GROSSMANS CORNER

Nickel Titanium Rotary Instruments : Making The Right Choice

Dr. V. Gopi Krishna
Dr. V. Gopi Krishna, MDS, FISDR is a clinician, researcher and academician of national acclaim. He is the Co-Editor of Grossmans Endodontic
Practice - 12th Edition (Wolters Kluwer Lipincott) and Editor of Preclinical Manual of Conservative Dentistry (Elsevier). He is also the Editor-in-
Chief of the Journal of Conservative Dentistry (www.jcd.org.in) and is working as Professor, Dept. of Conservative Dentistry & Endodontics at
Thai Moogambigai Dental College. He runs the Root Canal Centre - an exclusive endodontic training and treatment centre at Chennai, which
mentors more than 100 dentists every year in improving their endodontic skills. For more information on microscope aided clinical endodontic
training modules with live patient demonstrations you can contact Dr. Gopi Krishna at hi_gopikrishna@hotmail.com (Ph: 91-9840218818) and
on Facebook --> Root Canal Cente.

What we remove from the pulp space is far more
important than what we replace it with
Endodontic treatment can be divided into three main phases: proper
access preparation into the pulp cavity, cleaning and shaping of
the root canal and obturation. The initial step for cleaning and
shaping the root canal is proper access to the chamber that leads
to straight-line penetration of the root canal orifices. The next step
is exploration of the root canal, extirpation of the remaining pulp
tissue or gross debridement of necrotic tissue and verification of
the instrument working length. This step is followed by proper
instrumentation, irrigation and debridement and disinfection of the
root canal. Obturation completes the procedure.
The importance of adequate canal cleaning and shaping, rather
than reliance on antiseptics, cannot be overemphasized. Histologic
examination of pulpless teeth in which root canal therapy has failed
often shows that the canals were not completely cleaned. Obturation
of an improperly cleaned canal would still lead to an endodontic
failure (Fig. 1).
The objectives of cleaning and shaping are twofold:
To debride and disinfect the root canal system;
To shape /contour the root canal walls and apical constriction,
for the purpose of sealing the root canal completely with a
condensed, inert filling material.
To help achieve these objectives, each individual root canal should
be examined radio-graphically and explored with endodontic
instruments. The examination should include an assessment of
canal length, shape, size, curvature, entrance orifice, location of
foramina, canal ramifications and presence of calcifications or
obstructions.
According to Schilder, the cleaning and shaping of a root canal
should fulfill the following mechanical objectives: (Table I)
Should have a continuous tapering conical shape, with the
narrowest cross-sectional diameter apically and the widest diameter
coronally.
The walls should taper evenly toward the apex and should be
confluent with the access cavity,
To give the prepared root canal the quality of flow, that is, a shape
that permits plasticized gutta-percha to flow against the walls without
impedance.
Should keep the apical foramen as small as practical.
Should clean and shape the canal without transporting the apical
foramen.
Table I : Schilders Objectives for cleaning and shaping

One of the most significant changes in the practice of endodontics

Fig. 1A Endodontic failure in a well obturated lower molar.
B Endodontic failure in a poorly obturated lower molar.
Cleaning and shaping the root canal comprises the most important
phase of endodontic treatment. Other aspects of treatment cannot
be neglected, however, because they are all interrelated and
contribute to the success of endodontic therapy.
occurred with the evolution of nitinol, an equiatomic alloy composed
of nickel and titanium. This super elastic alloy does not exhibit
proportional strain under stress until a specific level is attained that
ultimately causes fracture.
This unique property is due to the austenitic crystalline structure
of the alloy, which gets transformed into a martensitic crystalline
structure under stress. Thus, Nitinol exhibits shape memory, i.e the

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Nickel Titanium Rotary Instruments : Making The Right Choice CORNER

ability to return to its original shape once the stress is removed.

This has lead to the development of numerous types of endodontic
instruments, which can be employed in a truly rotary or 360 degree
revolution within a curved root canal.

Components of a Nickel Titanium Rotary Instrument:

The standardization of endodontic files is a standard, which is
uniformly employed for stainless steel hand files. One of the
fundamental attributes of this is to recommend all endodontics
instruments be standardized with a constant taper of 2%. This was
mainly due to the limitation imposed by the physical property of
Fig 2: Comparison of 2%, 4% and 6% tapered instruments
stainless steel. As the core diameter or thickness of stainless steel
increases the flexibility of the instrument decreases. As all root 1 MM 2 MM 3 MM
Size of Taper of Tip
Above Above Above
canals have varying degrees of curvature it was considered prudent Instrument Instrument Diameter
Tip Tip Tip
to standardize stainless steel instrument with a minimal taper and NO 30 2% 0.30 mm 0.32 mm 0.34 mm 0.36 mm
hence 2% taper was chosen as the fixed taper. NO 30 4% 0.30 mm 0.34mm 0.38 mm 0.42 mm
Taper: Taper denotes the per millimeter increase in file diameter NO 30 6% 0.30 mm 0.36mm 0.42 mm 0.48 mm
from the tip towards the file handle. The taper is denoted either Table 2: Influence of taper on the diameter of endodontic
in numericals or in percentile. The traditional ISO instruments instruments
were standardized to have#.02 taper or 2% taper. In other Land: In certain file designs, a surface projects axially from
words, a size #20 ISO file will have a tip diameter of 0.20 mm the central core to the cutting edge between the flutes. This feature
and would have a 0.22 mm diameter 1 mm from the tip and is incorporated to reduce canal transportation and supports the
0.24 mm diameter 2 mm from the tip and 0.26 mm diameter cutting edge.
3 mm from the tip. Pitch: Pitch is the distance from one cutting edge to the next
With the advent of nickel titanium instruments, the taper need cutting edge. A file with short pitch will have more spirals than a file
not be a limitation for an endodontic file. As Ni-Ti could with a longer pitch.
retain its flexibility even in larger core diameters; it gives us an Rake Angle: On perpendicular sectioning of a file, the angle,
opportunity to use endodontic files with increased taper thereby which the leading edge forms with the radius of the file, is known
reducing time, number of instruments and effort in preparing as the Rake angle. If it forms an obtuse angle then the rake angle
a root canal. Nickel titanium instruments have now been is considered to be positive. An acute angle is termed as negative
developed with 4%, 6%, 8% and even 10% taper. Tapered rake angle.
instruments help in preparing canals of wider diameter without Helix Angle: It is the angle the cutting edge forms with the
over-enlarging the canal at working length. Thus 30-size file long axis of the tooth.
with 2% taper, 30-size file with 4% taper and a 30-size file with Table 3 gives an overview and salient features of the most widely
6% taper all would have the same tip diameter of 0.30 mm. used rotary nickeltitanium systems in endodontics
(Table 2, Fig. 2) Thus, over the past decade there are more than a dozen rotary Ni-Ti
This has led to both researchers and manufacturers to design systems, which have proved to be popular amongst practitioners.
different types of Ni-Ti files not only based on difference in taper but There has been a constant debate by both researchers as well as
also on other key parameters like the following: manufacturers on trying to prove the superiority of one over the
Flute: It is the groove or relief on the working surface of the other. Endodontic literature has hundreds of articles comparing the
file, which collects the debris as the file cuts through the substrate. various key technical aspects, which include:
Blade (Cutting Edge): It is the working area of the file and i. Torsional resistance
is the surface with the greatest diameter that follows the flute as it ii. Canal Centering ability
rotates.

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Nickel Titanium Rotary Instruments : Making The Right Choice CORNER

Table 3: Salient Features of Various Nickel Titanium Instruments

Instrument
Cross-sectional design Tip design Taper Other features
System

ProFile (Dentsply Fixed taper. 2%, 4% and 20-degree helix angle and
Non Cutting
Maillefer) 6%. constant pitch.
Triple-U shape with radial lands. Neutral
rake angle planes dentine walls.

GT Files (Dentsply Fixed taper. 4%, Files have a short cutting portion.
Non Cutting
Maillefer) 6%, 8%, 10% and 12%. Variable pitch.
Triple-U shape with radial lands.
Decreased helical angle,
Variable width lands (lands at the tip &
increased pitch. Heat treatment
GT Series X shank region of the file are narrower No 10% or 12% taper.
aims to improve cyclic fatigue
than mid-file lands)
resistance.

LightSpeed Instruments Specific instrument

Thin, flexible non-cutting shaft &
(Lightspeed, Non Cutting sequence produces a
short cutting head.
San Antonio TX) tapered shape.
Triple-U shape with radial lands.

Variable taper along Pitch and helix angle balanced to

ProTaper (Dentsply
Non Cutting the length of each prevent instruments screwing into
Maillefer)
Convex triangular shape, sharp cutting instrument. the canal.
edges, no radial lands. F3, F4, F5 files have
u-flutes for increased flexibility.

Fixed taper. 2%, Variable pitch. Files have a short

HERO 642 (MicroMega) Non Cutting
4% and 6%. cutting portion (12-16mm).
Triangular shape with positive rake
angle for cutting efficiency. No radial lands.

Fixed taper. 2%, Variable pitch and variable core

K3 (Sybron Endo) Non Cutting
4% and 6%. diameter.
Positive rake angle for cutting efficiency,
three radial lands and peripheral blade
relief for reduced friction.

Fixed taper. 2%, 4% and Individual helical angles for each

FlexMaster
Non Cutting 6%. Intro file has 11% instrument size to reduce
(VDW, Munich Germany)
taper. screw-in effect.
Convex triangular shape with sharp cutting
edges and no radial lands.

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Nickel Titanium Rotary Instruments : Making The Right Choice CORNER

Alternating cutting edges along

the file length due to alternating
RaCe (FKG, LaChaux De
Fixed taper. 2%, 4%, 6%, twisted and untwisted segments
Fonds, Switzerland) Non Cutting
Triangular shape (except RaCe 15/0.02 and 8% and 10%. (RaCe), or a continuous wave
Endowave (J.Morita)
20/0.02 which have a square shape), two design (Endowave). Intended to
alternating cutting edges, no radial lands. reduce screw-in effect.

Cutting (SC). Fixed taper. 2%, 3%, 4%, Flute space becomes
Quantec SC,
Non-cutting 5%, 6%, 8%, 10% and progressively larger distal to
LX (Sybron Endo) S-shape design with double-helical flute, (LX). 12%. thecutting blade.
positive rake angle and two wide
radial lands.

Variable pitch. Steep helical angle

Mtwo (Sweden & Martina,
Padova, Italy)
Twisted File (Sybron Endo)
Fixed taper. 4%, 5%, 6%
Non Cutting designed to reduce screw-in
S-shape design with two cutting edges, no and 7%
effect.
radial lands. Minimum core width to
improve flexibility.
Variable pitch. Made by
twisting a ground blank in
Fixed taper. 4%, 6%, 8%,
Non-cutting combination with heat treatment;
10% and 12%.
aims to increase superelasticity
Triangular shape, no radial lands. and cyclic fatigue resistance.

Controlled memory files made

Hyflex CM Fixed Taper by combination of alloy treatment
Non -cutting
(Coletene Whaledent) 4%, 6% and 8% and twisting.

Double fluted Hedstrom design Increases cyclic fatigue resistance

WaveOne Fixed Taper 6%, Reciprocating motion Single file

Non -cutting
(Maillefer Dentsply) 8%, concept

Convex Triangular

iii. Cyclic Fatigue Which is The Best System ?

iv. Apical extrusion of debris The million-dollar question is then which system provides us the best
v. Ability to negotiate canals of varying curvatures result. To answer this question we have to think carefully about the
vi. Effect of taper on canal cleanliness word RESULT. In the end, what result are we looking at.
Manufacturers selectively use this literature to promote their Are we trying to find which system gives us the best looking shape?
products. Thus you end up with claims and counter claims from all Are we having a competition where in which system does the fastest
ends. The ultimate result is that it leads to a confused consumer i.e or most number of preparations wins the race? If you think carefully
you and me !! we realize that the result we are interested is Healing of the
intra-canal and extra-radicular infection. This alone translates

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Nickel Titanium Rotary Instruments : Making The Right Choice CORNER

into clinical success. For this to happen, we need two important
parameters:
i. Shaping the canal in order to physically remove the
inflamed / infected contents.
ii. Cleaning the canal with appropriate irrigants, which
would clean and disinfect the pulp space.
In the end, the ultimate success of root canal therapy lies in the
ability of the irrigant to reach the critical apical third and the isthmus
region. The role of an instrument thereby lies primarily in creating a
shape or channel for the irrigant to be able to access the inaccessible
regions of the root canal. The critical clinical question that arises is
then What is the ideal size of canal enlargement?
A careful review of endodontic literature shows that over the past
40 years various clinicians and researchers have recommended
different sizes of MAF (Master Apical File) enlargement (Table 4)
the apical constriction due to the complexity in canal curvature and
canal configuration.
With the advent of rotary ni-ti instruments came the newer feature
of taper wherein both MAF size and taper play an important role
in root canal cleaning and shaping dynamics. A careful review of
endodontic literature reveals that the following combination of MAF
and taper have shown superior cleanliness in the crucial apical third
of the canal:
i. Master Apical File size #40 with a taper of 4%
ii. Master Apical File size #30 with a taper of 6%
iii. Master Apical File size #20 with a taper of 10%
The apical three mm of the root canal system is the most crucial area
to be cleaned in order to achieve clinical success. It is interesting to
compare the size of enlargement in each of the above-mentioned
three systems at the critical 3 mm level short of apex. (Fig. 3)

Glickman
.04 .06 .10
Tooth Grossman Tronstad and Weine
Dumsha
Maxillary
Centrals 80-90 70-90 35-60 3 sizes
Laterals 70-80 60-80 25-40 3 sizes
Canines 60-60 50-70 25-40 3 sizes 3 mm 3 mm 3 mm
First Premolars 30-40 35-90 25-40 3 sizes 0.52 0.48 0.50
0.48 0.42 0.40
Second Premolars 50-55 35-90 25-40 3 sizes
0.44 0.36 0.30
Molars 30-55-50 3 sizes
MB/DB 35-60 25-40 3 sizes
MAF # 40 MAF # 30 MAF # 20
P 80-100 25-50 3 sizes
Fig 3: Different effective combinations of MAF and Taper
Mandibular
From the above figure you can realize that all the three systems
Centrals 40-50 35-70 25-40 3 sizes
are enlarging the canal to a size of around #50 at the level 3 mm
Laterals 40-50 35-70 25-40 3 sizes
short of working length. This observation made me wonder whether
Canines 50-55 50-70 30-50 3 sizes
this could be a critical parameter, which a clinician should keep
First Premolars 30-40 35-70 30-50 3 sizes
in mind while doing cleaning and shaping. Thereby I conducted a
Second Premolars 50-55 35-70 30-50 3 sizes
study comparing the four common combinations of MAF and Taper
Molars 30-55-90 3 sizes
advocated by manufacturers. The study groups assessed were: (Fig.
MB/ML 35-45 25-40 3 sizes
4)
D 40-80 25-50 3 sizes
Group I MAF #25 with TAPER 8% Waveone (Dentsply)
Table 4 Recommendations of MAF size
Group II MAF #30 with TAPER 6% K3 (Sybron)
The most commonly advocated concept is the three sizes Group III MAF #35 with TAPER 5% M Two (VDW)
enlargement rule wherein after manually gauging the size of the Group IV MAF #40 with TAPER 4% HYFLEX (Coltene)
apical constriction; the clinician increases the apical third to three The study protocol consisted of instrumenting root canals with either
sizes more from the first file that binds at the apex. This concept has one of the four test groups. The irrigation regime consisted using
now been disproved, as it is impossible to accurately clinically gauge 5.25% NaOCl in between each instrument change and a final rinse

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Nickel Titanium Rotary Instruments : Making The Right Choice CORNER

of 1ml of 17% EDTA for 1 min followed by a 3ml rinse of 5.25%

NaOCl for 1 min. The canals were finally flushed with 3ml of saline Take Home Message
and the teeth were split horizontally for SEM analysis. Represenative The choice of a rotary system has to be based on a case-to-case
images of the various groups are shown in Fig. 5. need taking into consideration the following parameters (Fig. 6)
i. Initial size of the canal
ii. Degree of canal curvature

Fig 4 Combination of various MAF and Taper having an average of

#50 enlargement at the level of 3 mm short of WL

Fig. 6 Cleaning and shaping to a #50 at 3 mm short of working

length will ensure long term clinical success
iii. Presence / Absence of extra-radicular radiolucency
iv. Clinical ease of use of a particular system
The only clinical parameter one has to keep in mind is to ensure
that the chosen system is able to enlarge the canal to size #50 at
a level 3 mm short of the working length. The clinical correlation of
my study is that instead of thinking in terms of just Master Apical File
size; it is prudent for a clinician to think:
This change in thinking based on combination of taper and MAF
along with good clinical acumen and clinical skills will be the
major determining factor affecting the prognosis of endodontic
treatment.
Fig. 5 Representative SEM images of the tested four groups showing
similarity in canal cleanliness

Statistical analysis of the results revealed no difference in the MAF X TAPER Size of enlargement at
cleaning ability of the tested four groups. 3 mm short of Working length

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