You are on page 1of 73

Endodontic Rotary

Instruments
Fatima A. Elmahgoub

Classification of Endodontic
Instruments

Group I- hand operated
Group II- Low speed instruments with latch
Group III- Engine driven NiTi rotary Instruments
Group IV- Self adjusting files
Group V- Engine driven reciprocating instruments
Group VI- Ultrasonic Instruments
Group I: Manually-operated instruments
barbed broaches and K-type and H-type instruments.

Group II: Low-speed instruments with a latch-
type attachment
Typical instruments in this group are Gates-Glidden (GG) burs
and Peeso reamers. They are typically used in the coronal part
of the canal and never used in a canal curvature.
Group III: Engine-driven nickel-titanium rotary
instruments
They consist of a rotating blade that can safely be operated in, and
adapt itself to, curved root canals. Most engine-driven
instruments available today belong to this group.

Group IV: Engine-driven instruments that adapt
themselves three-dimensionally to the shape of the root
canal
Like other nickel-titanium instruments, they adapt to the shape of
the root canal longitudinally but additionally they adapt also to the
cross-section of the root canal. There is currently only one
instrument in this group: the self-adjusting file
Group V: Engine-driven reciprocating
instruments.
The reciprocating handpiece delivers turn motion at a rate of 3000x
per minute. This uses latch type K and H files

Group VI: Ultrasonic instruments.

Group II
Low-Speed Rotary
Instruments
Group II: Low-Speed Rotary
Instruments
Burs
In addition to conventional burs, burs with extended shanks for low-
speed contra-angle handpieces are useful for providing good visibility
during deep preparation of the pulp chamber.

Straight-line access to the initial point of curvature traditionally has
been accomplished using rotary instruments such as Gates-Glidden
burs and Peeso instruments.
Use of these instruments should be limited to the straight
portion of the canal preparation. The risk of perforation with
these instruments becomes a real possibility with attempts to
instrument beyond the point of curvature or if the
instruments are used to cut laterally.

The risk of lateral cutting resulting in perforation is lower
with Gates-Glidden burs than with the other instruments
mentioned. This risk is especially pronounced on the
furcation sides of mesial roots of molars.

Gates Glidden Drills
These are safe ended burs
Uses:
Initial opening of orifice
Flaring of coronal and middle thirds
Gates Glidden bur is a flame shaped bur with a latch attachment
consisting of:
Slender shank
Cutting bulb
Pilot tip
Must be continuously rotated. If they stop, the head may lock
in the canal leading to fracture
Its designed to have a weak spot in the shaft closest to the
handpiece so if they break they can easily be removed.
Available in various lengths:
Standard: 32 mm
Short: 24 mm
Long: 36 mm
OR
15mm and 19mm lengths from shank
Come in 6 sizes: No.1-6 ranging from 0.4 - 1.4mm in diameter


Peeso Reamers
Peeso reamers can be used as an adjunct in canal preparation
Used to prepare the coronal portion of the canal for post space
They have parallel cutting sides rather than elliptical
They may be found with or without safe tips
Disadvantage: Can cause lateral perforation
These reamers are available in a 32-mm length and a 28-mm
length for posterior teeth .
Comes in sizes 1-6 (0.7-1.7 mm)


Group III
Rotary Instruments for
Canal Preparation
Group III: Rotary Instruments for
Canal Preparation
Engine driven NiTi files allow greater control in
small, curved canals.
There is no cutting end
No tendency to transport apical preparation.



The cutting angles, helix angles, and external and core tapers
may vary along the working surface of the file, and the ratios
of these quantities can vary between instruments of the same
series. A change in any of these features can influence the
files effectiveness or its propensity for breakage as it
progresses into the canal space; this can explain why some
files act uncharacteristically compared with other files in the
same series
Historically, as an ISO standard, a file was fluted and tapered
at 2% (0.02) for 16 mm, but now files incorporate a wide
variation of lengths and tapers of working surfaces.

It became obvious that the preparation of the orifice and
middle third of the canal is important for apical preparation.
This led to the development of new endodontic files which are
different from the ISO standards.


Instrument Designs

Design changes are made in endodontic instruments to help
prevent procedural errors, increase efficiency, and improve
the quality of canal shaping.

Examples of instruments commonly used today are the
ProFile and ProFile GT, the ProTaper, the Quantec, the
EndoSequence, and the EZ-Fill SafeSider.

ProFile system
These are Nickel-Titanium, rotary files of 4% & 6% taper i.e.
0.04 & 0.06 taper. 0.08 taper is also available

These are claimed to be highly flexible to follow the path of
the root canal with a shape memory to return to original
form. They can be used at speeds between 150 & 350 r.p.m.



The importance of adequate, straight-line access to the root canals
cannot be overstated. Access into the root canal system needs to
provide a direct pathway into the orifices without weakening the
remaining tooth structure.
Coronal flaring facilitates direct access into the middle root canal
third and promotes access of irrigants.
Rotary files have noncutting tips; they should be advanced only
into an explored and open canal section. Therefore it is
recommended a glide path be created with stainless steel K-files,
sizes 10, 15 and possibly 20 to the depth that a subsequent rotary
should go.
As soon as this glide path is secured, NiTi rotaries are used in a
crown- down rather than in a step-back fashion. In other words,
rotaries are used from large to small sizes or tapers moving coronally
to apically

Any one file is advanced until a certain resistance is met and then
withdrawn. The next smaller rotary can then be advanced further; that
way the canal is sequentially prepared.

The apical canal portion is first explored with small K-files and
prepared up to a size #20 to working length, using a watch-winding or
a Balanced Force motion. This procedure is important as it secures an
open glide path, allowing a subsequent NiTi rotary to predictably
reach working length.
The guidelines mentioned above may need to be modified to
accommodate particular canal types. Canals that abruptly
curve or merge cannot easily be prepared with NiTi rotaries.

The extent and position of any curvature determines the
strain and fatigue a rotary is subjected to; a more coronally
located and/or more acute curvature precludes a file of larger
taper and/or larger tip diameter to safely operate at working
length.

ProTaper system
Another system is the Protaper also from Dentsply. The files
come in multiple progressive tapers and their benefits are:

1. Each file performs its own crown-down preparation.
2. Reduced contact area between flutes & dentin.
3. Higher flexibility.
4. Less number of files are needed to shape a canal.

The shaping files

Shaping File # 1 and Shaping File # 2, termed S1 and S2, have purple and
white identification rings on their handles, respectively.
The S1 and S2 files have D0 diameters of 0.17 mm and 0.20 mm,
respectively,
S1 is used to shape the coronal 1/3 while S2 is used to shape the middle 1/3
The Auxiliary Shaping File, termed SX, has no identification ring on its
gold-colored handle and, with a shorter overall length of 19 mm, provides
excellent access when space is restrictive. SX has a much quicker rate of
taper between D1 and D9 as compared to the other ProTaper Shaping
files. Usually used as an orifice shaper.

A unique feature of the ProTaper Shaping files is each
instrument has multiple increasing percentage tapers over
the length of its cutting blades. This progressively tapered
design serves to significantly improve flexibility, cutting
efficiency, and safety.

Also, a progressively tapered design typically reduces the
number of recapitulations needed to achieve length, especially
in small diameter or more curved canals.

The Finishing files
Three Finishing files named F1, F2 and F3 have yellow, red and blue
identification rings on their handles corresponding to D0 diameters of 0.20
mm, 0.25 mm, and 0.30 mm, respectively.
Additionally, F1, F2, and F3 have fixed tapers between D1 and D3 of .07, .08,
and .09, respectively
However, unlike the Shaping files, the Finishing files have decreasing tapers
from D4-D14. This design feature serves to improve flexibility, reduce the
potential for dangerous taper-lock, and prevent the needless over-enlargement
of the coronal two-thirds of a root canal.
These files are used to shape the apical third of the canal.








Advantages of Rotary Ni-Ti Files
Preservation of canal configuration.
Effective elimination of debris.
Rapidity.
Effectiveness in retreatment.
Drawbacks
Can broken without any tactile or visual warning due to:
high speed use
over use
instability of rotation
over stress
anatomic configuration (severe apical curvature, double s-shaped
curvature)

Clinical Strategies

Each NiTi rotary system has a specific, optimal way of use that
should be learned in a quality CE course. Following are a few
general strategic principles to help the practitioner safely and
successfully use NiTi rotaries:

1. Access Preparationpoor access will promote procedural
errors. While generally important in root canal preparation,
adequate access is crucial for the use of NiTi rotaries. Always
attempt to create straight line access into the coronal or
middle root canal third prior to rotary use.

2. Dont Force FilesNiTi rotaries require a passive technique.
If resistance is encountered, dont force the file! Stop
immediately, and before continuing, increase the coronal
taper and recapitulate using small stainless-steel hand files.

3. Difficult Canal Anatomycanals representing difficult
anatomy should be detected, analyzed and carefully
instrumented with hand files prior to introduction of rotaries.



4. Dont Overuse FilesOnce only is the safest number, but the
actual stress accumulating in the file depends upon the case.
Therefore files may be used for more than one canal, but may
have to be replaced during shaping of one particularly difficult
canal. Inspect instruments frequently and discard any bent
rotaries.
5. Avoiding Breakage Takes Practicerotary breakage occurs
more often during the initial stages of the learning curve. The
clinician changing from stainless steel to nickel titanium should
take continuing education courses with experienced clinicians
and educators, followed by extensive in vitro practice on plastic
blocks and extracted teeth.


6. Dont Try to Bypass Ledgesconfirmation or creation of a
pathway with straight K-files is required prior to the use of
any NiTi rotary.

7. Avoid Cutting With the Entire Length of Filethe more file
engaged in the root canal, the higher potential for instrument
fracture. This total or frictional fit of the file in the canal will
cause taper lock and fracture. Remember that an unnoticed
and broken rotary can cause serious procedural errors.



8. Dont Start and Stopsudden changes in the direction of a
rotary caused by the operator must be avoided. A smooth
gentle reaming motion is most efficient; rotaries should be
inserted and withdrawn from a canal while rotating.

9. Length Control is Criticalworking length should be well
established and controlled, as should the actual length of the
file.

Group IV
Engine-Driven
Three-Dimensionally
Adjusting Files
Group IV: Engine-Driven Three-
Dimensionally Adjusting Files
Self-Adjusting File
The self-adjusting file represents a new approach in file
design and mode of operation.

The file is a hollow device, designed as a cylinder of thin-
walled, delicate NiTi lattice with a lightly abrasive surface

The SAF mode of operation is vertical vibration (up and down
0.4mm stroke) 3000 - 5000 oscillations per minute. It is
operated with a modified KaVo handpiece.

The SAF is available in two diameters: 1.5 mm and 2 mm.
The SAF 1.5 mm is available in 3 standard lengths (21, 25, 31
mm) whereas the SAF 2 mm is available in two lengths (21, 25
mm).
As noted, the file is hollow, which allows for continuous irrigation
through the file while operated in the root canal.
The irrigant is delivered through a free-rotating hub to which a
silicone tube is attached.
Either a special irrigation unit or any appropriate dispenser-type
unit may be used to deliver a constant flow of irrigant at 5
ml/min.
This maintains a continuous flow of fresh, fully active irrigant
that carries with its outflow tissue debris and the dentin powder
generated by the file.

An initial glidepath is established with a #20 K-file to allow
the insertion of the SAF file

The overall concept is that the compressed file will adapt itself
to the root canal walls, applying a uniform cutting gradually
removing a uniform dentin layer from the canal walls.

Advantages:
Because it has no rigid metal core, the file is also extremely
adaptable longitudinally.
The inherent tendency to straighten curved root canals is greatly
avoided.
The absence of a metal core also makes the SAF extremely
resistant to fracture.
File separation has not been reported to occur, and mechanical
failure is limited to local tears in the delicate NiTi lattice.
It is clear that this interesting conceptual device will be subjected
to extensive independent study over the next few years.
Group V
Engine-Driven
Reciprocating
Instruments
Group V: Engine-Driven
Reciprocating Instruments

Endo-Eze Reciprocating Files
The Giromatic handpiece, a rotary instrument in use since 1969,
delivers 3000 quarter-turn reciprocating movements per minute.
Rasps and barbed broaches are most often used in Giromatic
handpieces, but K-type and H-type instruments also can be used.
The Endo-Eze file system is a recently introduced addition for
Giromatic handpieces.
The set has four instruments that are designed to clean the middle
third of the canal.
The sizes and tapers are 0.10 #0.025 taper, 0.13 #0.35 taper, 0.13 #0.45
taper and 0.13 #0.06 taper.
The use of stainless steel hand instruments is suggested for the apical
third of the canal.

Group VI
Sonic & Ultrasonic Instruments
Group VI: Sonic and Ultrasonic
Instruments
A radically different way of instrumenting root canals was
introduced when clinicians became able to activate files by
electromagnetic ultrasonic energy.
These units activate an oscillating sinusoidal wave in the file with
a certain frequency.
Ultrasonic devices operate at 25 to 30 kHz.
Sonic devices operate at 2 to 3 kHz.
Ultrasonic devices use regular types of instruments (e.g., K-files),
whereas sonic devices use special instruments known as Rispi-
Sonic, Shaper-Sonic, Trio-Sonic, or Heli-Sonic files.

The file in an ultrasonic device vibrates in a sinus wavelike
fashion.
If powered too high, especially with no contact with the canal
wall, the instrument may break because of the intense
vibration.
Therefore files must be used only for a short time, must
remain passive within the canal, and the power must be
controlled carefully.
The frequency of breakage in files used for longer than 10
minutes may be as high as 10%, and the breakage normally
occurs at the nodes of vibrations
Ultrasonic devices have proved very efficient for irrigating root
canal systems.
However, they have proved disappointing as instruments for
improving the removal of dentin from the root canal walls.
They do improve the ability to clean the pulp space and difficult-
to-dbride areas through acoustic streaming.

Cleaning is further enhanced by the excellent irrigation systems
some of the devices provide.
Application of a freely oscillating file with sodium hypochlorite
(NaOCl) irrigation for several minutes to aid pulp space
disinfection is believed to be useful after complete biomechanical
instrumentation of the pulp space.


Sonic devices are more useful for true hard-tissue removal
during root canal preparation.
Because the files operate like a conventional handpiece, the
file vibrations are less likely to be dampened by contact with
the root canal walls.
Therefore the special files used in these systems are true bulk
dentin removers.
New tip designs for piezoelectric ultrasonic units have also
been found extremely effective in dentin removal in the pulp
chamber and orifice of the canals

Thank you

You might also like