July 2016

1900s
EXCLUSIVE USE OF STAINLESS STEEL
(SS) HAND INSTRUMENTATION

1950s - 1960s
INTRODUCTION OF FIRST RECIPROCATING
INSTRUMENTATION (STAINLESS STEEL) METAL VS. MOTION:
1970s - 1980s Examining the
LIMITED USE OF STAINLESS STEEL ROTARY,
STILL PRIMARILY SS HAND
State of the Art in
1990s ENDODONTIC
INSTRUMENTATION
FIRST GENERATION NITI ROTARY FILES INTRODUCED

2000s
NITI ROTARY FILES WIDELY ACCEPTED
BY SPECIALISTS AND GPS

2010s
RE-INTRODUCTION OF RECIPROCATION WITH NITI.
INTRODUCTION OF NEW NITI METALLURGY
Weighing Your
ENDODONTIC
OPTIONS
Today's market includes more than 35 different NiTi file systems,
each claiming unique features and advantages. With the abundance
of options, many clinicians are more confused than ever before about
which instrument(s) will serve their practice best. The purpose of this
E-book is to investigate the state of the art in root canal instrumentation
(metallurgy) and to evaluate the clinical advantages and disadvantages of
their recommended methods of clinical use (motion).

A QUICK REVIEW
The primary objectives of root canal treatment remain straightforward:
Bacterial disinfection and sealing of the root canal system (to prevent
future microbial recolonization). In other words, the prevention and/
or treatment of apical periodontitis. The materials and methods used
to address the challenges of root canal debridement have been
refined over time as newer technologies have been developed. As
rotary instrumentation has evolved, we have come to understand that
an instruments metal composition, surface/heat treatment, design
characteristics, and even its motion during use impacts the instrument's
clinical performance. The following review will take us from the earliest
days of root canal instrumentation to the current state of the art.

Metal Vs. Motion: Examining the State of the

Art in Endodontic Instrumentation
 There are several schools of thought or methodologies as to how we shape the root canal system in

Root Canal
order to allow for optimal debridement and disinfection with irrigants. From step-back to crown-down
and the countless variations in between, we should be able to agree that the fundamental task of root
canal debridement is to:

DEBRIDEMENT
Remove as much pulpal tissue and bacterial substrate as possible.
Create enough volume for the irrigant to reach all aspects of the root canal system for proper
disinfection.

METHODS Throughout the years practitioners and countless researchers have considered the challenge of
disinfecting the human root canal system and have developed various products and techniques to
achieve the objective of shaping and cleaning the canal. See the below timeline for a review of the
evolution of root canal instrumentation.

ROOT CANAL DEBRIDEMENT TIMELINE

Stainless Steel K-File Stainless Steel Rotary NiTi Rotary Re-Introduction of Introduction of Heat
Hand Instrumentation Instrumentation Instrumentation Reciprocation Treated NiTi Metallurgy
(introduced in 1890s) (introduced in 1970s) (introduced in 1990s) (introduced in 1990s) (introduced in 1990s)

ADVANTAGES ADVANTAGES ADVANTAGES ADVANTAGES ADVANTAGES

Conservative shaping Improved efficiency and Improved efficiency and Slightly lower instance Higher resistance to cyclic
(.02 taper) less chair time less chair time (vs. hand of file separation fatigue
instrumentation) (compared to continuous More flexible
DISADVANTAGES DISADVANTAGES rotation)
User fatigue Much higher instance DISADVANTAGES DISADVANTAGES
Inefficient and time of file separation (never More technique sensitive DISADVANTAGES Lower resistance to
consuming fully embraced by Higher instance of torsional fatigue (deform
practitioners) debris extrusion easier)
(compared to continuous
rotation) Less efficient cutting

Higher instance of
post op sensitivity and
dentinal micro cracks

Metal Vs. Motion: Examining the State of the

Art in Endodontic Instrumentation
NiTi Metallurgies:
AUSTENITE VS.
Clearly NiTi rotary instrumentation is the most popular material/method for root canal
debridement. In todays market, NiTi files are available in a continuum between Austenitic
and Martensitic phases: two crystalline structures of the same nickel titanium metal, with

MARTENSITE
different characteristics. All brands currently available fall somewhere along this spectrum.

Austenitic (A) Martensitic (M)

Torque Resistant / Efficent Cutting Cyclic Fatigue Resistant / Flexible

AUSTENITIC - Traditional NiTi Files MARTENSITIC - Newer Heat-Treated NiTi Files

ADVANTAGES ADVANTAGES
Excellent resistance to torque (file deformation) Excellent resistance to cyclic fatigue (can work around a curve).
Excellent cutting efficiency and cutting edge fidelity Excellent flexibility
Can be pre-bent and are generally softer and less likely to
DISADVANTAGES transport the canal
Relatively lower cyclic fatigue resistance Good for significantly curved canals, bypassing ledges and
difficult access areas
Relatively less ductile and less flexible
May alter the true shape of the canal and apical
transportation can be problematic DISADVANTAGES
Relatively lower torsional fatigue resistance (will deform easier
than an austenite file of the same design)
Less cutting efficiency and cutting edge fidelity

Metal Vs. Motion: Examining the State of the

Art in Endodontic Instrumentation
How to Enjoy THE BEST OF BOTH METALLURGIES
Instead of trying to work with a file that incorporates some elements CONCLUSIONS ON METAL SELECTION
of both A and M, clinicians can utilize a system that includes files from While advancements in material science have addressed the need for more
both ends of the spectrumin the part of the canal where each type of cyclic fatigue resistant files, it should be understood that when using the
file excels. Austenitic files are better suited for most basic and advanced softer martensitic NiTi files, clinicians sacrifice cutting efficiency and torsional
(calcified) cases, but once you enter into advanced2 (severely curved) resistance. Clinicians should be aware of the applications, benefits, and
cases, a hybridized sequence is best. See example at bottom. limitations of these newer files and should also consider recent advancements
in endodontic handpiece technology when choosing an endodontic system.

ESX (Shape Memory Files) (A) KontrolFlex (Controlled Memory Files) (M)

Torque Resistant / Efficent Cutting Cyclic Fatigue Resistant / Flexible

Austenite Austenite Martensite/Controlled Memory

ADVANCED = CALCIFIED

ADVANCED2 = SEVERELY
CURVED, DIFFICULT
ACCESS, LEDGES

ESX Expeditor ESX Finishing File ESX Scouts to WL KontrolFlex to WL

to WL to WL Prior to Expeditor After ESX Scouts

Metal Vs. Motion: Examining the State of the

Art in Endodontic Instrumentation
Motion:
ROTATION VS.
Fundamentally continuous rotation is the ideal motion for root canal
debridement because the debris is removed coronally, but the rotary
motion puts more torsional stress on the instruments (when compared

RECIPROCATION
to reciprocation). Reciprocation reduces the torsional stress on the
instruments, but compared to rotation it has some disadvantages.

ROTATION RECIPROCATION
ADVANTAGES ADVANTAGES
Debris is removed coronally as the file spins clockwise Lower instance of file separation due to torsional fatigue
Less patient postoperative sensitivity
DISADVANTAGES
Lower instance of dentinal micro-cracks Higher instance of apical debris extrusion (apical and lateral)1
DISADVANTAGES Higher instance of postoperative sensitivity2
Higher instance of file separation due to torsional fatigue Higher instance of dentinal micro-cracks3
Higher instance of file transportation and loss of working length integrity4

REFERENCES
1. Robinson JP, Lumley PJ, Cooper PR, Grover LM, Walmsley D. Reciprocating root canal technique
induces greater debris accumulation than a continuous rotary technique as assessed by 3-dimensional
micro-computed tomography. J Endod. 2013;39(8): 1067-1070.
2. Nekoofar MH, Sheykhrezae MS, Meraji N, Jamee A, Shirvani A, Jamee J, Dummer PHM. Comparison
of the effect of root canal preparation by using WaveOne and ProTaper on postoperative pain: a
randomized clinical trial. J Endod. 2015;41(5): 575-578.
3. Brklein S, Tsotsis P, Schfer E. Incidence of dentinal defects after root canal preparation: reciprocating
versus rotary instrumentation. J Endod. 2013;39(4) 501-504.
4. Berutti E, Chiandussi G, Paolino DS, Scotti N, Cantatore G, Castellucci A, Pasqualini D. Effect of
canal length and curvature on working length alteration with WaveOne reciprocating files. J Endod.
2011;37(12): 1687-1690.

Metal Vs. Motion: Examining the State of the

Art in Endodontic Instrumentation
Introducing OTR
Rotary When You Want It and
RECIPROCATION ONLY
WHEN YOU NEED IT
Brasseler USA has recently introduced a new, smart
endo handpiece that provides all of the benefits of both OTR-SMART MOTOR TECHNOLOGY
continuous rotation and reciprocation without the associated
disadvantages. In addition, this new handpiece allows us
to reduce torsional and cyclic fatigue on the files we have
chosen. Referencing our earlier discussion, this means that
an austenite file will not succumb to cyclic fatigue as easily
and a martensitic file wont succumb to torsional fatigue
as easily. The handpiece is essentially a smart motor. It
overcomes the inherent shortcomings of each metallurgy.
The EndoSync Cordless Endodontic handpiece provides
continuous rotary motion until a selected torque limit is met, at Conventional rotary Reciprocal file systems OTR continually rotates in
systems continually rotate continually spin forward the forward direction, and
which point the motor reverses the file counter clockwise 90 in the forward direction and and backwards regardless only reverses 90 if the
degrees and then re-engages clockwise. The EndoSync motor then auto-reverse the file of torque on the file. torque limit is reached and
monitors the torque on the file up to 16 times per second. This out of the canal when Torque is unmonitored. immediately returns to the
reaching the torque limit, Studies indicate continual forward cutting direction,
motion is similar to the quarter-turn balanced force technique
reducing efficiency. reciprocation increases the maximizing efficiency.
used with hand instrumentation. This patented intuitive incidents of micro cracks,
disengagement technology is called OTR Optimized Torque debris extrusion and post-
Reverse and it is a very exciting advancement in Endodontics. operative sensitivity.

Metal Vs. Motion: Examining the State of the

Art in Endodontic Instrumentation
Taking Patient Safety
TO NEW LEVELS
The EndoSync is the only cordless endodontic motor that
allows for real-time apex locator readings. The unit is fully
synchronized with the EndoSync A.I. (Brasseler USA) and the
Root ZX Mini (J Morita). Not only does the unit provide real
time depth readings as you progress down the canal, but it
also features an auto slow/auto stop function which stops the
file from spinning when it reaches the apex (this function is
optional based on the clinicians preference). The combination
of OTR and real-time apex readings makes the EndoSync the
most advanced and safest endodontic handpiece on
the market.

Metal Vs. Motion: Examining the State of the

Art in Endodontic Instrumentation
OTR and Its
IMPACT ON
The early generation NiTi files featured large radial lands, which helped to keep the files centered in the
canal and provide strength. These designs require relatively high torque to progress apically. Through
the years, instruments have evolved toward a more open flute design to allow for better debris removal

FILE DESIGN
(debris loads in the chip space). Several patents protect the proprietary designs (EndoSequence,
ESX, RaCe) that enable these non-landed files to stay centered in the canal, to have lower torque
requirements, and to provide for canal disengagement along the axis of the file. These files are known to
cut very efficiently and now OTR technology enhances the already high level of safety of these files.

DIFFERENT FILE CROSS SECTIONS

GOOD BETTER BEST ESX

INTRODUCING ESX
THE ESX FILE The ESX file (Brasseler USA) was developed to take
advantage of the EndoSyncs unique OTR movement.
THE PATENT BT TIP The patented BT tip features six cutting edges
which cut on both the forward and reverse motion. The
THE COMBINATION
combination of the BT Tip and the OTR motion allows
THE OPEN ACP for extremely efficient canal clearing. The open ACP
(alternating contact point) file design allows for optimal
dentin cutting and debris accumulation in the flutes.

Metal Vs. Motion: Examining the State of the

Art in Endodontic Instrumentation
 The State of
the Art in ROOT CANAL DEBRIDEMENT
CONCLUSION
Smart OTR technology works synergistically with advanced metallurgy and file design to deliver
enhanced safety and efficiency to the debridement phase of the endodontic procedure.
The EndoSync motor in combination with ESX (and KontrolFlex in extremely advanced cases) allows me to safely and
efficiently negotiate even the most challenging canals without the fear of file separation. My clinical observation is that this
system takes full advantage of the newest advancements in metallurgy and endo motor technology.
- Allen Ali Nasseh, DDS, MMSc

The preceding material was provided by the manufacturer. Statements and opinions are solely those
of the manufacturer and not of the editors, publisher, or the Editorial Board of Inside Dentistry.

T H A N K YO U TO O U R S P O N S O R : B R A S S E L E R U S A

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