Nickel Titanium Rotary Root Canal Instrumentation

N I C K E L T I TA N I U M R O TA RY R O O T
C A N A L I N S T R U M E N TAT I O N

Image Courtesy: http://www.d2dendo.co.uk

Name: Omar Hamad AlKadhi
ID: 42510103
L: 12
Riyadh Colleges of Dentistry and Pharmacy

Endodontics DENC 624 Thursday, May 27, 2010 1
Omar.H.AlKadhi@gmail.com

N I C K E L T I TA N I U M R O TA RY R O O T
C A N A L I N S T R U M E N TAT I O N
Rationale for Root Canal Treatment:
The main cause of pulp inflammation is the microorganisms. Therefor, the main objective is to
clean and shape the root canal system to facilitate filling. The main objectives of root canal treat-
ment are:

1. Removal of all bacteria and inflamed and necrotic tissues from the root canal system

2. Shaping the root canal system to facilitate the insertion of filling.

3. Filling the root canal system to achieve a hermetic seal.

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Rotary Vs. Manual Instrumentation:
1. “Although no differences were found for cleaning capacity, the reduction of instrumentation
time by the rotary technique was a relevant clinical factor for endodontic treatment.” (Silva et
al., 2004).

2. “There was no significant difference in the rate of radiographic healing of the periapical lesions
between manual and rotary instrumentation.” (De Rossi et al., 2004).

3. “There was no significant difference between experimental groups cleaning efficacy at the cer-
vical, middle and apical root canal thirds. Only the coronal third scored higher in the hand in-
strumented group (P<0.001). Instrumentation with Flex Master rotary files was significantly
less time consuming (P<0.001).” (Moghaddam et al., 2009).


Lightspeed

The Design:
The Lightspeed design has a non-cutting pilot a short blade and a flexible non-cutting shaft. This
design facilitates negotiating the curvatures of the canal easily and safely (Steve and William,
2005).

Images Courtesy: http://www.discusdental.com

An Evaluation by Clinicians:
An evaluation of Lightspeed canal preparation technique. This evaluation was done using a survey
for 177 Swiss clinicians. The survey revealed the following:

1. 80% used the technique.

2. 60% found the method easier.

3. 43% found it quicker.

4. 58% used the technique on all tooth types.

5. 76% fractured an instrument at least once.

a. Causes of fracture:

i. 25% too much pressure.

ii. 17% incorrect angulation.

iii.15% complicated tooth morphology.


b. Location of Fracture:

i. 74% in the shaft.

ii. 7% near the tip.

6. 62% claimed that working length determination was easier.

7. 52% claimed that obturation of Lightspeed prepared canals was easier and quicker.

8. Only 10% would not recommend the technique. (Barbakow and Lutz, 2006).

Efficacy:
In this report, the efficacy of Lightspeed instruments was described in a sample of 40 canals:

1. The preparation time was 8.12 min regardless the canal shape.

2. No deformation nor separation was observed.

3. No canals were blocked during preparation.

4. In terms of working length:

a. 17 canals didn’t change length.

b. 16 increased in length.

c. 7 lost length.

5. Apical stops were found in 23 canals but they were of poor quality.

6. The canals were smooth in the apical half in 36 canals and smooth in the coronal half in 24 ca-
nals.

7. All the canals were poor in terms of tapering. (Thompson and Dummer, 1997).

Comparison of Lightspeed and Hand Instrumentation:
In 240 root canals, preparation of the canals were done to optimal apical preparation size. The api-
cal area was sectioned at 3 levels and evaluated microscopically. The analysis showed the follow-
ing:

1. 70% Lightspeed and 69% hand instrumentation, 2 of three levels showed the dentin was cut cir-
cumferentially.

2. No perforation.


3. 4 Lightspeed instruments separated. (Bartha et al., 2005).

Comparison of Lightspeed LS1 and LSX:
The design change carried out was the replacement of the U-shaped blade in LS1 with a spade-
shaped blade in LSX. 30 simulations of root canals were instrumented and showed the following:

1. ANOVA test showed no difference between LS1 instrumented canals and LSX instrumented ca-
nals regarding the degree of apical transportation and length control.

2. No separated instruments.

3. LSX and LS1 have the same effectiveness regarding apical transportation and length control.
(Iqbql et al., 2007).

ProFile

Design:
The ProFile rotary NiTi has three types .04, .06 and O.S.

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Shaping Ability of ProFile .04:
40 simulations of root canals made with different angles, positions, shapes and curvatures were pre-
pared using ProFile .04 taper. This study showed the following:

1. The time of preparation was not influenced by canal shape.


2. No fractured instruments.

3. 52 instruments deformed. Size 6 instruments deformed the most and canal shape didn’t influence
the deformation.

4. No blocked canals.Loss of working distance was 0.5 mm or less.

5. Most canals had apical stops, they were smooth with good taper. (Thompson and Dummer,
1997).

Effect of Electropolishing ProFile .04:
Electropolished and non-electropolished ProFile .04 size 25 were investigated for torque resistance,
fatigue resistance and cutting efficiency. The study showed the following:

1. Electropolishing reduced fatigue resistance.

2. Electropolishing did not affect torsional resistance.

3. Electropolishing reduced the angle at failure and amount of unwinding.

4. Electropolishing did not affect cutting efficiency. (Bui et al., 2008).

Non Electropolished (Left) and Electropolished (Right)

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Evaluation of Apical Debris Removal Using ProFile GT:
48 pairs of teeth were instrumented using size 20 and size 40 ProFile GT with .04, .06, .08 and .10
tapers. One tooth of each pair was enlarged to size 20 and one to size 40. Teeth were sectioned 1
mm and 3 mm from the apex. The amount of debris remained was calculated as a percentage of to-
tal area. The study showed the following:

1. Greater percentage of debris was found in size 20 in 1 mm level relative to size 40 for all tapers
except .10.

2. No difference in 3 mm level.

This study suggests that the removal of debris is more effective using .04, .06 and .08 ProFile GT
when apical preparation size is larger than 40 relative to size 20. When taper .10 was produced at
apical area, there was no difference in the removal of debris between size 40 and size 20. (Albrecht
et al., 2004).

EndoSequence

Design:
EndoSequence files offer an alternating contact points (ACP).
This allows the file to be in the center of the canal and reduce
the required torque. The metal is thin making the file more
flexible and sharper. ACP also prevents transportation.The En-
doSequence files have the advantage of a precision tip which is
a non-cutting tip that becomes engaged 1 mm from the tip (D1)
(Figure 16) allowing it to be safe and efficient.

Figure 16. Precision tip

Images Courtesy: http://www.dentalcompare.com and http://www.cda.org

EndoSequence files are electropolished making them sharper with increased cutting efficiency. En-
doSequence also have a variable helical angles which aid in reducing the required torque and allow
for higher speeds as high as 600 rpm. EndoSequence files are available in tapers of .04 and .06.


They are supplied with an initial file named “Expeditor” which is introduced to the canal initially to
determine the canal diameter. (Kurtzman, 2007).

Transportation in EndoSequence:
In this study, 22 meisobuccal and mesiolingual canals of extracted mandibular first and second mo-
lars were instrumented with EndoSequence size 30 taper .06, size 25 taper .06 and size 20 taper .06.
The study showed the following:

1.Average transportation from the working length was:

a. 0.077 mm at 0 mm.

b. 0.039 mm at 1 mm.

c. 0.040 mm at 3 mm.

2. The loss of working length was 0.001 mm. (Karabucak, 2010).

K3

Design:
The K3 system has many features includ-
ing:

1. Positive rake angle which gives an op-
timum cutting efficiency.

2. Variable helical flute angle which fa-
cilitates the debris transportation from
the canal to the orifice and out.

3. Peripheral blade relief which reduces
the friction preventing separation. Image courtesy: Endodontic Topics
4. Third radial land which prevents the instrument
form threading into the canal.

5. Variable core diameter increasing flexibility.

6. Safe-ended tip minimizing the chance of ledging, zipping and perforation.

7. Access handle allows easier access to the posterior area of the mouth.

8. Wide radial lands. (Gambarini, 2005).


Efficiency of K3 Compared with Hand K-Flexofile Part I:
In this study 24 canals were instrumented with K3 and 24 canals were instrumented with Hand K-
Flexofile. The study showed the following:

1 K3 instruments showed better canal shape and less canal transportation.

2. 11 K3 files fractured and non of the hand files did.

3. K3 was significantly faster. (Schäfer and Schlingemann, 2003).

Efficiency of K3 compared with Hand K-Flexofile Part II:
In this study 30 canals were instrumented with K3 and 24 canals were instrumented with Hand K-
Flexofile. The study showed the following:

1. 5 K3 files separated but non of K-Flexofiles.

2. No completely clean root canal observed.

3. K-Flexofiles showed better debris removal than K3.

4. K3 maintained the curvature of the canal better.

5. No time difference in canal preparation. (Schäfer and Schlingemann, 2003).

References
Silva L.; Leonardo M.; Nelson-Filho P. and Tanomaru J. "Comparison of rotary and manual in-
strumentation techniques on cleaning capacity and instrumentation time in deciduous molars." J.
Dent Child (Chic)., Vol. 71, No. (1), (2004), 45-47.

De Rossi A.; Silva L.; Mario R.; Lenaldo B. and Rossi M. " Effect of Rotary or manual instru-
mentation, with or without a calcium hydroxide/1% chlorhexidine intracanal dressing, on the heal-
ing of experimentally induced chronic periapical lesions." J. Oral Surgery, Oral Medicine, Oral Pa-
thology, Oral Radiology and Endodon., Vol. 99, No. (5), (2005), 628-635.

Moghaddam K.; Mehran M. and Zadeh H. "Root Canal Cleaning Efficacy of Rotary and Hand
Files Instrumentation in Primary Molars." Iranian Endodon. J., Vol. 4, No. (2), (2009), 53-57.

Barbakow F. and Lutz F. “ The ‘Lightspeed’ Preparation Technique Evaluated by Swiss Clinicians
for Attending a Continuing Education Courses” International Endodon. J., Vol. 30, No. (1), (2006),
46-60.

Senia E. and William L. “ The Lightspeed Root Canal Instrumentation System” Endodontic Top-
ics, Vol. 10, No. (1), (2005), 148-150.


Thompson S. and Dummer P. “Shaping Ability of Lightspeed Rotary Nickel-titanium Instruments
in Simulated Root Canals. Part 1” J. of Endodon., Vol. 24, No. (11), (1997), 698-702.

Bartha T.; Kalwitzki M.; Lost C. and Weiger R. “Extended Apical Enlargement With Hand Files
Versus Rotary NiTi Files. Part II.” J. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology
and Endodon., Vol. 102, No. (5), (2005), 692-697.

Iqbaql M.; Banfield B.; Lavorini A. and Bachstein B. “A Comparison of LightSpeed LS and
LightSpeed LSX NiTi Rotary Instruments in Apical Transportation and Length Control in Simu-
lated Root Canals” J. of Endodon., Vol. 33, No. (3), (2007), 258-271.

Thompson S. and Dummer P. “Shaping Ability of ProFile.04 Taper Series 29 Rotary Nickel-
Titanium Instruments in Simulated Root Canals. Part 1.” International Endodon. J., Vol. 39, No.
(1), (1997), 1-7.

Bui T.; Mitchell J. and Baumgartner J. “Effect of Electropolishing ProFile Nickel-titanium Ro-
tary Instruments on Cyclic Fatigue Resistance, Torsional Resistance, and Cutting Efficiency” J. of
Endodon., Vol. 34, No. (2), (2008), 190-193.

Albrecht L.; Baumgartner J. and Marshall G. “Evaluation of Apical Debris Removal Using
Various Sizes and Tapers of ProFile GT Files.” J. of Endodon., Vol. 30, No. (6), (2004), 425-428.

Kurtzman G. “Simplifying Endodontic With EndoSequence Rotary Instrumentation.” CDA J., Vol.
35, No. (9), (2007), 625-628.

Karabucak B.; Gatan A.; Hsiao C. and Iqbal M. “A Comparison of Apical Transportation and
Length Control between EndoSequence and Guidance rotary Instruments.” J. of Endodon., Vol. 36,
No. (1), (2010), 123-125.

Gambarini G. “The K3 Rotary Nickel Titanium Instrument System” Endodon. Topics, Vol. 10, No.
(1), (2005), 179-182

(Schäfer E. and Schlingemann R., 2003) “Efficiency of Rotary Nickel-titanium K3 Instruments
Compared with Stainless Steel Hand K-Flexofile. Part 1.” International Endodon. J., Vol. 36, No.
(3), (2003), 199-207.

(Schäfer E. and Schlingemann R., 2003) “Efficiency of Rotary Nickel-titanium K3 Instruments
Compared with Stainless Steel Hand K-Flexofile. Part 2.” International Endodon. J., Vol. 36, No.
(3), (2003), 208-217.


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