Basic Research—Technology

Apical Enlargement According to Different Pecking Times

at Working Length Using Reciprocating Files
Hyo-Jin Jeon, DDS, MS,* Avina Paranjpe, DDS, MS, PhD,† Jung-Hong Ha, DDS, MS,‡
Euiseong Kim, DDS, MSD, PhD,§ WooCheol Lee, DDS, MS, PhD,jj and
Hyeon-Cheol Kim, DDS, MS, PhD*

Abstract
Introduction: The purpose of this study was to evaluate
the apical preparation sizes resulting from repetitive
pecking motions at the working length (WL) by using
reciprocating files. Methods: Sixty simulated
endodontic training blocks with a J-shaped root canal
were instrumented using Reciproc R25 (VDW, Munich,
Germany) or WaveOne Primary (Dentsply Maillefer, Bal-
laigues, Switzerland) (n = 30 each). Each group was
divided into 3 subgroups based on the repetitive pecking
times at the WL: 1, 2, and 4 times. All specimens were
prepared by 1 operator who was competent in instru-
menting canals with both file systems. All of the proce-
dures, including the WL measurement, were performed
under an operating microscope. The replica of the
prepared canal was taken with silicone impression
material. After 24 hours of allowing the impression to
set, each sample was evaluated under a scanning elec-
tron microscope at the apical tip, and the apical prepa-
ration size (diameter) was measured at the D0 level of
the impression. The data were analyzed statistically
using 2-way analysis of variance and the Tukey post
hoc test at P = .05. Results: The mean diameter (mm)
varied between 253 and 274 and between 258 and
277 for Reciproc and WaveOne, respectively, without
significant differences. However, more repetitive peck-
ing motions at the WL resulted in a significantly larger
apical preparation size than the subgroups with less
pecking times (P < .05). Conclusions: Under the condi-
tions of this study, the results indicate that a greater
number of repetitive pecking times at the WL may result
in an apical preparation size that is larger than the actual
file size. (J Endod 2014;40:281–284)
Key Words
Apical preparation size, nickel-titanium rotary file, Reci-
proc, reciprocating file, WaveOne
R oot canal instrumentation is considered one of the most important procedures
during root canal therapy (1). This step determines the results of subsequent proce-
dures, which include canal irrigation and obturation, and is related to favorable treat-
ment outcomes in endodontic therapy (1). To date, many preparation modalities have
been used during root canal instrumentation procedures. Nickel-titanium (NiTi) rotary
instruments are frequently used during the shaping procedure because of their super-
elasticity, which facilitates efficient canal preparation (2).
NiTi instruments clinically have reduced the incidences of preparation errors like
zipping, ledging, perforation, and transportation and have shortened the treatment time
compared with stainless steel hand instruments (3–6). Thus, NiTi instruments have
become an important adjunct in endodontic therapy (1).
However, these instruments have several disadvantages, which include fractures
associated with repeated cyclic fatigue and torsional loading (7, 8) and the necessity
of using several instruments to enlarge the canal to an optimal apical size during
crown-down preparation.
It was shown that root canals can be shaped and cleaned with only 1 instrument
when using recently introduced reciprocating file systems including Reciproc (VDW,
Munich, Germany) and WaveOne (Dentsply Maillefer, Ballaigues, Switzerland) (9).
Moreover, the reciprocating motion of the NiTi rotary instrument has been shown to
decrease the impact of cyclic fatigue compared with continuous rotational motion
(10). Therefore, root canal preparation by using the reciprocating single-file system
was recommended to simplify instrumentation procedures and reduce unpredictable
file fractures. Previous studies have also shown that the single-file reciprocating move-
ment significantly reduced the shaping time in comparison with the conventional
continuous rotation usage of multifiles in a crown-down manner (11).
The Reciproc and WaveOne are available in 3 sizes: 25, 40, and 50 and 21, 25, and
40, respectively (12, 13). Although these instruments are designed to be used as a single
instrument, clinicians are often concerned that other file sizes such as #30 and #35
would be needed during instrumentation procedures. Furthermore, in practice, it is
necessary to identify the apical size after canal shaping for a hermetic seal during
obturation. Instrumentation procedures that use metal instruments may inherently
cause transportation of the prepared canal space, especially when these procedures
are applied to curved root canals (14). This apical transportation may negatively affect
the obturation and result in an unintended apical preparation size (15).
Notably, no studies have shown that the number of ‘‘repetitive’’ pecking motions at
the working length (WL) will affect the apical preparation size by using the recently
introduced reciprocating instruments. Therefore, the purpose of this study was to eval-

From the *Departments of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Korea; †Endodontics, Univer-
sity of Washington, Seattle, Washington; ‡Conservative Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea; §Conservative Dentistry, College of
Dentistry, Yonsei University, Seoul, Korea; and jjConservative Dentistry, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Korea.
Address requests for reprints to Dr Hyeon-Cheol Kim, Department of Conservative Dentistry, School of Dentistry, Pusan National University, Beomeo-ri, Mulgeum,
Yangsan, Gyeongnam, 626-787, Korea. E-mail address: golddent@pusan.ac.kr
0099-2399/$ - see front matter
Copyright ª 2014 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2013.08.020

JOE — Volume 40, Number 2, February 2014 Different Pecking Times at Working Length 281
Basic Research—Technology
uate the effect of different pecking times at the WL on the apical prep-
aration size by using WaveOne and Reciproc files, which have the same
apical tip size.
Materials and Methods
In this study, we used 60 simulated endodontic training blocks
(Dentsply Maillefer) with a J-shaped root canal that were divided into
2 groups according to the instrument used as follows: Reciproc and
WaveOne (n = 30 each). Each group was divided into 3 subgroups
based on the number of repetitive pecking motions at the WL: 1, 2,
and 4 times. Before canal preparation, the WL was determined by using
a #10 K-file (Dentsply Maillefer) in the canals until it was visible at the
apical foramen. The WL was calculated to be 0.5 mm less than the initial
length. A rubber stop for each file was fixed at the WL with cyanoacrylate
to maintain the WL accurately for all files in both groups. Canals were
instrumented to the WL by using Reciproc R25 (apical tip size #25)
or WaveOne Primary (apical tip size #25). All specimens were prepared
by 1 operator who was competent in both instrument systems and tech-
niques. Instrumentation was performed under an operating micro-
scope (10) (Leica M320 F12; Leica Microsystems, Wetzlar,
Germany).
All canals were shaped by using a slow in-and-out pecking motion
according to the manufacturer’s instructions with the dedicated recip-
rocating motor (Reciproc Silver, VDW). During the procedures,
patency was checked with a #10 K-file followed by copious irrigation
with saline. The final instrumentation was performed at the WL with
1, 2, or 4 ‘‘repetitive’’ pecking motions for the 3 subgroups. After the
instrumentation sequence was completed, separating medium (THE-
Sep; Mdclus, Cheongju, Korea) was applied by using a #25/.04 taper
gutta-percha cone (META BIOMED, Cheongju, Korea) to prevent any
possible distortion of the canal replica. The canals were subsequently
irrigated with saline and were dried by using paper points. Replicas
of the prepared canals were taken with silicone impression material
(Imprint 3 Light Body; 3M ESPE, Deutschland GmbH, Neuss, Germany)
(Fig. 1A–D). The D0 level of the impression replica was measured by
using a scanning electron microscope (S-4800 II; Hitachi High Tech-
Figure 1. Material preparation. (A) Resin block before preparation, (B) simulated canal after 4 repetitive pecking motions using Reciproc file, (C) instrumented
canal filled with impression material, and (D) impression material removed from the resin block canal.
282 Jeon et al.
nologies, Pleasanton, CA) to evaluate the apical preparation size (diam-
eter) at 24 hours after the impressions of the canals were taken (Fig. 2).
Five more simulated canal blocks were used for making canal impres-
sions without any instrumentation to verify the measurement method
using the impression replica.
The data established for the apical diameter of the canal were
recorded and were analyzed statistically by using 2-way analysis of vari-
ance and the Tukey post hoc test. The level of significance was set at
P < .05.
Results
The mean apical preparation size according to the different file
systems and the number of pecking times at the WL are shown in
Table 1. The simulated canals without instrumentation had a mean
apical diameter of 150 mm at D0, and the impression replica showed
reliable resistance from distortion.
The mean diameter varied between 253  11 mm and 274  9
mm and between 258  11 mm and 277  6 mm for Reciproc and
WaveOne files, respectively. The normality of the data distribution
and the homogeneity of variance were confirmed. Although 2-way anal-
ysis of variance revealed no significant differences in the apical prepa-
ration size between Reciproc and WaveOne files (P > .05), significant
differences were found among subgroups with a different number of
pecking times at the WL (P < .05). The Tukey post hoc test revealed
that more repetitive pecking motions at the WL resulted in a larger apical
preparation size compared with the subgroups with less pecking
motions at the WL (P < .05).
Discussion
NiTi rotary files are frequently used in canal shaping because of
their high cutting efficiency (4); however, techniques that use NiTi
rotary files require several instruments to shape the canal, and the files
have the risk of fracture (7, 8). Given these disadvantages, Yared
(16) introduced reciprocating movement by using the ProTaper F2
(Dentsply Maillefer) to find a simpler, more convenient, and safer
JOE — Volume 40, Number 2, February 2014

Figure 2. Representative scanning electron microscopic image of the apical
tip. The diameter measurement of apical preparation at the apical tip level after
using the Reciproc file (200).
method to prepare a root canal successfully. Although many studies
have evaluated and tested the efficacy of this single-file reciprocating
technique (9, 11, 17–19), no studies have investigated the apical
preparation size when using reciprocating files.
The purpose of this study was to compare the apical preparation
size of 2 new single-file systems, the Reciproc R25 and WaveOne
Primary, according to the number of repetitive pecking motions at
the WL. These files have different cross-sections but have an identical
tip diameter. In this study, the apical preparation size of the standard-
ized resin blocks were analyzed by the canal impression method with
silicon impression material, and scanning electron microscopic evalu-
ation was used for measurements. The data showed that the mean apical
preparation sizes by the 2 reciprocating files were similar in the groups.
Hence, the different cross-sectional designs of the 2 reciprocating files
did not influence the apical preparation size remarkably. However,
more repetitive pecking motions at the WL resulted in a significant
change in the apical preparation size compared with the groups in
which less pecking motions were used.
It is important to note that the apical preparation size becomes
larger when the number of pecking motions at the WL is increased.
The present study suggests that increasing the number of pecking times
at the WL by the reciprocating files results in an apical preparation size
that is larger than the ‘‘designated’’ size of the file. Several previous
TABLE 1. The Apical Diameters (mm) Resulting from the Use of Reciprocating
Files According to the Repetitive Times of Pecking Motions at the Working
Length
Files RTPM at WL Mean (SD)
Reciproc 1 253 (11)a
2 263 (10)b
4 274 (9)c
WaveOne 1 258 (11)a
2 264 (14)b
4 277 (6)c
No significant differences were found in the apical diameter between the 2 reciprocating file systems
(2-way analysis of variance, P > .05).
RTPM, repetitive times of pecking motions; SD, standard deviation; WL, working length.
a,b,c
Different superscripts indicate significant differences between subgroups (with a different repet-
itive number of pecking motions at the WL) using the Tukey post hoc test (P < .05).
JOE — Volume 40, Number 2, February 2014
Basic Research—Technology
reports suggested that a large apical size is necessary to remove infe-
cted dentin and old filling materials sufficiently (20, 21). Thus, this
increased apical enlargement may allow better reduction of infected
dentin and microorganisms.
On the other hand, another important aspect must be considered
for the root canal obturation procedure. After canal preparation,
a master gutta-percha cone with a diameter that is consistent with the
final apical file is usually selected for canal obturation. However,
considering the results of this study, a master cone that is bigger than
the final apical file should be considered for obturation. The manufac-
turers of reciprocating file systems supply designated gutta-percha
points that match the file sizes. However, the apical preparation size
of the canal may differ from the manufactured gutta-percha point,
and this may result in a poor hermetic seal during root canal obturation.
Thus, clinicians may need to use gutta-percha points that are larger than
the final file that is used.
During canal shaping, canal transportation or deviation may occur
because of the tendency of the file itself to restore its original linear
shape and the reaction torque to the root canal wall, especially in
a curved canal (22). Thus, the repetitive pecking motions at the WL
might result in this type of mechanical phenomenon, suggesting that
clinicians will need to avoid repetitive pecking motions at the WL to
obtain a predictable apical preparation size that is as large as the instru-
ment size.
Previous studies have used resin blocks to evaluate the shaping
ability of instruments and techniques for root canal preparation. Simu-
lated root canals in resin blocks were used in this study to standardize
the canal size and curvatures, which vary considerably if extracted teeth
are used. Although distinct differences exist in the mechanical proper-
ties of resin blocks and human teeth (3), we believe that the data from
this study provide a satisfactory understanding of apical preparation
sizes when using reciprocating files. The next step is to perform these
experiments in extracted teeth, which would better simulate a clinical
situation.
Within the limitations of the current study, we conclude that
although the 2 reciprocating file systems did not show statistically signif-
icant differences in apical preparation size, a greater number of pecking
times at the WL may result in an apical size that is larger than the actual
file size. Therefore, clinicians must prudently check the fits of the cone
by trying various sizes before obturation.
Acknowledgments
Supported by 2013 Clinical Research Grant, Pusan National
University Dental Hospital.
The authors deny any conflicts of interest related to this study.
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