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1. A Comparison of Three Nickel Titanium Rotary
Systems, EndoSequence, ProTaper Universal,
and Profile GT, for Canal-cleaning Ability
Authors:
Anne E. Williamson, DDS, MS,
Allan J. Sandor, DDS, and Bruce C. Justman, DDS
J Endod 2009;35:107–109

2. Contents
Introduction
1.
Aim
Material & methods
Results
Discussion
Conclusion
References

3. Introduction
Canal preparation is one of the major steps in root canal
treatment and is directly related to concomitant
disinfection and subsequent obturation.
In recent years, nickel-titanium rotary root canal
preparation systems such as the EndoSequence the
ProTaper Universal and the ProFile GT , along with
several others, have altered the techniques of canal
instrumentation.
NiTi instruments have been shown to be superior to
stainless steel (SS) in terms of cutting efficacy, flexibility,
and torsional resistance.

4. AIM
The purpose of this study was to compare cleaning
effectiveness of root canal preparation under scanning
electron microscopy (SEM) using three different rotary
NiTi instrumentation systems: the ProTaper Universal
variable taper, the ProFile GT .04 taper, and
EndoSequence .04 taper.

5. Materials & methods
Thirty-six mesiobuccal roots from extracted mandibular
molars selected for this study.
The teeth were randomly divided into three groups.
Each group had two teeth not instrumented that served as
controls.
Access cavities are prepared.
Canal patency was established by placing a K-Flex #15
SS hand file.
Straight-line access was achieved for the EndoSequence
and ProFile systems with the use of Gates Glidden drills
#2 through #4.
The ProTaper rotary system replaces the Gates Glidden
drills with rotary shaping files.
All teeth were prepared to a #40 master apical file
following the individual manufacturers’ instructions.
All three systems were used in the traditional “crown-
down technique”.

6. All samples were decoronated, and the mesial root was
longitudinally split buccolingually for evaluation under
SEM to determine canal cleanliness.
All teeth were analyzed with the SEM at 20.0 kV and
500X magnification in the middle third of the canal.
Five independent examiners using the following 5-score
index performed the analysis of the SEM images (Fig. 1):

7. (A) SEM image of a sample with a mean score of 1.8 (few
agglomerations of debris).
(B) SEM image of a sample with a mean score of 1.2
(clean root canal wall, only a few small debris particles).
(C) SEM image of a sample with a mean score of 2.8
(many agglomerations of debris covering less than 50% of
the root canal wall).
(D) SEM image with a mean score of 4.2 (more than
50% of the root canal wall covered by debris).
(1) score 1: clean root canal wall, only few small debris
particles;
(2) score 2: few small agglomerations of debris;
(3) score 3: many agglomerations of debris covering
less than 50% of the root canal wall;
(4) score 4: more than 50% of the root canal wall covered
by debris; and
(5) score 5: complete or nearly complete root canal wall
covered by debris.
The nonparametric Kruskal-Wallis test was used to
determine whether a statistical difference existed among
the three groups of instruments followed by a weighted
kappa to measure observer agreement.

8. Results
Kruskal-Wallis Test (Average of 5 Examiners)
Group n Mean SD Median Lower
Quartile
Upper
Quartile
ES 9 2.8 1.1 2.4 2.0 3.6
PF 10 3.0 1.3 3.4 1.4 3.6
PT 8 3.4 1.0 3.3 2.5 4.1
Control 6 5.0 - - - -

9. Discussion
The EndoSequence is a rotary file with a reamer-like
design incorporating alternate contact point geometry.
The manufacturer states that removing radial lands
increases cutting efficiency, increases flexibility, and
reduces “drag,” therefore lowering the torque
requirements of the files.
EndoSequence has a significantly higher rate of file
separation when compared with the Profile system. No
file separations occurred in our study.
In this study, SEM evaluation of the root canal surfaces
showed areas of the canal walls covered by a smear layer
and debris in all groups. Canals of all of the specimens
showed the existence of uninstrumented surfaces

10. regardless of the rotary system used. Complete canal
cleanliness was not achieved by any of the techniques and
instruments investigated.
This study did not compare the ability of NaOCl to
remove debris with that of other irrigants;
Conclusion
After root canal preparation with three different NiTi
rotary instruments, no statistically significant differences
in canal wall cleanliness at the midroot level between any
groups were found.
All sections showed a comparable level of cleanliness and
freedom of smear layer, with some scattered debris.
Under the conditions of this study, the EndoSequence,
ProFile, and ProTaper rotary instrument systems were
equally effective in root canal debridement.

11. REFERENECES
1.Haikel Y, Serfaty R, Bleicher P, Lwin TT, Allemann C.
Effects of cleaning, chemical disinfection, and
sterilization procedures on the mechanical properties of
endodontic instruments.
J Endod 1997;23:15– 8.
2. Short JA, Morgan LA, Baumgartner JC. comparison of
canal centering ability of four instrumentation techniques.
J Endod 1997;23:503–7.
3. Peters OA, Laib A, Gohring TN, Barbakow F. Changes
in root canal geometry after preparation assessed by high-
resolution computed tomography. J Endod 2001; 27:1– 6.