0099-2399/84/1002-0045/$02.

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journal of Endodontics
Copyright 9 1984 The American Association of Endodontists

Printed in U.S.A.

VOL. 10, NO. 2, FEBRUARY1984

SCIENTIFIC ARTICLES
File Damage during Root Canal Preparation
Steve Montgomery, DDS, Maria L. Canales, DDS, MS, and Carlos E. del Rio, DDS

The purpose of this study was to determine the

frequency of file damage during root canal
preparation and to observe any difference in the
frequency of damage between Unitek and K-Flex
files. Canals of 126 extracted human teeth were
prepared with filing motions by 18 sophomore dental
students. Eight students used Unitek and 10 used
K-Flex files. File damage or separation was
evaluated by two endodontists. The rate of damage
or separation was low (98 files) compared with
previous rates in this laboratory. Most file damage
occurred while filing canals in posterior teeth with
#10 files. One file separated for every 3.91 posterior
teeth that were filed. The mean number of separated
or damage files per student in the K-Flex group was
5.7 while the mean for the Unitek group was 5.13.
There was no statistical difference between the two
groups.

more space between the cutting edges, allowing more

debris to be removed per outstroke. Since the width of
the blank is decreased, the file is more flexible than the
standard square cross-section files. K-Flex files (DType) have 25% more flutes than K-type except for
size 10. The size 10 has 2.4 flutes per millimeter
whereas the K-type #10 file has 2.8 flutes per millimeter
(3).
Files, particularly small sizes, may easily be damaged
during use and should be discarded if any doubt exists
about their condition. Weine (4) suggests that sizes 8
and 10 should be discarded after one appointment and
sizes 15 through 25 should be discarded after two
appointments. The extent of file damage to these new
shaped files during actual root canal preparation has
not been established.
The purpose of this study was to determine the
frequency and degree of file damage during root canal
preparation and to see if there was any difference in
the rate of damage between Unitek and K-Flex files.

For many years few changes were made in root canal

file designs. Recently, however, several new design
innovations have been introduced. The main changes
have been aimed at increasing file flexibility (1).
Traditionally, files have been made from square-shaped
blanks that limit the flexibility characteristics of the file.
Square blanks have four 90-degree angles which are
not as sharp as triangular-shaped blanks with 60degree angles (Fig. 1). The triangular cross-section has
been shown to cut more efficiently than the square
cross-section (2).
Unitek Manufacturing Co. (Monrovia, CA) recently
began using triangular blanks and increasing the twists
t o gain more flutes per millimeter. The low degree angle
gave a sharper point, the thinner blank gave increased
flexibility, and more flutes gave better hard tissue
removal.
Kerr Manufacturing Co. (Romulus, MI) has recently
developed a rhombus-shaped blank for its K-Flex files.
This shape has a sharper edge since the angle is less
than 90 degrees. When the blank is twisted, there is

MATERIALS AND METHODS

The root canals of 126 extracted human teeth were
prepared by 18 sophomore dental students. To simulate clinical conditions, the teeth were mounted in dentoforms (Columbia Dentoform Corp.). Thirty-six anterior
teeth, 36 premolars, and 54 molar teeth were used.
Students were randomly selected to use either Unitek
or K-Flex files so that 8 students used Unitek and 10
used K-Flex. Four other students originally chosen decided not to participate in the study. Unitek files have
been used at this school for several years and served
as the controls.
The root canals were prepared using the technique
described in the University of Texas Preclinical Laboratory Manual (5). Circumferential filing motions were
used to clean and shape the canal walls. The canals
were irrigated before instrumentation and between
each file size with 2.5% sodium hypochlorite. Each time
a file was removed from a canal, it was wiped clean of
any debris. Middle and cervical thirds of the root canals
45

46

Journal of Endodontics

Montgomery et al.

were flared after adequate preparation of the apical

third.
The students were instructed to watch for signs of
file flute damage or shaft separation (Fig. 2). When
either these things occurred, the file was placed into a
coin envelope and given to an instructor. The total
number of files each student turned in was recorded.
The student was asked to record the following information on each coin envelope: (a) the type of file (control
or experimental); (b) file size; (c) whether the file was
damaged (unraveled flutes) or separated (fractured);
and (d) the tooth being prepared when the file was
damaged or separated.
Two endodontists examined the used files for damage or separation by observing them under x l 0 magnification and by measuring them with a millimeter ruler.
They compiled the data and analyzed it using chisquare and Mann-Whitney U-tests.
RESULTS

Ninety-eight files were separated or damaged in this

study (Table 1). Twenty-three files were separated and

75 were damaged, so that one file was separated or

damaged for every 1.29 teeth that were instrumented.
One file was separated for every 5.47 teeth that were
instrumented. When considering only the posterior
teeth, one file was separated or damaged for every
0.92 instrumented teeth and one file was broken for
every 3.91 instrumented teeth.
Of the files that separated, 48% were Unitek and
52% were K-Flex. Of the damaged files, 40% were
Unitek and 60% were K-Flex. There was no statistical
difference in the rate of separation or damage between
the two types of files. Eighty-seven percent of the files
that separated were size 10, while 9% were size 15
and 4% were size 20 (Table 2). Most of the damaged
files (69%) were also size 10, while 21% were size 15
(Table 3).
Practically all separation and damage occurred while
filing canals in posterior teeth: 16% occurred in premolars and 76% occurred in molars (Table 4). It was
not possible to determine when the damage occurred
6% of the time.
Students identified only one-fourth of the files that
separated (Table 5). The number of files turned in per
student ranged from 1 to 11. The mean number of KFlex files turned in per student was 5.7 while the mean
for Unitek was 5.13. The Mann-Whitney U-test showed
TABLE 1. Separated and damaged files
File
Type

Separated Files

Separated or
Damaged Files

No.

No.

No.

12
11

52
48

45
30

60
40

57
41

58
42

23
100
x 2 = 0.17979
p > 0.05

75

100

98

100

K-Flex
Unitek
Total

Damaged Files

TABLE 2. Separated file sizes

FiG 1. Types of files: top, Unitek; middle, Union Broach; bottom, KFlex.

Size
10
15
20
Total

K-Flex

Unitek

Total

11
0
1

55
0
100

9
2
0

45
100
0

20
2
1

87
9
4

12
52
x 2 = 3.1625
p > 0.05

11

48

23

100

TABLE 3. Damaged file sizes

Size
10
15
20
25
30
35
FIG 2. A, Damaged files: unraveled flutes at arrowheads. Top, Unitek;
bottom, K-Flex. B, Separated files: fracture sites at arrows. Top,
Unitek; bottom, K-Flex.

Total

K-Flex

Unitek

Total

33
9
0
2
0
1

63
56
0
100
0
100

19
7
2
0
2
0

37
44
100
0
100
0

52
16
2
2
2
1

69
21
3
3
3
1

30

40

75

100

45
60
x 2 = 8.35337
p > 0.05

File Damage

Vol. 10, No. 2, February 1984

47

TABLE 4. Types of teeth in which separation or damage occurred

Teeth

No. Separated

No. Damaged

Anterior
Premolars
Molars
Unknown

0
5
13
5

0
31
18
83

2
11
61
1

Total

23

23.5

75

In this study most file damage occurred while filing

canals in posterior teeth. Only two files were damaged
in anterior canals, and none separated. The other 96
files were broken or damaged while filing canals in
posterior teeth.
Of the size 10 files that were damaged, 63% were
K-Flex (Table 3). Although not statistically significant,
there seemed to be a tendency for the tips of these
files to double back. Perhaps the decrease in the width
of the blank (1) or fewer flutes per millimeter (3) allows
the tips of these files to double back and deform easily
(Fig. 2).
While checking the used files for damage, the examiners discovered many separated files that students
had previously described only as damaged. Prior to
turning in the files, the students wrote on coin envelopes whether the files were damaged or separated.
Apparently they had difficulty identifying separated files.
Perhaps this could have been avoided if they had
continuously measured their files during canal preparation. Frequent measurement of the entire file length
constitutes a sound clinical practice. Perhaps the study
would have had more validity if the examiners would
have observed all of the files used by the students and
not just the ones that they thought were damaged. If
the exact number of files used by each student would
have been recorded, parametric data analysis could
have been used.
Unitek file damage and separation in this laboratory
has been low for several years when compared with
previous damage rates when conventional files were
used with rotary motions. This has occurred despite
using many teeth with calcified and/or severely curved
canals and even though the files were being used by
Students for the first time. Students are encouraged to
find extracted teeth with few calcifications and fairly
straight canals but this is not always possible. The low
damage rate may be due to less chance for damage
Using only filing motions (6). It would be interesting to
COmpare the damage rate between filing motions and
rotary motions in this same laboratory using the new
types of files.

Total No. Separated or

Damaged

2
16
74
6

2
16
76
6

98

100

100
69
82
17
76.5

TABLE 5. Separated files

no statistical difference between the two groups (twotailed p = 0.8576).

DISCUSSION

No.

Student identified
Instructor identified

6
17

26
74

Total

23

100

In this study no files larger than size 20 separated

and no files larger than size 35 were damaged.
SUMMARY

The root canals of 126 extracted human teeth were

prepared with filing motions by 18 sophomore dental
students. Part of them used Unitek files (controls) and
part of them used K-Flex files (experimental). The used
files were evaluated for damage or separation by two
endodontists. The rate of damage or separation was
low (98 files). One file was damaged or separated for
every 0.92 posterior teeth that were filed, while one file
separated for every 3.91 posterior teeth. The mean
number of separated or damaged files per student in
the K-Flex group was 5.7 while the mean for the Unitek
group was 5.13. There was no statistical difference
between the two groups. Most of the damage and
separation occurred while filing root canals of posterior
teeth with #10 files. Of the files that separated, 52%
were K-Flex and 48% were Unitek, while 60% of the
damaged files were K-Flex. There was no statistical
difference between the rate of separation or damage
between the two types of files. Students identified only
one-fourth of the files that separated.
Dr. Montgomery is associate professor, Dr. Canales is assistant professor,
and Dr. del Rio is professor and chairman, Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX.

References
1. Weine FS. Endodontic therapy. 3rd ed. St. Louis: CV Mosby, 1982:259.
2. Felt RA, Moser JB, Heuer MA. Flute design of endodontic instruments:
its influence on cutting efficiency. J Endodon 1982;8:253-9.
3. Dolan DW, Craig RG. Bending and torsion of endodontic files with
rhombus cross sections. J Endodon 1982;8:260-4.
4. Weine FS. Endodontic therapy. 3rd ed. St. Louis: CV Mosby, 1982:266.
5. del Rio CE, Canales ML. A sophomore pre-clinical laboratory course
manual. San Antonio: The University of Texas Health Science Center, 1982:4952.
6. Cohen S, Burns RC (ed.). Pathways of the pulp. 2rid ed. St. Louis: CV
Mosby, 1980:673.