !mages were taken
preoperatielyG after, instrument 0 5)iCe -1, %.%1 taper6, instrument 8 5siCe -1, %.%$
taper6, and instrument "% 5siCe H1, %.%- taper6 were taken to length. Dach
se=uential postoperatie image was superimposed indiidually oer the
preoperatie image in order to highlight the amount and position of material
remoed during preparation. !ntra-canal impressions after preparation to siCe "%
were taken to ealuate three-dimensional canal form.
'.S:7,S& +erall, the mean preparation time to siCe "% was H.0 minG canal shape
did not hae a signifcant efect on speed of preparation. *o instruments fractured
within the canal, but 0 instruments separated from the latch grip, and a further >
instruments deformed. All canals remained patent. 7ollowing preparation to siCe "%,
"#
-# canals 50-46 retained their length, 0 5"046 lost length, and H gained lengthG the
magnitude of the change in length was always below " mm. Xips were created in >
canals 5046 after use of siCe "% instruments, but no perforations or danger Cones
were produced. Dxcess remoal of material along the outer aspect of the cure
between the beginning of the cure and the end-point 5outer widening6 was found in
-- canals 51146 after instrument 0, in >% 50146 canals after siCe 8 and in >1 canals
58846 after siCe "%. There was a signifcant diference 5< O %.%%%"6 between canal
shapes for the incidence of this aberration at all siCes.
(5N(7:S15NS& (nder the conditions of the study, Puantec ,B instruments
tended to remoe excess material from the outside of the cure between the
beginning of the cure and the end-point. These aberrations increased in prealence
and seerity following the use of larger instruments when they were taken to length.
)iCe 8, # and "% Puantec ,B instruments should be used with care and short of
length, especially in seerely cured canals.
21. 'ationale for t$e use of lo3-tor4ue en%o%ontic
motors in root canal instrumentation. 7racture of nickel-
titanium rotary fles is an iatrogenic error which can seriously 3eopardiCe root canal
therapy. !f a high-tor=ue motor is used, the instrument-specifc limit-tor=ue 5fracture
limit6 is often exceeded, thus increasing the risk of intracanal failure. A possible
solution to this problem is to use a low-tor=ue endodontic motor which operates
below these alues. !f the tor=ue is set 3ust below the limit of elasticity for each
instrument, the risk of fracture is likely to be markedly reduced. The purpose of this
paper was to discuss mechanical properties of *iTi rotary instruments, the rationale
for selecting low tor=ue alues, and to use clinically a new endodontic motor 5step-
motor6 which operates below the limit of elasticity of each rotary fle. The step-
motor was found to be helpful in reducing the risk of instrument fracture.
!rreersible material damage 5plastic deformation6 and instrument fracture were
rarely seen. ,ow-tor=ue instrumentation also increased tactile sense and,
conse=uently, mental awareness of rotary instrumentation.
22. (omparati+e analysis of cur+e% root canal
preparation usin/ nic0el-titanium instruments 3it$
or 3it$out .6,A.
The purpose of this study was to examine the efect of the use of D:TA as a root
canal irrigant in cured root canals instrumented with nickel-titanium 5*i-Ti6
instruments. Twenty extracted maxillary molars were selected. 9esiobuccal roots
were used. Teeth were mounted in self-curing acrylic resin bases to allow
standardiCed angulation of the initial and fnal radiographs. The preinstrumentation
radiographs were made with a S"1 fle in the canal. The canals were instrumented
with *i-Ti instruments by the step-back techni=ue, using or not using D:TA. The
post-instrumentation radiographs were made with a S>% fle in the canal. The flms
were pro3ected 5x"% magnifcation6, drawn, and superimposed. *i-Ti instruments
used with D:TA were less efectie in maintaining the original path of cured canals.
23. .Dcacy of ;uantec rotary instruments for
/utta-perc$a remo+al.
-%
A1MF The purpose of this study was to ealuate Puantec )2 rotary instruments for
remoal of gutta-percha during retreatment of straight root canals.
M.,H5657589F The root canals of >% central incisors were instrumented and
obturated before the teeth were randomly diided into three groups of "%
specimens each. Puantec )2 rotary instruments and a "$F" reduction handpiece
powered by an electric motor were then used to remoe the gutta-percha and
sealer from canals. A diferent speed was used in each group 5group ", >1% r.p.m.G
group -, 0%% r.p.m.G and group >, "1%% r.p.m.6. The followings factors were
ealuatedF time taken to reach working length, time for gutta-percha remoal, total
time, apically extruded material during flling remoal and number of fractured
instruments. Aadiographs were taken after the flling remoal and after the canal
wall cleanliness was ealuated. The teeth were grooed longitudinally, diided, and
the walls of each half were ealuated isually for cleanliness. They were then
digitiCed using a scanner and the residual debris measured.
'.S:7,SF The group in which a speed of "1%% r.p.m. was used had signifcantly
faster treatment than the other groups. The amount of apically extruded material
was not signifcantly diferent between groups. The only signifcant diference
between groups for canal cleanliness was the middle third by radiographic
ealuationF the group of >1% r.p.m. had larger amount of debris than the others. !n
group ", six instruments fracturedG in group -, four instruments fracturedG and in
group >, one instrument fractured.
(5N(7:S15N)F 2leanliness and residual debris were e=uialent for each group,
but the use of "1%% r.p.m. speed was more rapid and fewer instruments fractured.
24. (yclic fati/ue of 2ro)le rotary instruments
after simulate% clinical use.
A1MF The purpose of this study was to ealuate cyclic fatigue of <rofle *i-Ti rotary
instruments 5<A!s6 after dry heat steriliCation and up to "% times simulated clinical
use.
M.,H5657589F !nstruments of siCe H%-"1 were used in a crown-down
techni=ue. Three groups were included in this study. !n groups " and -, each set of
instruments was used in fe and "% canals, respectiely. Kroup > was the control
group. *a+2l at a concentration of -.14 was used as an irrigant. Dach set of
instruments was steriliCed before each use.
'.S:7,SF The <A! siCe H% demonstrated the lowest incidence of rotations to
breakage. +ne-way analysis of ariance and TurkeyVs @): test showed statistically
signifcant diferences among diferent fle siCes within each group.
(5N(7:S15NSF The results showed that dry heat steriliCation and simulated
clinical use in the presence of *a+2l did not lead to a decrease in the number of
rotations to breakage of the fles.
25. Step-=y-step %escription of a rotary root canal
preparation tec$ni4ue.
2,!*!2A, TD2@*!P(DF )ince the introduction of nickel-titanium in endodontics,
seeral canal preparation techni=ues inoling the use of rotary instruments hae
become popular. )uch engine-drien rotary instruments rotate between "1% and
-%%% r.p.m. and may be high or low tor=ue orientated. This paper describes one
-"
such engine-drien system called the <ro7ile techni=ue. The instruments are of a
diferent specifcation to that used for conentional endodontic fles and reamers.
This paper describes a techni=ue employed by the :iision of Dndodontology,
Xurich :ental )chool, in a step-by-step procedure using primarily photographs of
radiographs. The intention is to gie any interested clinician a better idea of the
techni=ue using radiographs taken from both the buccolingual 5clinical6 perspectie
and the mesiodistal pro3ection. &asically, the techni=ue inoles preparing the
coronal portion of the root canal using Kates-Klidden burs and the <ro7ile
instruments. +nly when any constricting coronal parts of the canals hae been
remoed is the working length established using conentional fles. 7inally, the
apical part of the canal is prepared using only the <ro7ile instruments. Three clinical
cases are also briefy described, in order to illustrate the potential of the techni=ue
in cases treated generally by clinicians.
26. (omparison of cuttin/ eDciency an%
instrumentation of cur+e% canals 3it$ nic0el-
titanium an% stainless-steel instruments.
The cutting eMciency and the efects of instrumentation on cured canal shape of
both stainless-steel and nickel-titanium nonstandardiCed <ro7ile )eries -# hand
instruments and stainless-steel 7lexoreamer were inestigated under standardiCed
conditions. 2oncerning cutting eMciency in rotary motion, the 7lexoreamer had
signifcantly 5p O %.%"6 greater cutting eMciency than stainless-steel <ro7iles and
nickel-titanium <ro7iles. 2hanges in the canal shape difered signifcantly between
the diferent instruments at all measuring points 5p O %.%%"6. After instrumentation
with 7lexoreamers with inclusion of two half-siCes 5S"0 and S--6, there were fewer
undesirable changes in canal shape compared with both stainless-steel and nickel-
titanium <ro7ile )eries -# instruments. !n this study, it seemed that fexible
stainless-steel instruments with noncutting tips were superior to the
nonstandardiCed <ro7ile )eries -# instruments with regard to cutting eMciency and
instrumentation of cured canals.
2. Dfect of steriliCation on the cutting eMciency of rotary
nickel-titanium endodontic fles.
5@A.(,1B.F *ickel-titanium instruments that ofer greater fexibility than
instruments made of other metallic materials hae been deeloped. This study
ealuated the behaior in itro of nickel-titanium rotary instruments under repeated
steriliCation cycles.
S,:69 6.S18NF To inestigate changes in cutting ability and superfcial
alterations, >$ <ro7ile instruments, "8 with a taper of .%H and "8 with a taper of .%$,
were exposed to diferent steriliCation cycles. )amples were diided into > groups of
"- fles each. The "- group A samples were exposed to "H cycles of steriliCation for
>% minutesG the "- group & samples were exposed to 0 cycles of steriliCation for >%
minutesG the "- group 2 samples were not steriliCed and sered as a control group.
2hemical compositions of the near surface layers of samples of each group were
determined by means of Auger spectroscopy.
'.S:7,SF The instruments that underwent the greatest number of steriliCations
5group A6 showed in-depth distributions of chemical composition that were diferent
--
from those seen in the control groupG this was the result of greater amounts of
titanium oxide on the surfaces of the steriliCed instruments. The fles of group A
showed a decrease in cutting eMciency in comparison with those of the control
group.
(5N(7:S15NSF +n the basis of this research on nickel-titanium fles, we
determined that repeated steriliCations under autoclae alter the superfcial
structure of such instruments.
2!. A comparison of instrumentation usin/ Na+i?e>
an% 2ro)le nic0el-titanium en/ine-%ri+en rotary
instruments.
This study was designed to compare the changes in canal confguration resulting
from instrumentation by either <rofle or *aifex instruments. 7orty mesial canals in
extracted human molar teeth were embedded and sectioned at two root leels.
Aeassembled teeth were instrumented with a modifed crown-down techni=ue as
described in the <rofle training ideo for <rofle fles and in a similar manner for
*aifex instruments. )uperimposed pre- and postinstrumented cross-sectional root
images were pro3ected, traced, and scanned into a computer for analysis. 2anal
moement, in relation to the furca, and canal area change were recorded. The
results showed no signifcant diference in canal center moement or canal area
change between the <rofle or *aifex groups. The degree of canal curature had
no efect on canal center moement or canal area change.
2". 'otary Ni-,i pro)le systems for preparin/
cur+e% canals in resin =loc0s& in?uence of operator
on instrument =rea0a/e.
A1MF The aim of this study was to determine the incidence of fracture of <ro7ile %.H
and %.$ taper )eries -# nickel-titanium instruments with respect to operator
experience.
M.,H5657589F A total of "-1 simulated root canals in resin blocks with the
same geometrical shape in terms of angle and radius of curature and coronal and
apical orifce diameter were used. 7ie operators prepared all the specimens using
an identical step-down instrument se=uence, each one preparing -1 canals. The
operators included two endodontists and three general practitioners. )tatistical data
concerning the incidence of instrument failure was compiled using )tatlab and
7isherVs partial least s=uare diference analysis of ariance.
'.S:7,SF A total of -" 5"$.846 instruments fractured, all had %.%H tapers. *ine
siCe -1 instruments failed, # siCe -% instruments failed and > siCe "1. :uring the
study, the &inary Tree analysis of instrument failure reealed two operator
populations belonging to two diferent study periods. The frst period, which
represented the frst "> root canal preparations, was called the Vlearning periodV,
and the second period, which represented the next "- sample preparations, was
called the Vapplication periodV. A greater number of instruments failed during the
frst period than during the second. !n the Vlearning periodV, both groups of operators
learned the same way. !n the Vapplication periodV, two groups could be distinguishedG
the frst group consisted of a general practitioner who produced worse results, and
the second group consisted of the other four operators.
->
(5N(7:S15NS& The results indicate the necessity of mastering this rotary canal
preparation techni=ue, and the importance of improing competence through
learning and experience.
3#. S$apin/ an% cleanin/ t$e root canal system& a
scannin/ electron microscopic e+aluation of a ne3
instrumentation an% irri/ation tec$ni4ue.
The purpose of the present scanning electron microscopic study was to inestigate
the eMcacy of a combination of D:TA, *a+2l, and surface-actie irrigating solutions
during and after root canal preparation with <ro7ile nickel-titanium rotary
instruments. Thirty canals were diided into three groups, instrumented and
irrigated as followsF 14 *a+2l and a fnal fush with "04 D:TA were used for group
AG group & specimens were irrigated using "04 D:TA, followed "1 s later by "4
TA!T+* B-"%% 5tensioactie agent6 and then by 14 *a+2lG and group 2 specimens
were irrigated with the same combination, but once shaping procedures were
completed the irrigating se=uence was repeated three times. After scanning
electron microscopic ealuation, group 2 specimens exhibited the most efectie
debridement of the root canals. Aesults showed that tensioactie agent contributed
to enhanced debridement. 2leaning was signifcantly improed once shaping
procedures were completed.
31. .*ect of rotational spee% on nic0el-titanium )le
%istortion..
)eparation of instruments while performing root canals is something that has
plagued all practitioners. The purpose of this study was to ealuate the efect of
rotational speed on nickel-titanium fle distortion and separation. 7orty extracted
human molars were instrumented with <rofle 5:entsply Tulsa :ental <roducts,
Tulsa, +?6 !)+ .%H rotary nickel-titanium instruments at "$$.$0 or >>>.>> rpm. The
instruments were ealuated after instrumentation for separation andJor distortion.
The results of this study were statistically signifcant and indicate that fle distortion
andJor separation is four times as likely to occur at >>>.>> rpm s. "$$.$0 rpm.
32. Eear of nic0el-titanium li/$tspee% instruments
e+aluate% =y scannin/ electron microscopy.
(sed rotary nickel-titanium instruments re=uire fre=uent replacing. This laboratory
study ealuated defects of ,ightspeed cutting tips before and after usage. The
instruments were fxed into custom-made holders, the cutting heads photographed
in a scanning electron microscope at x"-% to xH%% magnifcation at preset points
around the cutting tip 5#%, "8%, -0% and >$% degrees6 and head-on. !nstrument
siCes -% to >-.1, >1 to $%, and $1 to "%% were used in #, "8, and >$ canals,
respectiely, and autoclaed after shaping eery third root canal. The used
instruments were cleaned and then reexamined in a scanning electron microscope
as before. The presence of "" types of conditions was scored from the pre- and
postusage photographs. *o instruments fractured during the test, but all the cutting
heads had one or more imperfections, een before usage. The presence of debris,
pitting, and metal strips changed signifcantly. !mperfections were found on new and
used ,ightspeed cutting heads, indicating the general diMculty in machining defect-
-H
free nickel-titanium rotary instruments. @oweer, high =uality should remain a goal
to improe instrument eMciency.
33. A comparison of molar root canal preparation
usin/ stainless-steel an% nic0el-titanium
instruments..
7ifty-four extracted human mandibular molars were embedded and sectioned at two
leels. The reassembled mesial root canals were prepared with stainless-steel hand
?-fles 57lexofles6 and either *itifex or 9ity nickel-titanium hand ?-fles using a
push-pull anticurature fling techni=ue. Dach of the three experimental groups
contained >$ mesial canals randomly distributed. )uperimposed pre- and post-
instrumentation cross-sectional root images were magnifed using a
stereomicroscope and transferred to a computer for measurement and statistical
analysis. The direction and extent of canal center moement were ealuated. At the
apical leel, the groups produced no signifcant diference of direction of canal
center moement. !n cerical sections, all groups tended to moe in a distolingual
direction. The three groups, howeer, produced no signifcant diference in the
cerical sections in the extent of canal center moement. !n apical sections, *itifex
produced the least canal center moement.
34. S$apin/ a=ility of .#4 an% .#6 taper 2roFile
rotary nic0el-titanium instruments in simulate%
root canals.
A1MF The aim of this study was to determine the shaping ability of <ro7ile .%H and .
%$ taper rotary nickel-titanium instruments in simulated canals.
M.,H5657589F A total of H% simulated root canals made up of four diferent
shapes in terms of angle and position of curature were prepared using the
VcrowndownV approach recommended by the manufacturer. <re-operatie pictures of
each canal were recorded on optical discs using an image analysis package. The
simulated canals were prepared and postoperatie pictures superimposed on the
original images.
'.S:7,S& *o instrument fractures occurred and none deformedG none of the
canals became blocked with debris. 2hange in working distance was, on aerage,
%.%$> mm with >> canals retaining the correct length. +erall, fe Cips 5"-.146
were created and -H 5$%46 canals demonstrated a widened area on the outer
aspect of the canal between the end-point and the cure. Two danger Cones 5146
were created and two perforations but no ledges were found. &etween canal shapes
there were highly signifcant diferences 5< O %.%%%"6 for the incidence of Cips and
elbows but not for the other aberrations. There were highly signifcant diferences 5<
O %.%%%"6 for the total width of the canals between the arious canal shapes at the
apex of the cure, the beginning of the cure and half way to the orifce, and a
signifcant diference 5< O %.%16 at the end-point. There were highly signifcant
diferences 5< O %.%%%"6 for the amount of resin remoed from the outer aspect of
the cure at the end-point and at the beginning of the cure, and signifcant
diferences 5< O %.%16 at the apex of the cure and half way to the orifce. There
were highly signifcant diferences 5< O %.%%%"6 for the amount of resin remoed
from the inner aspect of the cure at the beginning of the cure and half way to the
-1
orifce. +erall, transportation was towards the outer aspect of the canal except at
the beginning of the cure.
(5N(7:S15NSF (nder the conditions of this study the combined use of .%H and .
%$ taper <ro7ile instruments was rapid, efectie and produced good canal shapes
except in those specimens with short cures that began near the end-point.
>1. ,ocation of contact areas on rotary <rofle instruments
in relationship to the forces deeloped during mechanical
preparation on extracted teeth.
A1MF The aim of this study was to locate the areas of direct instrument contact with
dentine in the root canal system during rotary preparation and to analyse the
relationship between these areas and the ertical forces and tor=ue deeloped
during the preparation.
M.,H5657589& 2anal preparations were performed by endodontists either with
the step-back 5)&6 or the crown-down 52:6 techni=ue. !n order to locate the areas of
contact, the instruments were coated with two layers of gold by electro-deposition.
They were photographed before and after use, and a coding system, based on mm
from the instrument tip, was deised to designate areas of gold remoal or
instrument wear due to friction. To standarise the conditions of instrument
manipulation, the teeth were fxed in the Dndographe holder, and this deice was
used to measure ertical forces and tor=ue.
'.S:7,S& The results showed that the frst series of instruments used for the 2:
techni=ue 5taper %.%$6 left - YJ- " mm of the tip with the gold intact, indicating that
these instruments and this step of the 2: techni=ue are the safest part of the
preparation. 7or all other instruments 5taper %.%H series6, the areas of gold remoal
inoled the > mm around the tip and this fnding was independent of the order of
instrument use and preparation techni=ue 5)& or 2:6. The diferences between the
two techni=ues were signifcant in terms of the mean area of decolouration and the
mean force and tor=ue alues. 7or the )& and 2: techni=ues, the contact areas
were, respectiely, "% YJ- > and 0 YJ- - mm. The forces and tor=ue alues were
correspondingly higher for )& s. 2:G the mean alues were, respectiely, "# and
-" * for ertical forces and "$ "%516 and "> "%516 *m for tor=ue.
(5N(7:S15NS& The recorded tor=ue alues and the location on the instruments
of the areas of contact with dentine during this deelopment of tor=ue i.e. at or near
the tip, indicate that great caution should be used with the rotary techni=ue,
particularly with the taper %.%H instruments, regardless of preparation techni=ue.
>$. Analysis of forces deeloped during mechanical
preparation of extracted teeth using <rofle *iTi rotary
instruments.
A1MF The aim of this study was to analyse the ertical forces and tor=ue deeloped
in the root canal system of extracted teeth during mechanical preparation using
<ro7ile *iTi instruments.
M.,H5657589F !nstrument wear and fracture is in great part due to the
repeated application of forces and tor=ue during the course of root-canal
preparation but research into the direct relationship has been hampered by the lack
of ade=uate measuring deices. 9easurements of these forces and tor=ue were
-$
made with a new force analyser deice, the Dndographe, that was e=uipped with a
holder to record and generate graphs of the ertical forces and tor=ue exerted
during the preparations. These preparations was performed by endodontists or
students either with a series of instruments of increasing siCe or with the crown-
down pressureless techni=ue.
'.S:7,S& The mean alues for the endodontists of the generated ertical forces
and tor=ue aried, respectiely, from H to $* and from 0."%1 to "-."%1 *m for the
step-back techni=ue and from -.# to H.- * and from "8."%1 to -%."%1 *m for the
crown-down techni=ue. This suggested that the crown-down techni=ue generated
lower stresses 5lower tor=ue and lower ertical forces6, although these fndings also
depend on the shape of indiidual canals. The students initially showed wide
ariations in generated forces, with signifcantly lower ertical force the tor=ue
alues. &y the end of the experimental sessions their alues were similar to those of
the endodontists, which indicated improement in the eMciency of manipulation.
(5N(7:S15NSF 7urther work is needed to inestigate the relationship between
the force and the tor=ue data from this study and the incidence of instrument
fracture with the two techni=ues, as the clinical implications are considerable. !t
must be noted, howeer, that the Dndographe is unable to take into account the
cutting eMciency of the instruments. The use of graphs proides a new approach to
the analysis of mechanical preparation.
3. ,$e remo+al of t$e smear layer usin/ t$e
;uantec system. A study using the scanning electron
microscope.
A1M& The aim of this study was to determine the ability of the Puantec )eries -%%%
rotary nickel-titanium endodontic system to remoe dentinal debris and smear layer
produced during canal preparation.
M.,H5657589& A frst group 5control6 of "- cured root canals was prepared
using conentional manual instruments and the step-back techni=ue. A second
group of "- cured root canals was instrumented using the complete Puantec
se=uence according to the manufacturerVs instructions. !n both groups, irrigation
was performed using a >4 *a+2l solution. The canal walls were obsered under a
scanning electron microscope and the coronal, middle and apical thirds of each
canal photographed at a magnifcation of 1%%. The iews were diided into "%
subareas by oerlaying a grid, and the absence or presence of a smear layer was
rated and scored on three appearances using the scale described by 2iucchi et al.
5"#8#6.
'.S:7,S& The scores were higher 5i.e. less debris was present6 in the middle third
5< O %.%%%"6 and in the apical third 5< O %.%%%"6 of canals prepared with the
Puantec system when compared with those prepared with ?-fles. *eertheless, in
canals prepared with Puantec instruments, the scores were signifcantly higher in
the coronal third compared with the apical third 5< O %.%%16.
(5N(7:S15NS& The Puantec rotary system produced cleaner canal walls than
conentional manual instrumentation, particularly in the middle and apical thirds.
This fnding may imply that stresses applied to the cutting regions of Puantec
instruments by accumulation and compression of the smear layer are minimiCed.
-0
3!. S$apin/ a=ility of ;uantec Series 2### rotary
nic0el-titanium instruments in simulate% root
canals.
The aim of this laboratory based study was to determine the shaping ability of
Puantec )eries -%%% nickel-titanium rotary instruments in simulated root canals. A
total of H% canals with four diferent shapes in terms of angle and position of cure
were prepared with Puantec )eries -%%% instruments using the techni=ue
recommended by the manufacturer. <art - of this report describes the eMcacy of
the instruments in terms of prealence of canal aberrations, the amount and
direction of canal transportation and oerall post-operatie shape. <re- and post-
operatie images of the canals were taken using a ideo camera attached to a
computer with image analysis software. The pre- and post-operatie iews were
superimposed to highlight the amount and position of material remoed during
preparation. Twenty-one Cips and elbows were created during preparation with a
signifcant diference 5< O %.%%16 between canal shapes in terms of the incidence of
aberrations. 7our perforations were created, with signifcant diferences 5< O %.%%16
between the canal shapesG three ledges were also created but no danger Cones.
@ighly signifcant diferences 5< O %.%%"6 were apparent between the canal shapes
in total canal width at specifc points along the canal length and in the amount of
resin remoed from the inner and outer aspects of the cure. 2anal transportation
at the end-point of preparation was most fre=uently directed towards the outer
aspect of the cure, and without exception in canals with H% degrees cures. At the
beginning of the cure, transportation became more eenly balanced between the
inner and outer aspect of the cure, although predominated towards the outer.
Transportation was generally directed towards the outer at the orifce, especially in
canals with H% degrees cures. 9ean absolute transportation at the arious
measurement points was less than %."" mmG signifcant diferences occurred
between canal shapes at the end-point of preparation 5< O %.%%%"6, at the Cips 5< O
%.%%16, at the apex 5< O %.%%%"6 and beginning of the cure 5< O %.%16 and at the
orifce 5< O %.%%%"6. (nder the conditions of this study, Puantec )eries -%%% rotary
nickel-titanium instruments created a relatiely large number of aberrations
including four perforations. The aberrations were created by the larger instruments
implying that these should be used with caution at the full working distance.
)canning electron micrographs of these instruments reealed sharp instrument tips
which appeared likely to predispose to transportation and the creation of defects
along the outer aspect of seerely cured canals.
3". 6ummer, S$apin/ a=ility of ;uantec Series
2### rotary nic0el-titanium instruments in
simulate% root canals. The aim of this
study was to determine the shaping ability of Puantec )eries -%%% nickel-titanium
instruments in simulated canals. A total of H% simulated root canals made up of four
diferent shapes in terms of angle and position of curature were prepared by
Puantec instruments using the techni=ue recommended by the manufacturer. <art "
of this two-part report describes the eMcacy of the instruments in terms of
preparation time, instrument failure, canal blockages, change in canal length and
three-dimensional canal form. The time necessary for canal preparation was on
-8
aerage 1.0 min and was signifcantly infuenced 5< O %.%"6 by canal shape. +ne
instrument fractured and three siCe nine instruments deformedG howeer, canal
shape did not infuence signifcantly instrument failure. All of the canals remained
patent, none became blocked with debris. The ma3ority of the canals maintained
working distance 5-$ out of H%6, howeer the mean change in length difered
signifcantly 5< O %.%16 between canal types. +erall, canals with H% degrees cures
lost length whilst those with -% degrees cures gained in length. Dxamination of
intracanal impressions reealed that preparation with Puantec )eries -%%%
instruments produced canals with defnite apical stops, smooth canal walls and
good fow and taper. @oweer, the =uality of apical smoothness and fow was
infuenced signifcantly 5< O %.%%%"6 by canal shape with specimens haing H%
degrees canals displaying less desirable =ualities. (nder the conditions of this
study, Puantec )eries -%%% rotary nickel-titanium instruments prepared simulated
canals rapidly, safely and with good three-dimensional form.
4#. 6ummer, S$apin/ a=ility of Mity 'oto 36#
%e/rees an% Na+i?e> rotary nic0el-titanium
instruments in simulate% root canals. The aim of
this study was to determine the shaping ability of 9ity Aoto >$% degrees and
*aifex nickel-titanium rotary instruments in simulated root canals. !n all, 8% canals
consisting of four diferent shapes in terms of angle and position of curature were
prepared by 9ity Aoto >$% degrees and *aifex instruments using the techni=ues
recommended by the manufacturers. This study describes the eMcacy of the
instruments in terms of preparation time, instrument failure, canal blockages,
change in canal length, and three-dimensional canal form. +erall, the mean
preparation time for canals prepared using 9ity instruments was 1.## min and 1.8"
min when using *aifex instruments. 2anal shape had no signifcant efect on the
speed of preparation with either instrument. *o instruments separated during the
studyG howeer, "H *aifex and - 9ity instruments were deformed. 2anal type did
not infuence signifcantly the tendency of either instrument to deform. *one of the
canals became blocked with debris during preparation. The ma3ority of canals
prepared by both instruments retained their original working length, and there was
no signifcant diference between the canal shapes in terms of the mean loss of
distance or category of distance change for either instrument. Apical stops as
3udged from intracanal impressions were present in -# 50-46 of the canals prepared
with 9ity instruments and in >> 58-46 of those prepared with *aifex instruments.
@oweer, the ma3ority were 3udged to be of poor =uality. )ignifcant diferences 5p O
%.%16 were noted in the =uality of apical stops between the canal types using 9ity
instruments. 2anals prepared with 9ity and *aifex instruments were found to be
smooth in the apical half of the canal in approximately one-half of the specimens
and coronally in nearly all canals. *either instrument produced horiContal or
longitudinal grooes. 7aorable fow characteristics were apparent in oer one-half
of the canals prepared with 9ity Aoto instrumentsG howeer, nearly all specimens
had poor taper. 7low and taper were generally poor in the specimens prepared with
*aifex instruments. (nder the conditions of this study, 9ity Aoto >$% degrees and
*aifex instruments prepared canals rapidly, with no separations, canal blockages,
and with minimal change in working length. Although, fow was ade=uate using 9ity
Aoto >$% degrees instruments, the taper characteristics were less than ideal
compromising the three-dimensional form of the canals. *aifex instruments, while
-#
creating better taper, produced poorer fow characteristics. The results suggest that
when using 9ity Aoto >$% degrees or *aifex instruments, the stepdown se=uence
should be modifed to improe canal fow and taper. Alternatiely, an instrument
with increased taper should be used to complete preparation before obturation.
41. .+aluatin/ t$e si<es of 7i/$tspee% instruments.
The diameters of six diferent siCed ,ightspeed cutting heads were measured using
a modifed optical micrometer. )ix specimens of instrument siCes -%, --.1, -0.0, >%,
>-.1 and H1 were examined. Dxcept for one cutting head of siCe >%, all the recorded
diameters were oersiCed compared to the expected diameter and the permitted
tolerance 5YJ- %.%%1 mm6. <erfectly machined instruments would increase by
"-.14, #.%#4 and 8.>4 from instrument siCes -%---.1, -0.1->% and >%->-.1,
respectiely. (nder the conditions of this study, the corresponding increases were
0."4, $.014 and 8.1H4. !nstrument siCe -% had the widest range and is the
smallest instrument in the ,ightspeed set. The largest diferences between the
recorded and expected means were registered for the siCe H1 group. An earlier
study using a diferent measuring method reported that ,ightspeed instruments
were mostly undersiCed.
42. Apical e>trusion of %e=ris usin/ t3o $an% an%
t3o rotary instrumentation tec$ni4ues.
The purpose of this study was to inestigate the =uantity of apical debris produced
in itro using two hand and two rotary instrumentation techni=ues. )ixty minimally
cured, mature human mandibular premolars with single canals were diided into H
groups of "1 teeth each and prepared using step-back instrumentation with ?-fles,
balanced force with 7lex-A fles, ,ightspeed nickel-titanium instruments, or .%H taper
<ro7ile )eries -# rotary nickel-titanium fles. :ebris extruded through the apical
foramen during instrumentation was collected on preweighed flters. The mean
weight of extruded debris for each group was statistically analyCed using a ?ruskal
'allis one-way analysis of ariance and a 9ann-'hitney ( rank sum tested.
Although all instrumentation techni=ues produced apically extruded debris, step-
back instrumentation produced signifcantly more debris than the other methods 5p
O %.%%%"6. There was no diference between balanced force hand instrumentation
and the two rotary nickel-titanium instrumentation methods 5p U %.%16. @and or
engine-drien instrumentation that uses rotation seems to reduce signifcantly the
amount of debris extruded apically when compared with a push-pull 5fling6
techni=ue. :ecreased apical extrusion of debris has strong implications for a
decreased incidence of postoperatie infammation and pain.
43. S.M FScannin/ .lectron MicroscopyG stu%y of
t$e %eterioration of 2roFile .#4 an% .#6.
@A(H8'5:N6& The <ro7ile are endodontic instruments made by a special nickel-
titanium alloy. They hae to work on constant rotation at a speed of >1% reolutions
per minute. The purpose of the study is to assess, through )D9 research, a possible
deterioration of diferent <ro7ile conicity.
M.,H56SF )ixteen dental elements pulled out for period dental reasons hae
been used as samples to assess the progressie deterioration of .%H and .%$ <ro7ile
>%
conicity. Dight molars and eight premolars with a total of >$ radicular canals were
examined. The types of <ro7ile tested were 8F they were respectiely H with .%H
conicity and H with .%$ conicity. &efore being used, all instruments are preiously
studied through )D9. The tested <ro7ile with .%H conicity had a diameter of "1, -1,
>% and H1. Those with .%$ conicity had a diameter of -%, -1, >% and >1. Dach tested
<ro7ile was introduced inside a radicular canal and was turned for "8% seconds with
a constant rotation of -%% reolutions per minute. After this frst step, the
alterations produced by the instrument could be obsered through )D9. Afterwards,
the same <ro7ile has worked again inside another radicular canal with the same
time and the same number of turns, before being obsered again through )D9. 'e
hae continued using this method up to the break of the instrument.
'.S:7,SF The instruments with .%H conicity and smaller diameter are sub3ect to a
faster deterioration, more isible at the point. After a working time of "8% seconds
all the instruments hae their distinct morphological alterationsF after other "8%
seconds it is possible to often obserer an alteration to the pitch of the instrument.
The breaking times are related to the diameter and conicity of <ro7ile tested.
(5N(7:S15NS& Dndodontic nickel-titanium instruments, een if they represent a
progress in the feld of canal preparation, undergo some alterations in their shape if
they are put under ineitable mechanical stress. The damages can beF break at the
top of the instrument and loss of cutting abilities at the turns leel.
44. .*ect of sterili<ation on cyclic fati/ue of rotary
nic0el-titanium en%o%ontic instruments.
The ability of heat treatment as a result of autoclae steriliCation to extend the life
of nickel-titanium rotary endodontic instruments by reducing the efect of cyclic
fatigue was ealuated using -8% siCe H% ,ightspeed instruments. !nstruments were
cycled in artifcial canals with angles of curature of >% degrees and either - or 1
mm radii of curature. !n a pilot study, instruments were steriliCed or not steriliCed
and cycled to failure to obtain mean cycles-to-failure alues for each group. !n the
frst experimental protocol, instruments were cycled to either -14, 1%4, or 014 of
the mean cycles-to-failure limit determined in the pilot study, then steriliCed or not
steriliCed before being cycled to failure. !n the second experimental protocol,
instruments were cycled to -14 of the mean cycles-to-failure determined in the
pilot study, and steriliCed or not steriliCed. The se=uence of cycling to -14 of the
predetermined cycles-to-failure limit followed by steriliCation was repeated until the
instruments failed. *o signifcant increases in cycles to failure were obsered
between groups for either experimental protocol when instruments were ealuated
at a similar radius. )ignifcant diferences in cycles to failure were only obsered
when instruments cycled to failure in the artifcial canal with - mm radius were
compared with instruments cycled to failure in the artifcial canal of 1 mm radius.
)canning electron microscopic photos showed crack initiation and propagation in all
instruments that were cycled to a percentage of the predetermined cycles-to-failure
limit. !t is concluded that heat treatment as a result of autoclae steriliCation does
not extend the useful life of nickel-titanium instruments.
45. .*ects of so%ium $ypoc$lorite on nic0el-
titanium 7i/$tspee% instruments.
)odium hypochlorite is a ma3or irrigant in endodontics, and nickel-titanium
>"
instruments are gaining in popularity. This paper inestigated the corrosion of
nickel-titanium ,ightspeed instruments in "4 and 14 *a+2l solutions. The
instruments were immersed in ultrasonicated *a+2l solutions for arying times up
to " h. 2orrosion was determined by electrothermal absorption spectrometry in "%%
micro, ali=uots of *a+2l. &ackground contamination of nickel in the "4 and 14
*a+2l solutions used was low, but high enough to interfere in detecting any
increases in nickel after immersing the instruments. The amounts of titanium
recorded in the "4 *a+2l solutions were insignifcant. @oweer, a statistically
signifcant amount of titanium was detected from the ,ightspeed instruments after
immersion times of >% and $% min in 14 *a+2l. 2linically such instruments do not
hae an Vin situV time of >% min, and this corrosion may be considered irreleant
clinically.
46. ,orsional properties of nic0el-titanium +ersus
stainless steel en%o%ontic )les.
The purpose of this study was to ealuate and compare the torsional properties of
stainless steel ?-type .%- taper and nickel-titanium (-type .%- and .%H taper
instruments. Torsion tests were performed on all three designs of instruments
according to A*)!JA:A specifcation number -8. 7or each design, -% instruments of
each of three siCes 5"1, -1, and >16 were tested. The three parameters measured
were maximum tor=ue, tor=ue at failure, and angular defection. )tainless steel ?-
type .%- taper and nickel-titanium (-type .%- and .%H taper instruments met or
exceeded specifcation standards for maximum tor=ue. They also satisfed and far
exceeded the standards for angular defection at the failure point. The stainless
steel instruments showed no signifcant diference between maximum tor=ue and
tor=ue at failure, whereas both of the nickel-titanium instruments showed a
signifcant diferential between maximum tor=ue and tor=ue at failure.
4. S$apin/ a=ility of 2roFile.#4 ,aper Series 2"
rotary nic0el-titanium instruments in simulate%
root canals. The aim of this study was to
determine the shaping ability of <ro7ile.%H Taper )eries -# rotary nickel-titanium
instruments in simulated canals. A total of H% simulated root canals made up of four
diferent shapes in terms of angle and position of curature were prepared by
<ro7ile instruments using a step-down approach. <art - of this two-part report
describes the eMcacy of the instruments in terms of prealence of canal
aberrations, the amount and direction of canal transportation and the oerall
postoperatie shape. *o Cips, perforations or danger Cones were created although
-H specimens 5$%46 had ledges on the outer wall of the canal. The incidence of
ledges difered signifcantly 5< O %.%%"6 between the canal shapes. At specifc points
along the canal length there were highly signifcant diferences 5< O %.%%"6 in total
canal width and in the amount of material remoed from the inner and outer
aspects of the cure between the arious canal shapes. +erall, H% degrees canals
were wider than -% degrees canals and canals with cures which began 8 mm from
the orifce were wider than "- mm canals. The direction of canal transportation at
the end-point of preparation was balanced between inner and outer in the 8 mm
canals, but more often towards the outer in the "- mm canals. At the apex of the
cure, transportation was inariably towards the outer aspect of the curature. At
>-
the beginning of the cure, transportation was more balanced between inner and
outer. 9ean absolute transportation, ignoring direction, was generally greater in H%
degrees canals and in those with the cure beginning 8 mm from the orifce. +f
particular importance was the fnding that excessie resin was remoed from the
outer aspect of the canal at the apex of the cure which was often associated with
irregular widened areas or ledges. This is in contrast to the pattern of tissue remoal
found with stainless steel hand instruments where more resin is remoed from the
inner aspect of the canal at the apex, to create a danger Cone.
4!. S$apin/ a=ility of N, .n/ine an% McCim rotary
nic0el-titanium instruments in simulate% root
canals.
The aim of this study was to determine the shaping ability of *T Dngine and 9cBim
nickel-titanium rotary instruments in simulated root canals. !n all, H% canals
consisting of four diferent shapes in terms of angle and position of curature were
prepared by a combination of *T Dngine and 9cBim instruments using the
techni=ue recommended by the manufacturer. <art " of this two-part report
describes the eMcacy of the instruments in terms of preparation time, instrument
failure, canal blockages, loss of canal length and three-dimensional canal form.
+erall, the mean preparation time for all canals was $.%" min, with canal shape
haing a signifcant efect 5< O %.%"6 on the speed of preparation. +ne instrument
fractured and only four instruments deformed, with most of the failures occurring in
canals with cures which began "- mm from the orifce, that is, in short acute
cures. *one of the canals became blocked with debris. 7ollowing preparation, -%
canals retained their original working length but "# lost length and one gained in
lengthG there were signifcant diferences 5< O %.%16 between the canal shapes in
terms of mean loss of distance and in the category of distance change. Apical stops
as determined from intracanal impressions were present in >0 of the canalsG "$
were 3udged to be of good =uality and -" of poor =uality. The canals were found to
be smooth in the apical half of the canal in >> specimens and in the coronal half of
># specimens. All canals had good taper characteristics and >1 had good fow
characteristics. (nder the conditions of this study, *T Dngine and 9cBim
instruments prepared canals rapidly, with few deformations, no canal blockages and
with minimal change in working length. The three-dimensional form of the canals
demonstrated good fow and taper characteristics.
>>
>H
>1
!* &A!D7 There Are )ome Types +f Aotary *iTi
!nstrumentsF
". <ro7ileF
The <ro7ile.%H Taper )eries -# is a motor system that uses nickel-titanium fles 5*iTi6
showing good fexibility 51%% times more than stainless steel alloys6, resistance to
plastic deformation and fracture, and designed to be used with rotary clock-wise
motion generated by electric motors or an air handpiece at slow speed 5"1%->1%
rpm6 and high tor=ue 5"%-11 *m6
These attributes ease their manipulation in root canals with stressed curature .
when compared to stainless steel instruments, they are more eMcient in relation
to the maintenance of the original path of the root canal .
-.?> )ystem &
!ntroduced in Zanuary -%%- by 6r.Ao$n Mcspa%%en The system has F
1.canal shaping fles which are aailable with aMxed taper of.%-,.%H or.%$.The.%-
tapered ?>flesare aailable in "1-H1 tip siCe sand -",-1 and >%mm length.the.%H
and .%$ tapered ?>fles are aailable in "1-$% tip siCes and -",-1 and >%mm length.
2.slightly positie rake angle.
>$
3.aariable core diameter. 4.three
radial lands with a relief behind two of the three.
5.asymmetrically placed radial lands as well as une=ual land widths ,fute width
and fute depth.
6.An Axxess handle design, which shortens the fle handle by approximately 1 mm
without afecting the working length of the fle.
.Aariable fute pitch . !.A color coding to distinguish between diferent
siCes and tapers. ".Asafe ended cutting tip.
1#.?>Dnhanced Taper &ody )haping5DT&)6 fles hae recently been introduced
with an enhanced taper of .%8, ."% and ."-.The DT&) can act as canal shaping fles
and orifces opener .
3.FKG S-Apex
Rotary endodonti in!tr"#ent! $it% in&erted taper
The FKG S-Apex line is the ideal complement for endodontic treatments, particularly during the canal
preparation near the apical area.
The S-Apex is intended to eliminate the risks of tip breakage of standard rotary NiTi instruments.
Ex'"!i&e te%nia' inno&ation! are at t%e root o( FKG S-Apex !"e!!
!. Negati"e conic shape #hich ensures a cylindrical preparation.
$. %re-determined &#eakest& point at !' mm of the tip to a"oid any risks of breaking the tip.
(. )ndulating cutting edges #hich pre"ent the scre#ing on*blocking effect and ha"e the ad"antages
of an extremely lo# operating tor+ue.
,. Sharp cutting edges for an impro"ed efficiency #ith fe#er instruments.
-. .lectro-chemical treatment better resistance to torsion and metal fatigue.
'. .xclusi"e rounded Safety tip for a perfect control, staying clear of lateral
canals or for getting round an obstacle.
>0
).GT ROTAR*
it need+
!. A high-tor+ue, slo#-speed hand piece is re+uired.
$. /perate the hand piece at (00 1%2 3re"olutions per minute4.(. )tili5e minimal apical pressure.
,. 6re+uently lubricate the canal throughout the procedure.
-. .xercise caution in the apical area and around significant cur"atures.
,GT Rotary In!tr"#ent! o#e in (o"r pri#ary !i-e!. ea% $it%/0 ## dia#eter tip!.
.!$ taper .07 taper
.!0 taper .0' taper
,a'!o in t%ree ae!!ory !i-e!. ea% %a&in1 a .2/ taper.
(- tip 80 tip -0 tip
3.4UANTEC
5.6ERO
7.LIG6T S8EED
and t%ere are #any type! !ti'' "nder re!ear%.

>8