Recent advances in endodontic instruments

By BDS,MSD,PhD
Lecturer in Endodontics
Nasr El Deen Rashad Faculty of Dentistry
Suez Canal University
Agenda
• History of root canal preparation
• Classification of rotary NiTi
• Guidelines of rotary instrumentation
Intended learning outcomes (ILOS)

By the end of this lecture you should be able to :

 Identify the reasons of using Rotary Niti

 Classify Rotary Niti Instruments
 Mention the guidelines of using Rotary Niti
 Cleaning and Shaping

Mechanical objectives
• I. Continuously tapering funnel from the apex to the access cavity.
• II. Cross-sectional diameter should be narrower at every point
apically.
• III. The root canal preparation should follow the shape of the original
canal.
• IV. The apical foramen should remain in its original position.
Cleaning And Shaping
 Cleaning And Shaping

Biologic objectives:
• I. Instruments should be confined to RC System
• II. Never force the necrotic debris beyond the apical foramen.
• III. Remove all tissue from the root canal space.
• IV. Create sufficient space for intra-canal irrigation and medicaments.
 What tools should I use?
• Indeed, Edward Maynard has been
the first one that develop the first
endodontic hand instruments which
was notching round wire (piano wires)
for extirpation of pulp tissue
 Carbon Steel
• Stiff
• Corrosion
 Stainless Steel
• Less Stiff than Carbon Steel

• Still not flexible enough to

follow canal curvatures in large
sizes
 Then came the …Niti revolution

The smart files

The nickel–titanium alloys used in root canal treatment contain

nearly 56% (wt) nickel and 44% (wt) titanium.
HISTORY of Ni Ti
NitiNol Alloy
• Nitinol is an acronym for the elements from which
the inter-metallic alloys materials were composed:
– Ni : for Nickel.
– Ti : for Titanium.
While Nol:
is name given from US Naval Ordnance
Laboratory.
 NITI
• 2 Main crystallographic forms
Austenite Martensite

Superelasticity Shape Memory

(Less flexible) (More Flexible)

Higher Cutting Efficiency Lower Cutting Efficiency

• The two forms transform to one another via Heat & Stress
 AF Temperature
• It is the temperature above which the file is in an austenitic phase
• Below the AF temperature the file is in a martensitic phase
• So if the AF temperature of a certain file is below room temperature…
• This means that this file is austenitic in room temperature
Why Rotary Nickel-Titanium
Instrumentation?
 Advantages of Rotary Nickel-Titanium
Instrumentation
1-The higher flexibility of Ni Ti
files allow the file to follow
the root canal and preserving
root canal curvature while
effectively cleaning and
shaping is achieved
2-Improve the efficacy of root canal preparation
because:
– both patient's and operator's fatigue minimized
& safe to use.
3- Reduction in apical extrusion & ability to collect
and remove debris from the canal system leading
to less post-treatment pain.
4-Reduction in the time required for instrumenting
the canal thus root canal system prepared
rapidly.
Disadvantages

1-Lack of tactile sense.

2-Unexpected instrument separation.
3-COST
 Niti generations

The First Generation

• These files are in Austenic phase with Af
temperature below room temperature
 The First Generation (SE files)
• Examples:
• Light speed
• Profile
• Revo-S
• Typhoon
• Pro Taper Universal
• K3
Main disadvantage is High incidence of fracture
 Why do files fracture?
Torsional Fracture
• tip becomes locked in the narrow canal while
the file shank continues to rotate associated
with using too much apical force
 Why do files fracture?
Cyclic (Flexural) Fracture
• Flexural fatigue fracture occurs due to overuse of the
metal alloy.
 ‫طب ايه الحل‬
NITI
• 2 Main forms
Austenite Martensite

Superelasticity Shape Memory

(Less flexible) (More Flexible)

Higher Cutting Efficiency Lower Cutting Efficiency

• The two forms transform to one another via Heat & Stress
 ‫طب ايه الحل‬
• Is to obtain a file in a hybrid austenite, martensite,
and R-phase state
• So… It has Higher Cyclic Fatigue Resistance

‫اززززززاى‬
The Second Generation
The Second Generation

• Depending on the thermo dynamic treatment of

the wires prior or during manufacturing, three
different wires were produced.
The Second Generation

• In 2008, Sybron Endo developed a new

manufacturing process aiming to
transform raw NiTi wire in the austenitic
phase to an R-phase and to stabilize the
R-phase at higher temperature then
create the flutes by a twisting process
resulting in file called Twisted file (TF)
 The Second Generation

• Properties:
• Superior mechanical characteristics in terms of
flexibility and cutting efficiency.
• An added advantage : Unwinding of flutes can be
seen, presenting a warning sign.
 The Second Generation
• M-Wire
• Introduced in 2007 by Dentsply Tulsa
• Produced by a series of heat treatment and annealing
cycles during the manufacturing process.
• WHY ?
• To obtain a file in a hybrid austenite, martensite, and R-
phase state
• So… It has Higher Cyclic Fatigue Resistance
The Second Generation
M-Wire
Which NiTi state would you choose to get a result like this?
 The Second Generation

• Controlled Memory Wire:

• CM wire was introduced in 2010.
• File is stable martensite at room
temperature.
• So it has high flexibility and cyclic
fatigue resistance
• Files can be pre-bent
• Examples: Hyflex CM , Fanta AF.
 The Second Generation

HyFlex CM
Fanta Classic CM
 The Second Generation

• Characteristics:
• Superior flexibility so it allows the file to
conform root canal anatomy, prevent canal
transportation, ledge formation
• Respond to excessive resistance inside root
canal by straightening to the flutes to reduce
binding to the canal walls to avoid torsional
failure (fracture) then return back to it’s
original shape by heating or autoclaving
• CM wire has the ability to precurve to follow
complex RC or correct a ledge.
A fractured NiTi instrument under magnification demonstrating the presence of micro-voids
The Third Generation
(Post Machining Heat Treatment)

• Recently, a new heating process after the machining of the files was
proposed
WHY?

• To overcome machining process defects since surface voids and

irregularities created during machining of instruments act as areas
of stress concentration and crack propagation.

• To modify the crystalline phase structure in terms of flexibility and

cutting efficiency.
 The Third Generation

(Post Machining Heat Treatment)

Hyflex EDM (Coltene Whaledent, Cuyahoga Falls, OH))
It is manufactured using the technique of electrical discharge machining
(EDM).
 The Third Generation

(Post Machining Heat Treatment)

• Examples:
Fanta AF Blue
• Files are manufactured through 2-stage transformation.
• Nitinol after machining, they undergo a special
heating Turned to R-phase

Turned to martensite
then cooling process –
 The Third Generation

(Post Machining Heat Treatment)

Examples:

1. TRU Shape Files

2. Protaper gold
3. WaveOne gold
4. Hyflex EDM
 The Third Generation

(Post Machining Heat Treatment)

 Guidelines for use

• Study the preoperative radiograph

• Coronal access
• Rubber dam isolation
• Scouting
• Coronal Preflaring
• Glide Path
• Brushing Motion
• Irrigate and Recapitulate
• Apical Gauging
 GUIDELINES FOR USE
1- Study the preoperative radiograph
,,,,,WHY

to analyze case difficulty

U can use any

generation
 GUIDELINES FOR USE
• Study the preoperative radiograph

U should use 3rd

generation
protocol

2) Prepare a conservative access cavity sufficient to reveal

all root canal orifices
3) Rubber dam isolation
 PROTOCOL FOR rotary root canal instrumentation

4) Access cavity and canals are flooded with

Irrigant
 5)Scouting
• The canal orifices, the coronal canal portions are
carefully explored with small (no. 10) K-files
passively placed several millimeters into the root
canal without attempting to reach the expected
working length
6) Coronal pre-flaring,,,,,,WHY
 Coronal flaring facilitates direct access
into the middle and sometimes even into
the apical canal third

WHY
 Promotes access for irrigants
 Allows rotary instruments to prepare the
apical canal third with less wall contact
and less friction.
 7- Negotiation to patency
Using gentle watch-winding motion till the feeling of the
apical constriction
8) Establish accurate W.L
 GUIDELINES FOR USE

• Glide Path Preparation

 9) glide path
• Def: Smooth radicular tunnel from the orifice of the
canal to the physiologic terminus of the root canal

‫ ليه‬WHY
• Facilitates the penetration of the subsequent
rotary instruments regardless of the technique
used.
Glide Path Preparation
• An open glide path is secured with K-files
#8,#10 and up to size #15 or #20,
depending on the canal anatomy

• Glide path is achieved when the hand

file(15 or 20) can enter from the orifice
and follow the smooth canal walls
uninterrupted to the terminus.
Manual creation of glide path with
stainless steel k files
• The oldest and commonest method to prepare a
glide path is with stainless steel k files
advs
• Lowers expenses
• Precludes the need of a separate handpiece
• Provides a better tactile sensation
Glide Path Preparation
Glide Path Preparation
Glide Path Preparation
 Scout Race Files
Glide Path Preparation
Glide Path Preparation
Glide Path Preparation
 Hyflex EDM Glide Path File

Glide Path Preparation

10) NiTi rotaries are then used in a “crown-
down” rather than in a “step-back” fashion
According to the manufacturer instructions and always stick to speed and torque
limit of each system

11) Irrigation & Recapitulation with a small

hand file is recommended along the whole
preparation
• Irrigate and recapitulate
12) Gauging the foramen, apical adjustment

• Done with manual file to adjust the size of the

master GP cone.
Somethings to avoid Somethings to do
Guidelines for use
 Greenwall, Linda. Bleaching techniques in restorative dentistry : an
illustrated guide
 Haywood, Van B. TitleTooth whitening : indications and outcomes of
nightguard vital bleaching / Van B. Haywood; Quintessence Publishing,
2007.
 Van Haywood’s article: Frequently Asked Questions About Bleaching;
Compendium / April 2003
 GOLDSTEIN, Ronald E Complete dental bleaching; 1995; Quintessence
 Sulieman M. An Overview of Bleaching Techniques: 1. History, Chemsitry,
Safety and Legal Aspects. Dent Update 2004; 31:608-616
 Sulieman M. An Overview of Bleaching Techniques: 2. Night Guard Vital
Bleaching and Non-Vital Bleaching. Dent Update 2005; 32: 39-46