doi:10.1111/iej.
12302
Deformation and fracture incidence of Reciproc
instruments: a clinical evaluation
G. Plotino1, N. M. Grande1 & P. F. Porciani2
1
Private Practice, Grande, Plotino & Torsello – Studio di Odontoiatria, Rome; and 2Tuscan School of Dental Medicine,
University of Siena, Siena, Italy
Abstract
Plotino G, Grande NM, Porciani PF. Deformation and
fracture incidence of Reciproc instruments:
evaluation. International Endodontic Journal.
Aim To investigate the incidence of fracture and
deformation observed on Reciproc instruments after
clinical use.
Methodology A total of 1696 Reciproc NiTi
instruments that were discarded after normal clinical
usage over 30 months were collected. Of these 1580
instruments were R25 (93%), 76 were R40 (5%), and
40 were R50 (2%). The treatments included 3780
root canal preparations, 3023 primary treatments
and 757 retreatments. Root canal preparation was
standardized and followed the manufacturer’s direc-
tions for the use of Reciproc files without creating
prior glide path with hand instruments. In retreat-
ment cases, Reciproc R25 instrument was used to
remove all filling material and to complete the prepa-
ration. Each instrument was used for shaping only
one tooth. All the instruments used were inspected
under a microscope to detect signs of fracture or
deformation and, if any fracture existed, the length of
the files was measured. Data were analysed using a
Introduction
Reciprocating movement has been used for stainless-
steel instruments for many years (Frank 1967, Klay-
man & Brilliant 1975). This original movement could
be defined as ‘complete oscillating reciprocation’ in
Correspondence: Gianluca Plotino, Via Calabria 25, 00187 Rome,
Italy (Tel.: +390642020595; e-mail: endo@gianlucaplotino.
com).
© 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd
chi-square test with a level of significance set at
P < .05.
Results A total of 8 Reciproc R25 instruments frac-
a clinical
tured during treatment, which represents 0.47% of
the number of instruments used and 0.21% of the
root canals treated. Five instruments fractured in
primary treatment cases and three instruments dur-
ing retreatments. Six Reciproc R25 deformed during
clinical use (0.35% of the number of instruments
used and 0.15% of the root canals treated), four dur-
ing retreatments and two during primary treatments.
The deformation reported was unwinding of the
blades, one at 1 mm from the tip and five between 2
and 3 mm from the tip. No deformations or fracture
were registered for the Reciproc R40 and R50 instru-
ments.
Conclusions Root canal instrumentation following
the manufacturer’s instructions can be performed
with Reciproc instruments with a very low incidence
of instrument fracture and deformation.
Keywords: deformation, fracture, nickel-titanium,
reciprocation.
Received 20 February 2014; accepted 20 April 2014
that the angle of reciprocation was the same in both
clockwise and counterclockwise directions. The recip-
rocation actually used with NiTi instruments is an
alternating movement in which the file rotates a cer-
tain angle in the cutting direction and shortly after in
the opposite direction over a much smaller angle
(Kim et al. 2012). Consequently, these instruments
complete a full rotation over several cycles of recipro-
cating movements, and therefore, this type of recipro-
cation may be defined as ‘Partial or asymmetrical
reciprocation with a rotary effect’.
International Endodontic Journal 1
 Deformation and fracture incidence of Reciproc Plotino et al.
Several studies have shown that the actual recipro-
cating movement of endodontic instruments is asso-
ciated with an extended cyclic fatigue instrument life
in comparison with conventional rotation (De-Deus
et al. 2010, Pedull
a et al. 2013b). This suggests that
such instruments could operate for a longer period of
time before failure (Wan et al. 2011) and confirms
that alternating rotation appears to be a valid and
safe alternative to continuous rotary movement (Va-
no et al. 2010).
rela-Pati~
The advantage of a single-use instrument has been
reported by Arens et al. (2003) who stated that
defects could occur even with new files in the hands
of experienced endodontists, and therefore, they con-
cluded that for absolute safety, a single-use approach
should be followed. These observations were con-
firmed by Shen et al. (2009d) who recommended the
single-use of endodontic NiTi instruments to reduce
instrument fatigue and the possibility of cross-
contamination.
Following these concepts, new single-file and sin-
gle-use reciprocating NiTi instruments have been
introduced. However, so far, no study has evaluated
the deformation and fracture of these instruments
during clinical use. The aim of this study was to
investigate the incidence of fracture and deformation
observed on Reciproc instruments (VDW, Munich,
Germany) after clinical use.
Materials and methods
A total of 1696 Reciproc NiTi instruments that were
discarded after normal clinical usage over 30 months
were collected. Three operators (GP, NMG and PFP)
prepared 3780 root canals divided into 3023 primary
treatments and 757 retreatments (Table 1).
Root canal preparation was standardized strictly
following the manufacturer’s directions for the use of
Reciproc files (http://www.vdw-dental.com/fileadmin/
redaktion/downloads/presse/yared_reciproc_concept_en.
pdf).
In primary treatment cases, the pulp chamber was
opened using burs and ultrasonic tips and the coronal
pulp tissue removed. Scouting of the root canals was
Table 1 Number of teeth treated in this study
Central Lateral
incisors incisors Canines Premolars
Maxillary 80 75 53 298
Mandibular 18 47 32 142
2 International Endodontic Journal
made passively with a size 30 and 20 stainless-steel
K-file (VDW) to choose the correct size of the Reciproc
file to be used: R25, R40 or R50. In cases in which
R40 or R50 were used, a stainless-steel K-file size 20
and 30, respectively, reached the apex passively. In
these cases, working length was established using an
electronic apex locator and patency was maintained
with a size 10 stainless-steel hand K-file (VDW).
In cases in which R25 was used, the coronal and
middle thirds were initially prepared based on a work-
ing length estimated from the preoperative radiograph,
without any prior glide path with hand instruments.
In all the cases, manufacturer’s instructions were fol-
lowed in doing three up-and-down strokes advancing
with the instrument, then removing it, cleaning the
flutes and flushing the root canals with 5.25% sodium
hypochlorite. These steps were repeated until the esti-
mated working length of the two coronal thirds was
reached by the instrument. When R40 or R50 instru-
ments were used, this procedure was repeated until the
entire root canal length previously established with the
electronic apex locator was reached.
When preparation was performed with R25 instru-
ment, a straight (not pre-bent) size 10 stainless-steel
hand K-file was used to check apical patency and to
determine the final electronic working length as sug-
gested by the manufacturer (http://www.vdw-dental.
com/fileadmin/redaktion/downloads/presse/yared_reci
proc_concept_en.pdf). Preparation of the apical third
was completed with R25 with the same technique
described previously, until the entire root canal lenght
was reached. In cases in which a straight hand stain-
less-steel size 10 K-file did not reach the working
length, the R25 instrument was used to the point where
the hand instrument had reached and the apex was pre-
pared by hand with stainless-steel and NiTi hand files.
In retreatment cases, after the removal of restora-
tions, the most coronal part of the root filling material
was removed by Gates Glidden or ultrasonic tips.
Reciproc R25 instruments were used to remove all
filling material and to complete the preparation as
previously described once the root canal was made
patent with a size 10 stainless-steel hand K-file. In
those retreatment cases in which it was not possible
to reach the entire working length, Reciproc files were
used to the point of the canal where the hand file
reached. In all cases, a lateral brushing cutting action
was performed to relocate the orifices and to prepare
Molars
around the entire canal circumference.
509
All Reciproc files were used driven by an endodon-
394
tic motor (Silver Reciproc or Gold Reciproc; VDW)
© 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Plotino et al. Deformation and fracture incidence of Reciproc

with its specific reciprocating function (Reciproc ALL)

and a 6:1 hand-piece (Sirona Dental Systems GmbH,
Bensheim, Germany).
After canal preparation, irrigation using ultrasoni-
cally activated 5.25% sodium hypochlorite and 17%
EDTA was used, and canals dried and then filled in
the same or a subsequent visit.
Each instrument was used for shaping the canals of
only one tooth. All the instruments used were ultra-
sonically cleaned and sterilized by autoclaving before
inspection under an optical stereomicroscope at sev-
eral magnifications to assess for the signs of fracture
or deformation. The discarded files were grouped
according to the file size (R25, R40 and R50) and, if
any fracture existed, the length of the files was mea-
sured from the shaft to the tip using a digital calliper,
to determine the length of the fractured fragment. A
database of all cases involving Reciproc instruments
was maintained and included data on instrument
fracture, such as tooth and canal involved, type of
the treatment (primary treatment or retreatment), size
of fractured instrument, length of the fractured frag-
ment and resolution of the case, that is, instrument
removed, bypassed or remained in the canal.
Data were analysed using a chi-square test with a
level of significance set at P < 0.05.
Results
A total of 1696 Reciproc NiTi instruments were dis-
carded within 30 months of clinical practice. Overall,
1580 instruments were R25 (93%), 76 were R40
(5%), and 40 were R50 (2%).
No statistical significant differences were found
between the number of fractured and deformed
instruments (P = 0.44). A total of 8 Reciproc R25
instruments were fractured during treatments, which
represents 0.47% of the number of instruments used
and 0.21% of the root canals treated. Five instru-
ments fractured in primary treatment cases, which
represents 0.29% of the number of instruments used
and 0.13% of the root canals treated, and three
instruments during retreatments, which represents
0.18% of the number of instruments used and 0.08%
of the root canals treated. No significant difference
was found for fractured instruments between treat-
ment and retreatment cases (P = 0.31).
Five of the fractured fragments were removed
(three during primary treatments and two during
retreatments) (Fig. 1), one of the instruments frac-
tured during a primary treatment was bypassed, and
only two instruments remained inside the root canal.
In two cases, the length of the fractured fragment

Figure 1 (a) Radiograph of a mandibular second molar with a fragment of fractured instrument; (b) Radiograph in which the
fragment was partially removed; (c) Radiograph with gutta-percha cones after the complete removal of the fractured fragment;
(d) Postoperative radiograph after three-dimensional filling of the root canal and direct restoration with a fibre post in the distal
canal; (e) Photograph of the access cavity after root canal filling; (f) Photograph immediately after the coronal reconstruction;
(g) 1-year radiographic control; (h) 1-year control photograph.

© 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal 3
 Deformation and fracture incidence of Reciproc Plotino et al.

was 16 mm from the tip of the instrument (one in ments, fracture can occur during clinical use (Paras-
the palatal canal of a maxillary first molar and one in hos & Messer 2006). Malentacca & Lalli (2002)
the single canal of a maxillary second premolar) and suggested that a reciprocating rotation might repre-
they were removed, whilst the other six fractures sent an advantage for the safer use of NiTi instru-
were reported between 2 and 3 mm from the tip. One ments, thus reducing fractures and deformations.
of these instruments fractured 3 mm from the apex in The results of the present study reveal a low per-
the buccal canal of a maxillary first premolar centage of fracture (<0.5%) and deformations (<0.4%)
(removed), one 5 mm from the apex in the disto-buc- for Reciproc NiTi instruments. This percentage is
cal canal of a maxillary second molar (removed) and lower than most of the previously published fracture
another one at the canal terminus of the mesio- rates on rotary instruments (Table 2) and is similar
buccal canal in a maxillary first molar (not bypasssed to that of De-Deus et al. (2013) in which only a single
nor removed). Three R25 instruments fractured in fracture (0.2% of 502 root canals instrumented with
second mandibular molars, one inside a curvature in Reciproc) occurred in a root canal with moderate cur-
the middle portion of the distal canal (bypassed), one vature. Therefore, the reciprocating movement may
at the orifice of the mesio-lingual canal (removed) play a role in preventing instrument fracture, as the
and the other one in the apical portion of the mesio- cyclical reversal of rotation seems to drastically
lingual canal in a C-shaped tooth (not bypasssed nor reduce torsional stress. Furthermore, the reciprocating
removed). rotation that is a characteristic of the Reciproc move-
Six Reciproc R25 instruments deformed during clin- ment may help the instrument in its advance towards
ical use (0.35% of the number of instruments used the canal terminus, following a mechanical balanced
and 0.15% of the root canals treated), four during force advance, as reported by De-Deus et al. (2013),
retreatments (0.23% of the number of instruments whilst reducing the risk of blockage for the tip of the
used and 0.10% of the root canals treated) and two instrument (Gavini et al. 2012). In fact, the actual
during primary treatments (0.11% of the number of reciprocating rotation aims to minimize the risk of
instruments used and 0.05% of the root canals trea- fracture of the instrument caused by torsional stress
ted). No significant difference was found for deformed as the angle of rotation in the direction of cutting is
instruments between treatments and retreatment
cases (P = 0.24). The deformation reported was
Table 2 Fracture and deformation rate of rotary instruments
unwinding of the blades, one at 1 mm from the tip reported in previous studies
and five between 2 and 3 mm from the tip.
No deformations or fracture were registered for the Fractures, Deformations,
% %
Reciproc R40 and R50 instruments.
Ramirez-Solomon et al. (1997) 3.7
Baumann & Roth (1999) 9.4
Discussion Sattapan et al. (2000) 21 28
Hulsmann et al. (2003) 6–10
The present study aimed to evaluate the deformation Parashos et al. (2004) 5 12
and fracture incidence of Reciproc NiTi instruments Ankrum et al. (2004) 1.7–6 2.4–15.3
discarded after normal clinical use. The use of NiTi Alapati et al. (2005) 3–23 7–22
instruments for shaping root canals represents the Peng et al. (2005) 23
Cheung et al. (2005) 23
gold standard of contemporary endodontic practice. It
Shen et al. (2006) 7–14 0.3–5
is well established that rotary NiTi files are faster and Wolcott et al. (2006) 2.4
produce equal or less canal transportation than stain- Di Fiore et al. (2006) 1.9
less-steel hand files whilst also being associated with Knowles et al. (2006) 1.3
reduced operator fatigue, fewer procedural errors and Cheung et al. (2007) 14
Wei et al. (2007) 12.9
shorter duration of canal preparation (Bergmans et al.
Tzanetakis et al. (2008) 1.8
2001, Peters 2004, Peters & Paque 2010). The Inan & Gonulol (2009) 16 10
mechanical properties of NiTi have enabled endodon- Shen et al. (2009a,b) 5 3
tic files to be more flexible, to be better able to con- Shen et al. (2009c) 0.3 1
form to canal curvature, to resist fracture and to Shen et al. (2009d) 0.26 2.9
Wu et al. (2011) 2.6
wear less than stainless-steel files (Plotino et al.
De-Deus et al. (2013) 0.2
2009). Despite the advantages of NiTi rotary instru-

4 International Endodontic Journal © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd
 Plotino et al. Deformation and fracture incidence of Reciproc

designed to be less than the elastic limit of the instru-
ment (Kim et al. 2012).
The very low frequency of R25 instrument fracture
reported in the present study can be possibly under-
stood also as an improvement in cyclic fatigue resis-
tance associated with the reciprocation kinematics
(Pedull
a et al. 2013a,b), the instrument cross-sec-
tional design (Grande et al. 2006, Plotino et al. 2012)
and the superelastic M-wire alloy (Johnson et al.
2008). Cross-sectional ‘S-shape’ design may play a
further role to provide great cutting ability to this
instrument (B€ urklein et al. 2012, Plotino et al. in
press). Furthermore, the use of only one NiTi file in
reciprocation to prepare the entire root canal, as pro-
vided by the Reciproc technique, may reduce the
accumulation of metal fatigue, costs and avoid cross-
infection (Shen et al. 2009d, De-Deus et al. 2010).
In the present study, six of the eight fractured files
were removed or bypassed. In these cases, file fracture
seems to have no impact from a clinical point of view,
as the treatments were completed normally. This is of
particular importance in cases with primary infection
(Ungerechts et al. 2014). Two R25 files fractured
16 mm from the tip of the instrument during the pas-
sive brushing action in the outward lateral move-
ment. For this reason, both instruments were outside
the orifice, not engaged in the dentine and their
retrieval was performed easily (Fig. 2).
As previously reported, the reciprocating technique
was the most rapid method to effectively remove
gutta-percha and sealer from the root canal space
during retreatment (Zuolo et al. 2013). The results of
the present study reveal that removal of old filling
materials and re-preparation of the root canals was
performed with a very low fracture rate using Reci-
proc R25 instrument in retreatment cases. Deforma-
tions occurred more frequently in retreatments than
primary treatments (0.2% vs. 0.1%), as during the
removal of filling materials, too much pressure may
be exerted in some cases.

Figure 2 (a) Radiograph of a maxillary first molar with a 16-mm fragment of fractured instrument in the palatal canal; (b)
Intra-operative radiograph of the working length after the removal of the fractured instrument; (c) Photograph of the access
cavity with the fractured instrument protruding outside the orifice of the palatal canal; (d) Photograph of the fragment after
removal using the Instrument Removal System; (e) Photograph of the access cavity after the removal of the fractured instru-
ment; (f) Postoperative radiograph after three-dimensional filling of the root canal system; (g) Photograph of the indirect lith-
ium disilicate onlay immediately after cementation; (h) 1-year radiographic control.

© 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd International Endodontic Journal 5
 Deformation and fracture incidence of Reciproc Plotino et al.
Conclusions
Root canal instrumentation can be performed with
Reciproc system used as single instrument in all types
of root canals with a very low incidence of instru-
ment fracture and deformation.
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International Endodontic Journal 7