Evolution of nickeltitanium

instruments: from past to future

MARKUS HAAPASALO & YA SHEN
Over the decades, a wide array of nickeltitanium (NiTi) instruments has been introduced for shaping root
canals.
Each generation of instruments has had something new to offer and has been intended to improve upon previous
generations. Many variables and physical properties influence the clinical performance of NiTi rotaries.
Ultimately,
clinical experience, handling properties, safety, and case outcomes should decide the fate of a particular
instrument
design. This review article summarizes the metallurgical and mechanical properties of NiTi endodontic
instruments and the design features of each generation, with a special focus on the latest generation of NiTi
instruments. Experimental and clinical evaluations of the performance of NiTi instruments in endodontic
treatment are discussed.
Received 22 October 2013; accepted 1 November 2013.
Introduction
Root canal instrumentation is accomplished by the use of endodontic instruments and irrigating solutions
under aseptic working conditions. Root canal instrumentation may be carried out using hand-held
or engine-driven (rotary) instruments. Up until the last decade of the past century, endodontic
instruments were manufactured out of stainless-steel. Stainless-steel files have an inherent stiffness that
increases as the instrument size increases. As a result, when preparing a curved root canal, restoring forces
attempt to return the instrument to its original shape, especially when the operator uses a filing
motion. Therefore, in curved canals, steel instruments must be pre-curved for use, which effectively prevents
them from being used in a rotary motion. An instrument that is too stiff will cut more on the convex
(outer) side than on the concave (inner) side, thereby straightening the curve. Rotary root canal instruments
manufactured out of a nickeltitanium (NiTi) alloy have proven to be a valuable adjunct for root canal
therapy. NiTi instruments are highly flexible and elastic (1). Advantageously, NiTi rotary shaping files
have nearly eliminated the iatrogenic instrumentation complications that are often connected to endodontic
steel instruments. NiTi instruments were introduced over two decades ago. Since their first appearance,
instrument design has changed considerably; progress has been made in manufacturing as well as alloy
processing. Traditionally files had been produced according to empiric designs, and even today many
instruments are still devised by individual clinicians rather than developed through an evidence-based
approach. The development of new files nowadays is a fast and market-driven process. Clinical procedures
and ideal working parameters are still being refined as new instruments continue to be introduced to the
market. With new versions rapidly becoming available, the clinician may find it difficult to choose the file
and technique most suitable for an individual case. NiTi instruments have undergone a revolution regarding
different designs to produce an instrument that cuts effectively while exhibiting resistance to
fracture even in the most challenging anatomical confines. One should always bear in mind that all file
systems have benefits and weaknesses. Instrument properties are derived from the type of alloy, degree of
taper, and cross-sectional design. This article presents an overview of the design features, mechanical
properties, and instrumentation performance of the new generation of NiTi instruments.
Design features of each
file generation
The application of NiTi in endodontics was first reported by Walia et al. (2) who used nitinol
orthodontic wire (3) to fabricate intracanal files, size 15. These files were shown to have two to three times
the elastic flexibility in bending and torsion, as well as superior resistance to torsional fracturing when
compared to similar stainless-steel instruments. A game-changing outcome of files manufactured out of
NiTi was that curved canals could be mechanically prepared utilizing a continuous rotary motion. By the
1990s, the first commercially available NiTi rotary files had come to market. Most NiTi rotary files have
rounded non-cutting tips that serve as a guide in the canal. Unlike the tip, the instrument shaft retains
its cutting action; only the transition angle at D1 is modified. In the following, a mechanical classification
of each generation of file systems is presented and discussed. Rather than identify the myriad of crosssections
available, files will be characterized as having either a passive or an active cutting action. Some of the
early systems have been removed from the market or play only minor roles; others, such as the ProFile
(Dentsply Tulsa Dental, Dentsply Maillefer), are still widely used. New file designs are continually produced,
but the extent to which clinical outcomes (if any) will depend on their design characteristics is difficult to
forecast (4).

First-generation files
The first rotary 0.02 taper NiTi instrument was designed by Dr. John McSpadden and came to market
in 1992. Although these instruments began to change how dentists viewed instrumentation, there were
problems associated with file breakage. In 1994, Dr. Johnson introduced a line of files which became
known as the ProFile 0.04 tapered series. Following soon after were the ProFile 0.06 tapers and the
Orifice Shapers. Their cross-sectional shapes were made by machining three equally spaced U-shaped
grooves around the shaft of a tapered NiTi wire. For this classical design, an unground space remained
next to each groove, providing the so-called radial land area. This flat area prevents the file from locking
in the dentin, while cutting occurs through a passive planing action. Dr. Johnson broke the paradigm of ISO 0.02
tapered files by making these more highly tapered files, and together with Dr. McSpadden, the two are generally
regarded as the fathers of NiTi rotary files. Other rotary file lines came along soon afterwards, each with its
purported advantages, such as the LightSpeed developed by Dr. Steve Senia and Dr. William Wildey, the
Quantec developed by Dr. John McSpadden, and the Greater Taper files developed by Dr. Steve Buchanan. The
design of the LightSpeed files (now also known as LS1) deserves special attention. LightSpeed was introduced
as an instrument differing from all others because of its long, thin non-cutting shaft and short anterior cutting
part. The same design principles apply to the recently developed LSX instrument (Discus Dental, Culver City,
CA) that is manufactured not by milling but by stamping. The files are used for apical preparation and do not cut
over most of the canal length because of the existence of a smooth smalldiameter shaft that also enhances the
flexibility of the instrument.

Second-generation files
To appreciate the evolution of instruments, it is useful to know that all first-generation NiTi rotary files had
passive cutting radial lands, fixed tapers over the length of their working parts, and required a considerable
number of files to achieve preparation objectives. By the end of the 1990s, the next generation of NiTi
rotary files came to market. The critical distinctions of this generation of instruments are that they have
actively cutting edges without radial lands and fewer instruments are required to fully prepare a canal. The
angle between the cutting blade and the longitudinal axis of the instrument is lower than in first-generation
files, which greatly reduces the tendency for a screwing effect during use. This generation of NiTi files includes
the ProTaper (Dentsply Tulsa) rotary files which, unlike all other passive or active NiTi cutting
instruments, have multiple tapers of increasing and decreasing size on a single file. The ProTaper system is
based on a unique concept and originally comprised just six instruments: three shaping files and three
finishing files. The ProTaper Universal set is now complemented by two larger finishing files and a set
designed for re-treatment procedures. The crosssection of finishing files F3, F4, and F5 is slightly relieved for
increased flexibility.

The first-generation rotary systems had neutral or slightly negative rake angles. Several secondgeneration
systems were designed with positive rake angles, which gave them greater cutting efficiency
[e.g. K3 system (SybronEndo, Orange, CA) invented by Dr. McSpadden]. The most obvious difference
between the Quantec and K3 models is the K3s unique cross-sectional design: a slightly positive rake
angle for greater cutting efficiency, wide radial lands, and a peripheral blade relief for reduced friction. Unlike
the Quantec, a two-flute file, the K3 features a third radial land to help prevent threading-in. In the
lateral aspect, the K3 has a variable pitch and variable core diameter, which makes the file stronger close to
its apical tip. To discourage taper lock and the resultant screw effect associated with both passive and active
fixed tapered NiTi cutting instruments, EndoSequence (Brasseler, Savannah, GA, USA) and BioRaCe (FKG
Dentaire, La Chaux-de-Fonds, Switzerland) provide files with alternating contact points (5). Although this
feature is intended to mitigate a taper lock, these files still have a fixed taper over their active portions. The
BioRaCe instruments undergo a proprietary finishing treatment (electropolishing) after the traditional
grinding process aimed at reducing the surface defects and improving the mechanical properties of the
instruments (6). It has been suggested that the surface condition of the NiTi instrument contributes to fatigue
resistance because most fatigue failures nucleate from the surface, especially in the presence of high stress
amplitude or surface defects (7). During this period, manufacturers began to focus on other methods to
increase the resistance to file separation. Attempts to enhance the surface of NiTi instruments, resistance to
cyclic fatigue, and cutting efficiency have resulted in a variety of strategies including ion implantation (810)
and electropolishing (1113).
Third-generation files
Improvements in NiTi metallurgy became the hallmark of what may be identified as the third generation of
mechanical shaping files. Heat treatment (thermal processing) is one of the most fundamental approaches
toward adjusting the transition temperatures of NiTi alloys (1418) and affecting the fatigue resistance of NiTi
endodontic files. Since 2007, several new thermomechanical processing and manufacturing technologies have
been developed in order to optimize the microstructure of NiTi alloys. Recently, several new
thermomechanically processed endodontic NiTi files such as the HyFlex CM (HyFlex; Coltene Whaledent,
Cuyahoga Falls, OH), K3XF (SybronEndo, Orange, CA), ProFile GT Series X (GTX; Dentsply Tulsa Dental
Specialties, Tulsa, OK), ProFile Vortex (Vortex) and Vortex Blue (Dentsply Tulsa), TYPHOON Infinite Flex
NiTi (TYP CM; Clinicians Choice Dental Products, New Milford, CT), and Twisted Files (TFs; SybronEndo)
have been introduced. M-wire (SportsWire, Langley, OK) was introduced in 2007. It is produced by applying a
series of heat treatments to NiTi wire blanks. M-wire instruments include Dentsplys ProFile GT Series X,
ProFile Vortex, and Vortex Blue. The first commercially available endodontic rotary system using the new
M-wire NiTi material was the GT Series X files. The design principles of GT files are mostly still present in
the current incarnation of GTX instruments. The main differences are the use of M-wire for GTX, subtle
changes in the longitudinal design, and a different approach to instrument usage, emphasizing the use of
the no. 20/0.06 rotary. In 2009, the ProFile Vortex file was introduced by Dentsply Tulsa Dental. The
major difference between the Vortex and the classical ProFile files lies in the non-landed cross-section of the
Vortex files, whereas the tip sizes and tapers are similar in both files. Manufactured out of M-wire, the ProFile
Vortex also has a varying helical angle to counteract the tendency of the non-landed files to thread into the
root canal. Vortex Blue instruments, new NiTi rotary instruments made out of M-wire, show a unique blue
color not seen in traditional superelastic (SE) NiTi instruments. The blue-color oxide surface layer of
Vortex Blue files is a result of the proprietary manufacturing process (Fig. 1). The relatively hard titanium oxide
surface layer on the Vortex Blue instrument may compensate for the loss of hardness compared with ProFile
Vortex M-wire (19) by improving the cutting efficiency and wear resistance. CM Wire (DS Dental, Johnson
City, TN) is a novel NiTi alloy with flexible properties that was introduced to endodontics in 2010. CM NiTi
files are manufactured using a special thermomechanical process that controls the memory of the material,
making the files extremely flexible but without the

Fig. 1. Vortex Blue NiTi instruments.

Both the HyFlex and TYPHOON CM instruments are made out of CM Wire. They exhibit a lower percent by
weight of nickel (52 Ni %wt) than the common 54.557 Ni %wt of the great majority of commercially available
SE NiTi rotary instruments. HyFlex instruments have a triangular cross-sectional design. TYP CM files,
introduced in 2011, feature a triangular cross-section and a 12-mm-long cutting flute. In 2008, SybronEndo
presented the first fluted NiTi file manufactured by plastic deformation, a process similar to the twisting process
that is used to produce the majority of stainless-steel K-files and reamers. According to the manufacturer, a
thermal process allows twisting during a phase transformation into the so-called R-phase of NiTi. The
instrument was first available with only no. 25 tip sizes in tapers 0.04 up to 0.12. However, instruments with tip
sizes no. 30, 35, and 40 were recently added. The design of K3 instruments was recently updated by
SybronEndo, and the system has been available under the name of K3XF since 2011. K3 and K3XF
instruments are identical in shape and differ only in that K3XF instruments undergo post-machining
heat treatment (16). The manufacturer claims that K3XF has a third radial land and variable pitch,
superior flexibility, and resistance to fatigue

Numerous micropores with various diameters can be seen on the surface of the instrument flute on K3XF
instruments (Fig. 2). These small pores do not contribute to the failure, but serve as a local stress/strain
discontinuity from which the crack nucleates.
Fourth-generation files
The greatest number of commercially available files that are utilized to shape root canals are manufactured out
of NiTi and are mechanically driven in continuous rotation. However, reciprocation, defined as any
repetitive back-and-forth motion, has been clinically utilized to drive stainless-steel files since 1958.
Initially, all reciprocating motors and related handpieces rotated files in large equal angles of 90
clockwise (CW) and counterclockwise (CCW) rotation. Over time, virtually all reciprocating systems in the
marketplace began to utilize smaller, yet equal, angles of CW/CCW rotation. Currently, the M4 (SybronEndo),
Endo-Eze AET (Ultradent), and Endo-Express (Essential Dental Systems) are examples of reciprocating
systems that utilize small, equal 30 angles of CW/CCW rotation. In 2008, Dr. Ghassan Yared identified the
precise unequal CW/CCW angles that would enable a single reciprocating 25/0.08 ProTaper file to optimally
shape virtually any canal (20). Although this specific reciprocation technique stimulated considerable
interest, this ProTaper F2 file was never designed to be used in this manner. In 2011, both WaveOne (Dentsply
Tulsa Dental Specialties and Dentsply Maillefer) and Reciproc (VDW) were launched as single-file shaping
techniques. Both files are made out of M-wire. Innovation in reciprocation technology led to a fourth generation
of instruments for shaping canals. Clinical experience and future studies will determine whether this generation
of instruments and the related technology has fulfilled the promise of the long hoped-for single-file technique.
WaveOne represents a convergence of the design features from the second and third generation of files,

Fig. 2. Lateral-view scanning electron micrograph of a new K3XF (AC) and K3 instrument (DF). (C) High
magnification view of the specimen showing voids on the surface of K3XF.

coupled with a reciprocating motor that drives any given file at unequal bidirectional angles. The CCW
engaging angle is five times the CW disengaging angle and is designed to be less than the elastic limit of the
file. Strategically, after three CCW and CW cuttingcycles, the file will have rotated 360, or one complete
circle. This novel reciprocating movement allows a file to progress more readily, cut efficiently, and auger
debris effectively out of the canal (20). The WaveOne technique is both a single-file and single-use concept.
Strategically, only one file is generally utilized to fully shape virtually any given canal. However, there are
three WaveOne files available to address a wide range of endodontic anatomy commonly encountered in
practice. The three WaveOne instruments are termed Small (yellow 21/0.06), Primary (red 25/0.08), and
Large (black 40/0.08). The Small 21/0.06 file has a fixed taper of 6% over its active portion. The Primary
25/0.08 and the Large 40/0.08 WaveOne files have fixed tapers of 8% from D1-D3, whereas from
D4-D16, they have a unique progressively decreasing percentage tapered design. The design feature of the
WaveOne files is that they have a reverse helix and two distinct cross-sections along the length of their active
portions. From D1-D8, the WaveOne files have a modified convex triangular cross-section (Fig. 3),
whereas from D9-D16, these files have a convex triangular cross-section. The design of the two
WaveOne cross-sections is further enhanced by a changing pitch and helical angle along their active portions.
The WaveOne files have non-cutting modified guiding tips, which enable these files to safely
progress through virtually any secured canal (21). Reciproc instruments have a short shaft of 11 mm,
enabling better access to molars compared to many other instruments which have a shaft of 13 mm or
longer. The design of the cross-section is S-shaped. The three Reciproc files have a regressive taper: R25
(25/0.08) for narrow canals; R40 (40/0.06) for medium canals, and R50 (50/0.05) for wide canals. The
instruments are used at 10 cycles of reciprocation per second, the equivalent of approximately 300 rpm. The
values of the CW and CCW rotations are different. When the instrument rotates in the cutting
direction, it will advance in the canal and engage dentin. When it rotates in the opposite direction (smaller
rotation), the instrument will immediately disengage. The end result, related to the degree of CW and CCW
rotations, is an advancement of the instrument in the canal without the risk of a screwing effect. The self-
adjusting file (SAF; ReDent-Nova, Raanana, Israel) represents a new approach in file design and mode of
operation (22). The file is a hollow device, designed as a cylinder of thin-walled, delicate NiTi lattice with a
lightly abrasive surface.

Fig. 3. Cross-section of WaveOne file 3 mm (top) and 9 mm (bottom) from the tip of the
instrument.

Different from the traditional nickeltitanium (NiTi) rotary files, the SAF system uses a hollow reciprocating
instrument that allows for simultaneous irrigation throughout the mechanical preparation. When
inserted into the root canal, the manufacturer claims that the SAF is capable of adapting itself to the
canal shape three-dimensionally (23). The instrument is used in a transline (in-and-out) motion, and the
abrasive surface of the lattice threads promotes a uniform removal of dentin (22). An initial glide path is
established with a #20 K-file to allow the insertion of the SAF file (22).

Fifth-generation files
The fifth generation of shaping files has been designed such that the center of mass and/or the center of
rotation are offset. In rotation, the files that have an offset design produce a mechanical wave of motion
that travels along the active length of the file. Like the progressively percentage tapered design of any given
ProTaper file, this offset design serves to further minimize the engagement between the file and dentin
(24). Commercial examples of file brands that offer variations of this technology are Revo-S, One Shape
(Micro-Mega, Besanon, France), and ProTaper Next (PTN; Dentsply Tulsa Dental Specialties/
Dentsply Maillefer). ProTaper Next is the successor to the ProTaper Universal system. There are five PTN files
available, in different lengths, for shaping canals: X1 (17/0.04), X2 (25/0.06), X3 (30/0.07), X4 (40/0.06), and
X5 (50/ 0.06). The tapers shown above indicate the taper of the tip region of each file and are not fixed over the
active portion of any given PTN file. The PTN X1 and X2 files have both an increasing and decreasing
percentage tapered design on a single file; whereas thePTNX3, X4, and X5 files have a fixed taper from D1-D3,
then a decreasing percentage tapered design over the rest of their active portions. PTN files are the convergence
of three significant design features, including various tapers on a single file, M-wire technology, and the
fifth generation of continual improvement, the offset design. An offset design generates a traveling
mechanical wave of motion along the active portion of a file. This swaggering effect serves to minimize the
engagement between the file and dentin compared to the action of a fixed tapered file with a centered mass of
rotation. Reduced engagement limits any undesirable taper lock, the screw effect, and the torque on any given
file. An offset file design may also decrease the probability of laterally compacting the debris and blocking the
root canal system anatomy. The Revo-S NiTi instrument system includes three shaping instruments: the shaping
and cleaning instrument (SC) number 1 (SC1) (#25/0.06), SC2 (#25/0.04), and the universal shaper (#25/0.06).
The asymmetrical cross-section of the Revo-S facilitates penetration by a snake-like movement and is
intended to reduce torsional stress on the instrument. The manufacturer claims that this sequence has a cutting,
debris elimination, and cleaning cycle which optimizes the root canal cleaning by improving the
upward removal of the generated dentin debris. The One Shape file from Micro-Mega (Besanon, France) is the
only single-file NiTi instrument in continuous rotation for root canal preparations. The One Shape instrument
presents a variable cross-section along the blade which has an optimal cutting action in three zones of the canal.
The first zone presents a variable three-cutting-edge design; the second, prior to the transition, has a cross
section that progressively changes from three to two cutting edges; and the last (coronal) has two cutting edges.
Metallurgical and mechanical properties
NiTi shape memory metal alloy can exist in two different temperature-dependent crystal structures
called martensite (lower temperature or daughter phase) and austenite (higher temperature or parent phase). The
crystal lattice structure can be altered by either temperature or stress. This is important because several
properties of the two forms are notably different. Near equiatomic NiTi alloys contain three microstructural
phases (i.e. austenite, martensite, and R-phase), the character and relative proportions of which determine the
mechanical properties of the metal (25). When the material is in its martensite form, it is soft and ductile and can
easily be deformed, while austenitic NiTi is quite strong and hard (26). Detailed information about the
mechanical properties of NiTi instruments is described in the chapter by Zhou et al. in this volume of
Endodontic Topics (27). The conventional SE NiTi file (1st and 2rd generation) has an austenite structure at room
and body temperatures (19,2631). It is well known that the nature of the alloy and the manufacturing process
greatly affect the mechanical behavior of the instrument (32). To improve the fracture resistance of NiTi files,
manufacturers have either introduced new alloys to manufacture NiTi files or developed new manufacturing
processes (3336). Recently, a series of proprietary thermomechanical processing procedures has been
developed with the objective of producing SE NiTi wire blanks that contain the substantially stable martensite
phase under clinical conditions. Enhancements in these areas of material management have led to the
development of the new generation (3rd, 4th, and 5th generation) of endodontic NiTi instruments. NiTi files with
thermal processing (e.g. CM Wire and M-wire) contain a mixture of austenite and martensite conditions at body
temperature (19,26,31,37). The martensitic phase of NiTi has some unique properties that have made it an ideal
material for many applications (38). The martensitic phase transformation has excellent damping characteristics
because of the energy absorption characteristics of its twinned phase structure. In addition, the martensitic form
of NiTi has an excellent fatigue resistance (36,3942). The TF is a NiTi rotary file manufactured by twisting
when the metal is in the so-called R-phase. The R-phase shows good superelasticity and shape memory
effects; its Youngs modulus is typically lower than that of austenite. Thus, an instrument made out of R-phase
wire would be more flexible (30,43). Also, the stress hysteresis is smaller for TFs than for ground files (30). A
narrower stress hysteresis means that more austenite can be transformed into martensite during the stress
induced (44). Hence, it is not surprising that a higher fatigue resistance was found in TFs than in
conventional NiTi files (4548). K3XF instruments are post-machining heat-treated
NiTi files. Although K3XF instruments consist mainly of austenite in the oral environment, the bending load
values in the superelastic range are lower for K3XF than for K3 instruments (49). This is not surprising because
the R-phase of K3XF possesses lower shear modulus than martensite and austenite, and the
transformation strain for the R-phase transformation is less than one tenth of that of the martensitic
transformation (50). Differential scanning calorimetric analyses have found that two overlapping endothermic
peaks were observed on the heating plot of K3XF instruments, indicating that reverse transformation of
the alloy passes through the intermediated R-phase, and thus reflecting the complex phase transformation
behavior traced back to the manufacturing process (49,51). Therefore, it is possible that K3XF instruments are
more flexible and resistant to cyclic fatigue than the K3 instruments (49,52,53). A reciprocating motion may
decrease the impact of cyclic fatigue on NiTi rotary instrument life compared with rotational motion (5456). It
has been postulated that the increased fatigue resistance occurs because of the release of reaction stresses built
up in the material by reversing the rotational direction (55 57). Recent articles reported a higher cyclic fatigue
resistance of the reciprocating motion than continuous rotation in instruments specifically designed to be used
in a reciprocal motion as well as in those manufactured for continuous rotation use (54,57,58). Kim et al. (59)
assessed the cyclic fatigue resistance and torsional resistance of two reciprocating motion systems, the Reciproc
R25 and WaveOne Primary files, compared with the ProTaper F2 in a continuous rotation. The results showed
that both reciprocating files demonstrated higher cyclic fatigue and torsional resistance than the ProTaper.
Markvart et al. (60) evaluated the influence of a glide path by using PathFiles on canal curvature and axis
modification after instrumentation with WaveOne Primary files. It was shown that the creation of a previous
glide path before any NiTi rotary or reciprocating motion instrumentation appeared to be appropriate for safely
shaping the root canals.

Root canal preparation

Shaping properties
First- and second-generation literature: mixed results
ProFile instruments shaped canals without major preparation errors in a number of in vitro investigations (61
64). A slight improvement in canal shape was noted when size 0.04 and 0.06 tapered instruments were used in
an alternating fashion (65). Studies on GT files found that the prepared shape stayed centered and was achieved
with few procedural errors (6669). A shaping assessment using micro-CT showed that GT files machined
statistically similar canal wall areas as ProFile and LightSpeed files (68). These walls were homogeneously
machined and smooth (68,69). In a study using plastic blocks, the ProTaper files created acceptable shapes more
quickly than GT, ProFile, and Quantec instruments (69), but they also created more aberrations. This was
recently corroborated by comparing ProTaper Universal preparations of mesial root canals in mandibular
molars ex vivo to Alpha file preparations (Brasseler Komet, Lemgo, Germany) (70). In a comparison of
ProTaper and K3 instruments, Bergmans et al. (71) found few differences, with the exception of some
transportation by the ProTaper into the furcation region. A study using micro-CT showed that the ProTaper
created consistent shapes in constricted canals, without obvious preparation errors, although wide canals may be
insufficiently prepared with this system (72). Some authors have recommended a hybrid technique where
ProTaper is combined with less tapered, more flexible rotaries to reduce apical transportation (73). The effect of
Mtwo and ProTaper Universal (PTU) on root canal geometry was compared using micro-CT. The result showed
that PTU produced greater transportation at the apical third (74). The shaping ability of K3 files in vitro seems
to be similar to that of the ProTaper (71) and superior to that achieved with hand instruments (75). When curved
canals in lower molars were shaped to a size 30/0.06, K3 had less canal transportation in a modified Bramante
model than RaCe but more than ProFile (76). Few results of in vitro experiments comparing RaCe to other
contemporary rotary systems are available (5,77): canals in plastic blocks and in extracted teeth were prepared
by the RaCe with less transportation from the original curvature than occurred with the ProTaper (5). In a
separate study, ProTaper and RaCe performed similarly when canals were prepared to an apical size 30 (78).
When preparing to a size 40, RaCe prepared canals rapidly and with few aberrations or instrument deformities
(79). The newer BioRaCe instrument sequences attempt to utilize 0.02 tapered instruments to promote larger
apical sizes; this is also possible in a hybrid technique described above.

New generations (from 3rd to 5th generations)

The canal shaping properties of Hyflex CM, TFs, and K3 rotary NiTi files were described by using micro-CT
in maxillary first molars (80). The TFs system produced significantly less transportation than the K3 system in
the apical third of canals (Fig. 4). No significant difference in apical transportation was found between TFs and
Hyflex CM instruments. Recently, in a comparison of GTX, Twisted File, Revo-S, RaCe, Mtwo, and ProTaper
Universal systems on maxillary first permanent molars, Celik et al. (81) found that there was no significant
difference between NiTi rotary system groups at any level except for 2.5 mm from the working length. At this
level, the ProTaper Universal system caused more canal transportation than the other files tested. The shaping
ability of NiTi instruments (FlexMaster) in either continuous or reciprocating movements was compared in
plastic blocks (82). The results showed that in the most apical third of the

Fig. 4. Representative three-dimensional reconstructed panels of MB root canals of maxillary first molars for groups
of Twisted Files. (A) Preoperative reconstructions. (B) Postoperative reconstructions. (C) Superimposed
reconstructions. (D) Cross-sections of the apical, middle, and coronal thirds of canals. Red indicates preoperative
area; green indicates postoperative area. Courtesy of Drs. Da Zhao and Bin Peng.

canal, the continuous rotation group produced a greater enlargement of the canal than the reciprocating group. In
the apical third, the continuous rotation group displayed significantly greater enlargement of the canal at the
external side (82). You et al. (83) evaluated the shaping ability of reciprocating motion (RM) in comparison
with continuous rotation motion (CRM) with the ProTaper in curved root canals using micro-CT. The
results showed that changes in curvature, root canal volume, surface area, and structure model index were
not affected by the instrumentation technique used. There were no significant differences in the degrees
and directions of transportation between the CRM and RM groups (82). It was indicated that the application of
reciprocating motion during instrumentation did not result in increased apical transportation when compared to
continuous rotation motion. Reciprocating motion may thus be an attractive alternative method to prevent
procedural errors during root canal shaping. Moreover, the single-file technique presented similar debridement
quality in round canals as the complete sequence of ProTaper rotary instruments (84). The shaping ability of
WaveOne instruments has been evaluated in plastic blocks and extracted teeth (60,85). The WaveOne NiTi
Primary reciprocating single file maintained the original canal anatomy better, with less modification of the
canal curvature than the ProTaper system up to F2 (60). Brklein et al. (85) compared the shaping ability of two
reciprocating single-file systems (Reciproc and WaveOne) with Mtwo and ProTaper rotary instruments during
the preparation of curved root canals in extracted teeth. The results showed that both single-file systems
maintained root canal curvature well and were safe. The use of Reciproc and WaveOne files resulted in
significantly shorter preparation times than the other two file systems, which are used in continuous rotation
(85).

Reduction of intracanal bacteria

The eradication of a microbial infection is accomplished mainly through mechanical instrumentation and
chemical irrigation (72,86). With the advent of NiTi rotary systems, perhaps too much credit has been given to
these systems as being the solution to overcome the challenges of root canal disinfection. Indeed, it is important
to note that no difference in the effectiveness of bacterial removal has been found between hand and rotary
instruments (86). Dalton et al. (87) sampled root canals irrigated with saline solution before, during, and after
instrumentation and then cultivated and counted colony-forming units. They found that using instrumentation
without an antimicrobial irrigant reduced the number of bacteria regardless of whether NiTi rotary or stainless-
steel hand instrumentation was used. However, neither technique achieved bacteriafree canals. Their result was
confirmed by Siqueira et al. (88) in a study showing that instrumentation

Fig. 5. Scanning electron microscopic images of the areas outside the groove (AB) and inside the groove (CD) after
treatment using hand K-files (A & C) and SAFs (B & D). Courtesy of Dr. James Lin.

combined with saline irrigation mechanically removed more than 90% of bacteria in the root canal.
Siqueira et al. (89) compared the capability of SAF and rotary NiTi instrumentation with irrigation to eliminate
Enterococcus faecalis populations from root canals of extracted human teeth. Long oval canals
from mandibular incisors and maxillary second premolars were infected with E. faecalis for 30 days to form
biofilm-like structures. The preparation of long oval canals with the SAF was significantly more
effective than rotary NiTi instrumentation in reducing intracanal E. faecalis counts. Data regarding the
incidence of negative and positive cultures revealed that while in the SAF group 80% of the samples were
rendered free of detectable levels of E. faecalis, instrumentation with rotary NiTi instruments resulted in only
45% of culture-negative samples, indicating that the SAF system has the potential to be particularly
advantageous in promoting disinfection of ovalshaped canals. Recently, Lin et al. (90) found that
hand and rotary files techniques were equally effective in removing bacteria from the main canal (outside the
standard apical groove), although both were unable to achieve complete elimination of the microbes (Fig. 5).
However, it appeared that the rotary files were capable of achieving better removal of biofilm bacteria within
the apical groove than the hand files. The SAF removed significantly more bacteria from the groove than the
rotary and hand files (90).

Clinical use
Instrument fracture is a potentially serious mishap that can complicate and compromise the endodontic
treatment outcome, especially if the fragment prevents access to the apical part of an infected root canal
(91,92). NiTi rotary files are available in a variety of designs, each with features that affect the manner in
which they engage and cut dentin (93) and the stress that may be generated within the file (94,95). The
incidence of SE NiTi instrument fracture in clinical practice for files used multiple times has varied from
0.05% to 39% (96103). It is possible that the high fracture percentages in some studies are a consequence
of repeated use of the same files far beyond the recommendations of the manufacturers. The reasons
for the fracture of NiTi instruments may be complex and multifactorial; the most important reasons may be
operator-related (such as skill, experience, instrumentation technique, method of use), instrument design, bulk
material properties, and root canal anatomy (51,97,101108). Operator proficiency is an important consideration
when evaluating the propensity of instrument failure. The operators ability to sense and resist the binding or
locking tendency is a skill that can be obtained only with experience. That is, judgment error or inadvertent
misuse by the operator may be more important than the number of uses in causing the breakage of the
instrument in the canal. A clinical study on HyFlex NiTi instruments (51) found that none of the 468 HyFlex
instruments fractured during instrumentation of three teeth by each file. Only 3.4% (16 of 468) of the
instruments revealed plastic deformation. However, multiple clinical uses caused significant changes in the
microstructural phases of HyFlex instruments. The enthalpy values for the transformation from martensitic to
austenitic on the instrument apical regions were smaller in deformed instruments than in unused instruments
(51). This difference was attributed to variations in local stress on the tip region during instrumentation. Smaller
instruments should be considered single-use. Previous studies (101,105) also confirmed this trend toward a
high incidence of instrument distortion in smaller conventional superelastic NiTi instruments. Given the same
torque, smaller instruments would be more susceptible to torsional failure than larger instruments. Therefore,
caution should be exercised regarding the reuse of small HyFlex rotary instruments. In conclusion, it seems that
HyFlex instruments, subjected to a proprietary manufacturing process, are safe to use in endodontic treatment.
Although multiple clinical uses of NiTi rotary files may be one of the causes of instrument breakages and
deformations, some studies (107,109) have found that a brand-new SE NiTi instrument may also fail at first use.
One study has been published (109) that showed that the 0.9% ProFile series 29 rotary file fractured after a
single use; the result was based on a total of 786 clinical samples from one endodontic office. Recently,
a study (103) showed that only one ProFile Vortex file out of a total of 2,203 files used fractured during a single
clinical use over a 2-year period in an undergraduate clinic. The cause of the fracture was shear stress.
Unwinding of the files was not detected except for the fractured file. Gao et al. (39) studied the
torsional properties of superelastic wire files, M-wire files, and Vortex Blue NiTi files. The results showed that
the M-wire was 20% higher in torque strength than the superelastic wire and the Vortex Blue NiTi,
whereas the superelastic wire exhibited a slightly higher distortion angle at breakage than M-wire. It is possible
that the higher torque strength and lower angular distortion (compared with superelastic NiTi
wire) makes ProFile Vortex files less likely to undergo such deformations, and, therefore, separation might
occur without warning. A study of the metallurgical characteristics of unused and clinically used Vortex
instruments found that a clinical single use had no detectable effect on the austenite-martensite phase
transformation of the files. Unused and clinically single-used files contain a similar phase structure
at body temperature (103). Although detailed information about the thermomechanical treatment history of the
Vortex file made out of M-wire is not available, it seems that this processing is a promising way to achieve
substantial improvements in the safety of endodontic instruments.

Conclusions
New endodontic files for root canal instrumentation are continually added to the armamentarium, and older
systems are updated. First-generation NiTi rotary files relied much on the superelasticity of the metal, while in
instrument design the emphasis was on maximized safety (e.g. radial lands) rather than cutting effectiveness.
Since then the focus has shifted to new manufacturing processes (thermomechanical treatment and R-phase) and
different unique features such as a variable cross-section along the length of the active portion of the file. Many
variables and physical properties influence the clinical performance of NiTi rotaries. Ultimately, clinical
experience, handling properties, safety, and case outcomes will decide the fate of a particular design. In the
future, new instruments should fulfill the three sacred tenets for shaping canals: safety, effectiveness, and
simplicity. Research will be needed to validate the performance and benefits of each new system.