Endodontics

Lecture 5
Intracanal Instruments

Rotary Instrumentation systems using Nickel Titanium

ProFile system
The ProFile system was introduced in 1994.
ProFile instruments have increased tapers
compared with conventional hand instruments.
The tips of the ProFile Series 29 rotary
instruments had a constant proportion of
diameter increments (29%). Cross section of a
ProFile instrument has a U-shape design with
radial lands and a parallel central core. Lateral
views show a 20-degree helix angle, a constant
pitch, bullet- shaped noncutting tips and with a
neutral or slightly negative rake angle. This configuration facilitates a reaming action. Debris
is transported coronally and is effectively removed from the root canals. The preferred speed
is 275-325 rpm.

ProFile GT Files.
The Greater Taper (GT) file was introduced in
1994. This instrument also has the U-shape file
design. The instruments comes in four tapers
(0.06, 0.08, 0.10, and 0.12), and the maximum
diameter of the working part coronally is 1 mm.
The instruments have a variable pitch and an
increasing number of flutes in progression to the
tip; the apical instrument diameter is 0.2 mm.
Instrument tips are noncutting and rounded.

ProTaper Universal system.

The ProTaper system is based on another concept and composed of six instruments: three
shaping files and three finishing files. This set is increased by two larger finishing files and a
set designed for retreatment procedures. In cross section, ProTaper shows a modified K-type
file with sharp cutting edges and no radial lands; this creates a stable core and sufficient
flexibility for the smaller files. The cross section of finishing files F3, F4, and F5 is slightly
relieved for increased flexibility. The difference in design of this system is the varying tapers
along the instruments’ long axes. The three shaping files have tapers that increase coronally,
and the reverse pattern is seen in the five finishing files. Shaping files #1 and #2 have tip

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diameters of 0.185 mm and 0.2 mm,
respectively, 14-mm-long cutting blades. The
diameters of these files at D14 are 1.2 and 1.1
mm, respectively. The finishing files (F1-F5)
have tip diameters of 0.2, 0.25, 0.3, 0.4, and
0.5 mm, respectively, between D0 and D3,
and the apical tapers are .07, .08, .09, .05,
and .04, respectively. The finishing files have
rounded noncutting tips.
The convex triangular cross section of
ProTaper instruments reduces the contact
areas between the file and the dentin. The
greater cutting efficiency of this design has
been improved by balancing the pitch and
helix angle, preventing the instruments from threading into the canal. ProTaper instruments
can be used with 250 to 300 rpm.
Two usage characteristics are recommended for the ProTaper system:
1-The preparation of a glide path.
2- The use of a more lateral “brushing” working stroke. Such a stroke allows the clinician to
direct larger files coronally away from danger zones and counteract any “threading-in” effect.

RaCe, Bio Race

The RaCe was manufactured since 1999 by FKG.
The name stands for reamer with alternating cutting
edges. This design aimed at reducing the tendency to
thread the file into the root canal. Cross sections are
triangular or square for #.02 instruments with size
#15 and #20 tips. The surface quality of RaCe
instruments is done by electropolishing. The tips are
round and noncutting.

Twisted File.
In 2008, the first fluted NiTi file was introduced and
manufactured by plastic deformation, a process
similar to the twisting process that is used to produce
stainless steel K-files. This is done when a thermal
process allows twisting during a phase
transformation into the “R-phase” of nickel-titanium.
The instrument is available with size #25 tip sizes
only, in taper .04 up to .12. This production process resulted in superior physical properties.

Wave One single file reciprocating system

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This system is a single-use, single file system to shape the root canal. In most cases, the
technique only requires one hand file followed by one single Wave One file to shape the canal
completely using the reciprocation motion. The file is made with M-wire technology which
improves strength and resistance to cyclic fatigue about four times the traditional rotary NiTi
files. The system is composed of:
- The Wave One small file. It is used in narrow
canals. The tip has an ISO of 20 with a
continuous taper of 6%.
- The Wave One primary file. It is used in the
majority of canals. The tip has an ISO of 25
with an apical taper of 8% that reduces towards
the coronal end.
- The Wave One large file. It is used in wide
canals. The tip has an ISO of 40 with an apical
taper of 8% that reduces towards the coronal
end.
The instruments are designed to work with a reverse cutting action. All instruments have a
modified convex triangular cross section at the tip end and a convex triangular cross section at
the coronal end. This design improves instrument flexibility. The variable pitch flutes along
the length of the instrument improve safety.

ProTaper Next
This system is composed of 5 files, namely X1, X2, X3, X4 and
X5. These files correspond to sizes 20/04, 25/06, 30/07, 40/06 and
50/06 respectively. The X1 and X2 have variable tapered design
whereas X3-X5 files have a fixed taper from D1-D3 then a
decreasing percentage tapered design over the rest of their active
portions.
This system has a rectangular cross section that is of centered
which allows 2 points contact with the dentin wall and the rest of
the space free for storing debris which will be removed by the file
swaggering motion.

Group IV: Engine-Driven Three-Dimensionally

Adjusting Files (Self-adjusting file)
The self-adjusting file (SAF) 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. An initial glidepath is established with a #20 K-file to allow
the insertion of the SAF file. The file is proposed to be compressed
from its 1.5 mm diameter into dimensions equivalent to those of a #25
K-file. The handpiece generates in-and-out vibrations with 5000
vibrations per minute and 0.4 mm amplitude. The compressed file will

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adapt itself to the root canal walls, applying a uniform cutting action gradually removing a
uniform dentin layer from the canal walls. There a continuous flow of irrigant which removes
the tissue debris and the dentin powder generated by the file.

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 (Ultradent) 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 and Ultrasonic Instruments

A very different way of instrumenting root canals was introduced when files or ultrasonic tips
(of different shapes and sizes) were activated by electromagnetic ultrasonic energy.
Piezoelectric ultrasonic units are also available for this purpose. These
units activate an oscillating sinusoidal wave in the file with a frequency of
about 30 kHz.
Two types of units, ultrasonic and sonic, are primarily available.
Ultrasonic devices, which operate at 25 to 30 kHz, include the
magnetostrictive (Cavi-endo), and the piezoelectric (Enac). Sonic devices
operate at 2 to 3 kHz (Sonic Air MM 1500) 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.
Although similar in function, piezoelectric units have some advantages over the
magnetostrictive systems. For example, piezoelectric devices generate little heat, so no
cooling is needed for the electric handpiece. The magnetostrictive system generates
considerable heat, and a special cooling system is needed in addition to the irrigation system
for the root canal.
The file in an ultrasonic device vibrates in a sinus wave–like fashion. A standing wave has
areas with maximal displacement (i.e., antinodes) and areas with no displacement (i.e., nodes).
The tip of the instrument exhibits an antinode. Files must be used only for a short time, must
remain passive within the canal, and the power must be controlled carefully.
Ultrasonic devices have proved very efficient for irrigating root canal systems.
During free ultrasonic vibration in a fluid, two significant physical effects are observed:
cavitation and acoustic streaming. During oscillation in a fluid, a positive pressure is followed
by a negative pressure causing implosion. This is cavitation. Acoustic streaming creates small,
intense, circular fluid movement around the instruments.

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Generations of the NiTi rotary instruments
From the 1990s, until now, NiTi rotary instruments have undergone revolutionary changes in
terms of the construction and as a result physical characteristics of the NiTi instrument .
Furthermore, the design, shape, and number of instruments used in each group have been
highly modified. The aim of modifying and improving these instruments is to develop a NiTi
rotary instrument which cuts and removes the dentine strongly and also is resistant to fracture
even in the most challenging narrow, curved root canals. Another purpose of modifying and
improving these instruments is to simplify the cleaning and shaping stage and to reduce the
number of using instruments along with preserving the original shape of the prepared root
canal.
1 -First Generation
This category of NiTi rotary instruments were first introduced to the market during the mid-
1990s. The most important characteristic of the first-generation NiTi rotary files is having
passive cutting radial lands along with fixed 0.04– 0.06 tapers over the full working length.
The main important NiTi rotary instruments within this category are LightSpeed Endodontics
(1992), Profile-Dentsply (1993), Quantec-SybronEndo (1996), and GT system-Dentsply
(1998) . Several researches showed that all first-generation rotary instruments created smooth
root canal walls which centered in the middle and caused low procedural errors. The main
deficiency of this generation of NiTi rotary instruments was requiring numerous files to
achieve these goals and complexity.
● Advantages
Optimum flexibility is the ability of the instrument to accompany the curvature of a root canal
avoiding the formation of steps, perforations along the root canal or at the apical level; cutting
efficiency; reduced working time for the operator, greater comfort for the patient and a lower
incidence of postoperative pain .
● Disadvantages
They generate costs for the operator since they must be used only once; possibility of
instrument fracture; poor cleaning in flattened root canals.
2 -Second Generation
The second generation of NiTi rotary files was introduced into the market in 2001. These
instruments had active cutting edges with greater cutting efficiency, so the number of
instruments required to achieve complete cleaning and shaping was almost less in comparison
with the previous generation. Notable systems in this generation are ProTaper Universal-
Dentsply, K3-SybronEndo, Mtwo-VDW, Hero Shaper-Micro-Mega, I Race, and I Race Plus-
FKG Dentaire.Several studies have also approved the efficiency of these systems in fast
preparation and also preserving the original shape of canals even in curved and calcified
challenging cases although some researchers have reported some degrees of canal
transportations along with tendency for breakage while usage.
● Advantages
High resistance to cyclic and torsional fatigue, lower fracture index, greater cutting efficiency,
offers a shorter working time providing a reduction of stress for the professional, lower
incidence of postoperative pain, therefore in greater comfort for the patient.
● Disadvantages
They generate costs to the operator since they must only be used once, possibility of fracture
but with a lower incidence than with the first generation instruments The NiTi Alloy Phase R
was also used in the manufacture of the Oscillating (Asymmetric) Systems, usually called
Reciprocants, Oscillating Systems (Reciprocants) TF Adaptive (2013) (SybronEndo Kerr
Group)

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3- Third Generation
It was in late 2007 that the manufacturers started to apply the heating and cooling
technologies on NiTi alloys to improve the safety of these instruments, especially in the
curved root canals . In making third generation of the NiTi rotary files, the manufacturers
have highly focused on metallurgic properties of the NiTi alloy using heating and cooling
procedures on wires which results in reduction of the cyclic fatigue of the files and also
reduction of the separation risk of the instruments which is highly demanded by the
practitioners. Applying M-wire and R-phase technologies and electrical discharge methods
make instruments with high memory shapes and low risk of separation K3 XF Files-
SybronEndo, Profile GTX Series–Dentsply, controlled memory (CM) Files (HyFlex CM)–
Coltene, and Vortex Blue (Dentsply Tulsa) are notable files in this group which have been
exposed to heat treatments to increase flexibility and safety. The CM property helps the
instrument to save the shape of the canal when it is moved out of the canal. Flex files
(NeoEndo) files have been predisposed to gold thermal treatment which increases their
cutting efficiency along with cyclic fatigue resistance.
● Advantages
High resistance to cyclic and torsional fatigue, lower fracture index when used more than
once, greater cutting efficiency, greater flexibility compared to first generation (15% more
flexible), less working time for the professional, greater comfort for the patient, lower
incidence of post operative pain.
● Disadvantages
They generate higher costs, because according to the manufacturer they must be used only
once; possibility of fracture, but with a lower incidence compared to the instruments of the
previous generation.
4- Fourth Generation
Reciprocation which is described as any repetitive back and forth or up and down motion is
another philosophy in canal preparation which was first introduced by Blanc, a French dentist,
in the late 1950s. Instead of full rotation, the reciprocating NiTi rotary instruments have
movements in which clockwise and counterclockwise degrees of rotation are quite equal. The
reciprocation theory of canal preparation has led to development of the fourth generation of
NiTi rotary instruments. The use of a single file technique to achieve a thorough cleaning and
shaping goals at this phase was another success which was also derived from the reciprocating
philosophy in cleaning and shaping the root canal systems Many studies have shown that the
Wave One and the One Shape single-file systems can efficiently reduce the bacterial number
in the root canal along with preserving the original shape of it. Wave One-Dentsply, self-
adjusting file (SAF)-ReDent Nova, and Reciproc-VDW are featured instruments of fourth
generation
● Advantages
Is indicated for root canals with severe anatomical complexity. High resistance to cyclic
fatigue, lower fracture index. (300% more resistant), greater cutting efficiency, greater
flexibility, 80% more flexible than conventional instruments, offers less working time, lower
incidence of postoperative pain, greater patient comfor.
● Disadvantages
Contraindicated for wide or relatively wide and straight ducts.
5- Fifth Generation
In this generation, the efficiency of canal shaping has been improved by offsetting the center
of rotation. The offset designed files produce a mechanical wave of motion that distributes
along the full length of the NiTi file which improves cutting and removing the debris in
comparison with a centered mass rotating instrument. Furthermore, this offset design reduces
the taper lock or the screwing effect which causes instrument separation. HyFlex/electrical

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discharge machining (EDM)-Coltene, Revo-S-Micro-Mega, One Shape Micro-Mega, and
ProTaper Next-Dentsply are important files of the fifth generation.
The Revo-S and the One Shape systems of the fifth generation, both manufactured by the
Micro-Mega Company, offer proper root canal shaping by continuous clockwise rotation of
the instruments inside the root canal system.
One Shape which is just a single number 25/0.06. Taper instrument with asymmetrical cross
section along the entire blade has variable cross section and longer pitch. Using the glide path,
the instrument is optional in One Shape instrumentation strategy. Micro-Mega also offers
optional using apical finishing files. These sterile single-use NiTi-finishing files are used after
root canal shaping with One Shape in order to enlarge the root canal diameter.
● Advantages
They are 80% more flexible than the files of conventional rotary systems, more resistant to
cyclic fatigue by 150% compared to the Universal Protaper System, shorter working time.
6-New generation system (NiTi Blue)
New generation system (NiTi, Blue): They are manufactured with NiTi Alloy with Blue
Treatment. NiTi Vortex BlueTM instruments (Dentsply/Sirona-United States) manufactured
with Nitinol 508 and consisting of a blue titanium oxide layer, not seen in traditional super-
elastic NiTi instruments. This relatively hard surface layer of Vortex Blue instruments can
compensate for the loss of hardness compared to Profile Vortex M-Wire .Vortex Blue and
shape memory technologies use special thermal processes to control the transition of extreme
temperatures, making the instruments highly flexible .
● Advantages
Indicated for root canals that present a severe anatomical complexity. They follow the natural
curvature of the root canal due to its great flexibility, greater resistance to cyclic fatigue (65%
higher in relation to instruments manufactured with M-Wire® NiTi and 99% in relation to the
first generation NiTi instruments), greater resistance to torsion, offers a lower working time, a
reduced memory effect of the instrument (that is, it can be pre-curved slightly and not return
to its original position), generating a less resistance of the instrument when introduced into
the root canal.
Vortex Blue instruments have improved material properties within creases fatigue resistance
and flexibility compared to Profile Vortex (M-Wire) instruments. However, both NiTi Blue
and M-wire alloy show better fatigue resistance compared to conventional nickel titanium
alloy. Torsion resistance is also affected by the cross-sectional design, the metal mass and the
properties of the alloy.