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The reciprocating
movement in endodontics
Nicola Maria Grande, Gianluca Plotino, Hany Mohamed Aly Ahmed,
Stephen Cohen and Frédéric Bukiet provide a clinical perspective on the
reciprocating movement in endodontics
Figure 5: Left: previous Waveone Primary Figure 6a: Preoperative radiograph of a Figure 6b: Working length. Note the sharp
file made in M-wire alloy and features of lower left second molar tooth apical curvature of the distal root
Figures 3b and 3c: Superimposition of preoperative three-dimensional reconstruction Figure 3d: Showing the modification of
the coronal, middle and apical part of the
and postoperative bi-dimensional sections at coronal middle and apical level root canal anatomy and geometry induced
instrument. Right: the new Waveone Gold
by reciprocating instrumentation Figure 6c: One-year control radiograph.
Primary file and features of the coronal,
Note conservative access only removed
middle and apical part of the instrument.
the old filling. Maximum maintenance of
The heat treatment of the files has been
the dental structure of the distal area
(Turek, Langeland, 1982; Harty, Stock, 1974; Hülsmann, complex canals (Peters, Paque, 2010). changed from M-wire to gold alloy
makes it compatible to proper cleaning,
Gambal, Bahr, 1999; Bolanos et al, 1988; Lehman, Gerstein, treatment. Note the ability to prebend the
shaping and filling procedures
1982; O’Conell, Brayton, 1975; Teodorovic, Ivanovic, 1998; The birth of modern reciprocation for nickel titanium file
Cheung, Chan, 1996; Nagy et al, 1997; Smith, Edmunds, files of greater taper
1997; Hülsmann, Rummelin, Schäfers, 1997; Petschelt et al, Studies have demonstrated the potential in using greater
1994). taper nickel titanium files in shaping the root canal even in
The other common observation after RCP with mechanical the most challenging of anatomical complexities (Hulsmann,
SS files was that increasing the size of the preparation risked Peters, Dummer, 2005; Parashos, Messer, 2006). asymmetrical motion and the file used was a Protaper F2 diameter) SS scouting files allows the clinician to determine
a higher incidence of procedural errors (Hülsmann, Gambal, However, fracture of nickel titanium rotary instruments (Dentsply Maillefer). The angles used were described as four- the size of the RSF, which will shape the canal (De-Deus et al,
Bahr, 1999; Bolanos et al, 1988; Lehman, Gerstein, 1982; continues to be of concern (Best et al, 2004) and appears to tenth of a circle (144°) in clockwise (CW) cutting direction 2010a; De-Deus et al, 2010b). This approach can be risky for
O’Connell, Brayton, 1975; Teodorovic, Ivanovic, 1998; be a manifestation of continuous rotation. In 2004, one study and two-tenth of a circle (72°) in counter-clockwise (CCW) files used in complete rotation because if the file exhibits
Cheung, Chan, 1996; Nagy et al, 1997; Smith, Edmunds, investigated the endurance limit of nickel titanium files (Best non-cutting direction with a speed of 400rpm. The technique ‘taper lock’ in the canal, immediate fracture could occur
1997; Hülsmann, Rummelin, Schäfers, 1997; Petschelt et al, et al, 2004); this is the level of stress or strain at which the file showed promising results (Malentacca, Lalli, 2002). (Yared, 2008). This modified CW/CCW movement led to
1994; Abou-Rass, Jastrab, 1982; Ianno, Weine, 1989). can be subjected to before separating (Lindeburg, 1999). This The overall speed of this kind of rotational reciprocation is nickel titanium files specifically designed for the use in partial
Other studies have also reported procedural errors linked value is a specific deflection angle (DA), characteristic of each much lower than the speed used for symmetric oscillating reciprocation, such as Waveone (Dentsply Maillefer) and
to metal stiffness and restoring force of SS and worse results instrument; it depends on the size and design features of the reciprocation. Consequently, the rotating effect given by the Reciproc (Dentsply VDW).
compared to nickel titanium instrumentation systems (Hilaly instrument. net difference between CW and CCW movements maintains The files are used with different angles in the cutting and
Eid, Wanees, Amin, 2011; Ceyhanli et al, 2014). Every time a rotating file cuts dentine in a constricted an adequate cutting efficiency and an apical progression of non-cutting direction of 150°/30° (Reciproc with an average
canal, torsional deformation develops on its axis. If the the instrument while reducing torsional stress. speed of 300rpm and Waveone with an average speed of
The modern use of SS files in reciprocation deformation is within the plastic limit of the metal, there are It has been speculated that this kind of reciprocation is 350rpm) and that are within their characteristic endurance
Although there are many systems on the market, the tendency no structural changes. However, if repeated cyclic axial similar to the manual balanced force technique as described limit (Webber, 2015).
is to limit use to the scouting phase prior to shaping deformation accrues, the instrument will fracture due to by Roane and colleagues in 1985. The dynamics enables the Actual and set values of the asymmetrical reciprocating
procedures, to obtain a glide path. This would minimise the torsional fatigue and this is in addition to the flexural fatigue instrument to remain centred in the canal, as the cutting force movement of different motors was assessed because variables,
adverse effects of SS files especially in larger more rigid sizes. that develops within a curved canal (Pedulla et al, 2015). is equal on the concave and convex side of the canal curvature such as the delay between the two directions of movement
Despite the widespread use of mechanical SS files, there is Limiting the angle of rotation in the cutting direction (Figures 2, 3 and 4). Torsional stresses, which are developed and the acceleration to reach the desired speed, could play an
still a lack of scientific evidence on their efficacy (Limpngi et under the endurance limit of the instrument led to the on the shank of the file during the cutting action, are reduced important role in the efficacy of the different instruments
al, 2004). development of a movement that could be defined as partial as the rotation is under the ideal limit of the DA specific for (Fidler, 2014). Additional studies are needed to explore this
SS files used for glide path management should be used or asymmetrical reciprocation (Figure 1), in which the angle the file. variable. For commercial reasons, the flutes of reciprocating
with equal 30° forwards and backwards movement in a of rotation in the cutting direction is higher than the angle of This novel asymmetrical movement led to the development files are manufactured in a backwards direction so that the
reciprocating handpiece (M4 Safety Handpiece (Sybronendo/ rotation in the opposite non-cutting direction. After a certain of dedicated reciprocating single file (RSF) systems and a new CCW movement is greater than the CW movement and after
Kerr). The primary observations regarding small SS files for number of cutting cycles the instrument would complete a technique where only one file is needed to fully shape a canal three cutting cycles the instrument completes a full reverse
glide path management seems to be promising, but studies full rotation. When first introduced (Yared, 2008), an ATR to length. rotation. All commercially available nickel titanium files
are lacking on how they would fare in calcified, curved and Teknica motor (ATR, Pistoia, Italy) was programmed for this Initial canal negotiation with small (0.08, 0.10mm tip rotate in a CW direction (Fidler, 2014). Both commercially
as viable alternatives middle thirds of the root canal effectiveness, microcrack formation, bacterial reduction, tomography evaluation of apical root canal transportation with the use of
ProTaper, RaCe and Safesider systems in human teeth. Aust Endod J 40: 12-6
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1778-83
extrusion of debris and removal of root canal filling materials.
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2013). This procedure has been follows (Plotino et al, 2015):
131-4 Hilaly Eid GE, Wanees Amin SA (2011) Changes in diameter, cross-sectional
shown to be clinically successful • Reciprocation extends the lifespan of all types of files tested
De-Deus G, Moreira EJ, Lopes HP, Elias CN (2010a) Extended cyclic fatigue life area, and extent of canal-wall touching on using 3 instrumentation
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the clinician follows the manufacturers directions for use on the cyclic fatigue life of the files tested 1063-8 Endod 112: 688-95
(Plotino, Grande, Porciani, 2015). • Reciprocation does not reduce the cutting efficiency of the De-Deus G, Brandão MC, Barino B, Di Giorgi K, Fidel RA, Luna AS (2010b) Hulsmann M, Gambal A, Bahr R (1999) An evaluation of root canal preparation
TF Adaptive files and the dedicated Elements motor files tested Assessment of apically extruded debris produced by the single-file ProTaper with the automated Excalibur endodontic handpiece. Clin Oral Invest 3: 70-8
(Sybronendo) have recently been launched. The motor • Reciprocating and rotary motion have similar cutting F2 technique under reciprocating movement. Oral Surg Oral Med Oral Pathol Hulsmann M, Rummelin C, Schäfers F (1997) Root canal cleanliness after
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