ENDODONTIC INSTRUMENTS

Dr. soliman M. Kamha

Sol_kamha@hotmail.com
Soliman.kamha@pua.edu.eg


1- Endodontic explorer
Double ended instrument with tapered tines at right or obtuse
angle.

This facilitates location of canal orifices

They are very stiff should not be inserted into canals or used for
condensing gutta-percha.
Should never be heated.

A small, curve probe, It is used to probe the walls of the access

cavity for the presence of over-hangings. Ardines’ probes 3 are
also useful for this purpose.


2- Pulp tester:

This device is used to evaluate the pulp vitality.

3- Tooth slooth:
It is used for diagnosing various
stages of incomplete crown
fractures (cracks).
It is designed in such a way that
chewing force can be applied
selectively on one cusp at a time.

4- Transillumination
By placing a high-intensity light source on the tooth surface, a
root fracture can be observed.Access cavity is viewed with
cervical fiber optic transillumination.


 I n s tru m e n ts u s e d fo r a cce s s
o p en in g

D ia m o n d ro s e Ta p er e d fis su re Saf e e n d l on g
ca rb id e bu r s t a p ere d d iam on d E n d o -Z b u r
h ea d b u r s

Various surgical length burs to allow direct vision

Intra – canal preparation instruments

A- Instruments used for pulp tissue

removal:-
1- Nerve broaches:

a- Smooth broach (path finder).

b- Barbed broach.
2- Endodontic excavator.


B- Instruments used for root canal
preparation:-

1- Reamers 2- Files

Intra-canal instruments used for canal

preparation may be classified into:
A) Hand – operated instruments:
(nerve broaches, reamers & files)
B) Engine driven instruments:
(engine driven reamers & files, Gates-glidden drills, peeso
reamers, constant & greater taper and protaper).
C) Ultrasonic & sonic instruments.


According to the material of which R C instruments are
made, we have 3 materials:
•Carbon steel, it is not used now because of its liability to
corrosion.
•Stainless steel, it is more resistant to corrosion but it has
limited flexibility.
•Nickel-titanium, it is more flexible & is more adaptable to
canal curves (3 times as flexible as st.st. with very low
modules of elasticity)

Physical properties of files:

To debride a region of the canal space completely, the

instruments must contact and plane all the walls.

Despite continual improvement in design, and physical

properties, there are still no instruments that produce
complete cleaning & shaping of all root canal spaces.
Irregular canal spaces do not correspond to and cannot
always be well prepared by an instrument with a regular
(round) shape.

Flexibility, sharpness, corrosion & fracture resistance are all

important physical properties required for endodontic instruments.
1- A flexible instrument would go in curved canals with less
transportation than a non flexible one.
2- A Sharp instrument would debride canal walls more efficient
than a dull one.
3- Corrosion resistance reduce the risk of fracture & allows the
instrument to be used more than once.
4- Fracture resistance will cause less instrument separation
when the instrument is twisted


Factors Affecting Flexibility
- Instrument cross sectional shape
- Number of flutes
- Work hardening
- Material
- Size

Effect of cross sectional shape and flutes number On

flexibility.

By changing the cross-sectional design from square to

triangular or rhomboid & decreasing the number of flutes
per millimeter, greater flexibility is gained.

Work Hardening:
Work hardening is a function of size, shape and
tightness twists i.e.:
1. For the same shape and amount of twists the larger
the instrument the greater the work hardening.
2. A square shafted instrument due to it’s greater bulk
at the extremities will have greater work hardening than a
triangular instrument.
3. The tighter the twists the greater the work hardening
induced [i.e. Reamers have ½ No. of flutes of files and ½
work hardening.


Effect of material on flexibility

Blank nickel-titanium wire is more flexible than st.st. It posses a

modulus of elasticity that is 1/4 -1/5 that of st.st. & has a wide
range of elastic deformation.

Advantage:
Increased flexibility is that a file may follow the canal curvature
with less deformation of the curve during enlargement.

Disadvantage:
 Less control in negotiating tiny canals
 Inability to pre-curve the file for introduction into canals of
posterior teeth when there is a decreased inter occlusal
opening.
 Cutting efficiency may be reduced compared to stainless
steel due to the greater elasticity.
 Thus to benefit from nickel-titanium, (passive
instrumentation) may have to be substituted for more
aggressive use, including engine-driven configurations.

Standardization:

This includes:
1. length
2. sizing
3. tip design
4. torsional limits
5. color coding

1. Lengths:
File & reamer lengths are available in 3 shaft
lengths 21, 25, 31 mm.
Shorter instruments offer improved operator
control and easier access to posterior teeth, to
which limited opening impairs, access.
Longer roots are served by 31 mm instruments
2. Sizing:

Dimensions of standardized files & reamers are

designated according to the diameters of the instrument
at specified positions along its length.

File tip diameter (D 0) increases in 0.05 mm

increments up to size 60 file (0.60mm at the
tip), then by 0.10 mm increments up to size 140.
15,20,25……60,70,80……140

The spiral cutting edge of the instrument (blade) must be at least

16mm long.
The diameter at this point is called (D 16).
File diameter increases at a rate of 0.02mm per running mm of
length (2% constant taper).

3. Tip design:
Tip angle of K-type files & reamers is 75O +
or – 15O
New instruments have different tip angles &
designs to minimize canal alterations.
Non cutting tips guide the file through the curve rather than cut
the outer canal wall.

4. Torsional limits:
 It is the amount of rotational torque that can be applied to a
locked instrument to the point of failure (separation).
 Instruments should have sufficient strength to be rotated and
worked vigorously without separation.

5. Color coding:
color coding of file handles indicates size as follows
Size D0 D 16 Handle color code

06 0.06 0.38 Pink

08 0.08 0.40 Gray

10 0.10 0.42 Purple

15 0.15 0.47 White

20 0.20 0.52 Yellow

25 0.25 0.57 Red

30 0.30 0.62 Blue

35 0.35 0.67 Green

40 0.40 0.72 Black


 Size D0 D 16 Handle color code

45 0.45 0.77 White

50 0.50 0.82 Yellow

55 0.55 0.87 Red

60 0.60 0.92 Blue

70 0.70 1.02 Green

80 0.80 1.12 Black

90 0.90 1.22 White

100 1.00 1.32 Yellow

110 1.10 1.42 Red

120 1.20 1.52 Blue

130 1.30 1.62 Green

140 1.40 1.72 Black

- Original recommendation for standardized instruments. Cutting

blades 16 mm in length are of the same size and numbers as
standardized filling points.
- Instruments number is determined by diameter size at D0 in
hundreds of a millimeter.
- Diameter at D16 is uniformly 0.32 mm greater than D0
- Standardized dimensions of root canal files and reamers
established by ISO. Two modifications from Ingle’s original
proposal are an additional measurement at D3, 3mm from D0


and specification for shapes of tip-75°, plus or minus 15°.

- Taper of the spiral section is at 0.02mm gain for each mm of

cutting length.

Intermediate File Sizes:

The temptation to force larger instruments into canals may be

avoided, and a smoother progress through file sizes achieved, by
creating intermediate files as described by Weine, who
suggested trimming 1mm from the tip of the file and rounding off
sharp edges on a diamond nail file. In this way, files sizes 10, 15,
20 & 25 may be converted to sizes 12, 17, 22 & 27. the
disadvantages of this technique are that the files are made
disposable & the edges may be difficult to smooth, which
therefore creates ledges during filing.

Intermediate File Sizes: (Golden medium)

Recent innovations overcome these problems

using “Golden Medium” intermediate files.

Reamers & files:

According to the method of manufacturing, we have either
A) Ground twisted or B) Machined files


The ground twisted instruments include:
K-type reamer K-type file
K-flex file Flexofile
Names Cross section Type of motion
Names Twisting and Cross
pullingsection Type of motion
reaming action
K-reamer stainless
Twistingsteel blank
and pulling reaming action
i.e. rotation &
K-reamertriangular
stainlessor square
steel blank
i.e. rotation &
triangular or square
in cross – section. passive withdrawal
in cross – section. passive withdrawal
Twisting square or
Twisting square or
K-file triangular cross section
K-file st.triangular
st. st.
blank
cross section
st. blankwith
with Passive “widdling”
2.52.5
twists
twistsper
permm.
mm.
Passive “widdling”
motion
motion
Twisting and
Twisting andpulling
pulling aa
rhomboidal
rhomboidal cross
cross section
section Rotated
Rotated (1/4(1/4
turn)turn)
and and
K-flex
K-flex filefile st. st. blank. It has
st. st. blank. It has withdraw
withdrawn n ag aiag nst
ai nst
moremore flexibility&&more
flexibility more
d iff erent portion
d ifferent portion
cutting efficiency.
cutting efficiency. o f the ca na l w a ll
o f the ca na l wa ll
(circumferential filling)
(circumferential filling)
Twisted from a st st blank of
Twisted
Flexofile triangularfromcross
a stsection
st blank of
with
1.81 flutes
triangular per section
cross mm. the with
tip is
Flexofile
1.81modified
flutes perto bemm.
non-cutting.
the tip is
modified to be non-cutting.


Those instruments are made from a st st wire that is 1st ground to
a tapered triangle, square, or rhomboid cross section, then it is
twisted to generate the instrument.

The machined files include:

Hedstrom file( H-file )
Names
Shape and function

Manufactured from round tapered st st wire.
Hedstrom File
Spiral groove is cut into the shank producing
(H-file) sharp blades aggressive in pull stroke.

Cutting Edges contact dentin at almost 90°

May break if rotated.

Bulk of metal does not extend to the edges
of the file but is a central core.

Flexible & strong only as the central core
so it is [easy to fracture].

Modification of the H-file where one side

of the file (the flutes) are ground
Safety Hedstrom
flat along its length.
Files

Cross section: rounded with
one flat side used for
anti-curvature filing.

Names Shape and function

Almost identical in appearance to H files.

“S” files Has a double helix ground into the shaft.

(S shape) The flutes are not as deep into the shaft
as H files leaving more bulk in the shaft.
Depth of flutes increases from the tip to the
handle.
manufactured similar to “H” & unifiles. It has
3 cutting blades:
In appearance it resembles a reamer.
Helifile It has greater cutting efficiency & flexibility

It is machined from triangular blank
resembles a twisted instrument in shape.

It has increased stiffness and strength
Flex R File in small sizes and increased flexibility in
larger sizes.

It has modified safe-ended tip.


“K” Type Files and Reamer: [Ground Twisted]
- Introduction by Kerr in 1901.
- “K” type instruments are stiffer than other instruments due to
their mode of manufacturing [Twisting and Pulling] as:
• Grain structure of the wire is preserved.
• The entire bulk of metal makes up the blade with it’s
cutting edges.
A- Ground twisted instruments:
i- K-type instruments:
K-type file & reamer (Kerr manufacturing company): are the
oldest instruments used for canal preparation.

K-reamer:

Manufactured by twisting and pulling stainless steel blank

triangular or square in cross – section. Used in a reaming action
i.e. rotation & passive withdrawal. Cuts during rotation in clockwise
direction. A reamer has less number of flutes per mm compared
to a file

ii) K-file:

Manufactured by twisting square or triangular cross section st. st.

blank with 2.5 twists per mm.
Advanced to full canal length using passive “widdling” motion
Next it is rotated (1/4 turn) and withdrawn against canal walls
 Motions are repeated with file kept against a different portion of
the canal wall (circumferential filling)

iii) K-flex file:

manufactured by twisting and pulling a rhomboidal cross section
st. st. blank. It has more flexibility & more cutting efficiency. It has
alternating deep & shallow flutes.


iv) Flexofile:
This is a flexible instrument twisted from a st st blank of triangular
cross section with 1.81 flutes per mm. the tip is modified to be
non-cutting.

Hedstrom file K-type file K-type reamer

( H-file )

B- Machined Files

1) Hedstrom File (H-file):

Cutting Edges contact dentin at almost 90° Manufactured from
round tapered st st wire. Spiral groove is cut into the shank
producing sharp blades. Aggressive in pull stroke. May break if
rotated. Bulk of metal does not extend to the edges of the file but
is a central core. Flexible & strong only as the central core is
[easy to fracture].

2) Safety Hedstrom Files:

Modification of the H-file where one side of the file (the flutes) are
ground flat along its length. Cross section: rounded with one flat
side used for anti-curvature filing.


3) “S” files (S shape):

Almost identical in appearance to H files. Has a double helix

ground into the shaft.The flutes are not as deep into the shaft as
H files leaving more bulk in the shaft. Depth of flutes increases
from the tip to the handle.

i.e. : shallower flutes at the tip

Greater bulk at the shaft and

more strength

Deeper flutes at the

handle

Less bulk and better flexibility

Itis more resistant to fracture than “H” files.

Can be used in rotation or filing motions

N .B .
W ith th e “S ” file : c u ttin g is m o s t
e ffic ie n t in p u ll s tro k e s , h o w e v e r
its d e s ig n a llo w s fo r c u ttin g b y
ro ta tio n a s w e ll.

T h e m a n u fa c tu re r re c o m m e n d s
re a m in g fo r a p ic a l p re p a n d filin g
fo r c o ro n a l fla rin g


4) Helifile:
manufactured similar to “H” & unifiles. It has 3 cutting blades:
In appearance it resembles a reamer.
It has greater cutting efficiency & flexibility
5) The Flex R File:

It is machined from triangular blank resembles a twisted

instrument in shape.

It has increased stiffness and strength in small sizes and

increased flexibility in larger sizes.

It has modified safe-ended tip.

Engine – Driven Instruments

1-Engine driven files & reamers

-Has a latch type handle.
-Used on special hand pieces that provide ½ or ¼ rotation and
slight up and down movement [Giromatic]
-Difficult to control & created irregular, poorly debrided preps.
particularly in curved canals.
-Generates large amount of debris that was packed apically.


2) Gates – Glidden Drills:
Sizes:
From 1 to 6
No. 1 = file # 50
No. 2 = file # 70
No. 6 = file # 150
15 or 19 mm long

Uses:
• Achieve straight line access by reaming dentin shelf.
• Flaring of occlusal and middle canal third [not beyond the
curvature]
• Remove G.P. & drill post space.
• Used from small to large sizes (step back) or large then
smaller size (crown-down)

N.B.
• It should not be used with pressure.
• The instrument is designed to break high in the shank to
facilitate its removal upon breakage as the broken part will
protrudes outside the canal.

3) Peeso Reamers:

Used for canal prep. [like G.G drills]. Parallel rather

than elliptical shape.
Sizes:
From 1 to 6
No. 1 = file # 70
No. 2 = file # 90
No. 6 = file # 170
Available with and without a safe tip.
Not as well control as G.G drills.

Disadvantages of G.G drills & peeso reamers:

They are both aggressive and might rapidly over prepare the
canal or cause perforations if used incorrectly.

Engine driven Nickel-Titanium instruments

These are rotary instruments enhance the ability of the operator

to shape the canal uniformly with less transportation and ledging
due to their high flexibility.

1- Constant taper Nickel-Titanum files

.02, .04, and .06 tapered

2. Greater taper files

They have greater taper 8% & 10% & 12% and used to complete the
profile series so that all canal flaring is done with these files,
instead of using Gates-Glidden drill to flare the preparation.


3. Protaper files
Protaper files are Multiple & progressively tapered, nickel titanium
,rotary files. from 2 % -19% ( different taper in the same file ).
It also serves clinically to improve flexibility, cutting efficiency &
reduce the number of recapitulations needed to achieve length,
specially in tight or more curved canals.

Instruments used for Obturation

1. Lentulo Spirals (paste fillers)

- Rotated in clock wise direction after being introduced
in the canal.
- It is removed from the canal while still rotating.
- Care must be taken as not to extrude material to the
apex.
Types:
• Coiled wire most liable to break.
• Twisted blade less prone to fracture.
• Coiled wire with safety devise the handle has a tight coil
near the shaft so it will break high up for ease of removal.

2. Root canal spreaders

Used for lateral condensation [pointed end].
• Handled spreaders [stiff].
• Finger spreaders :
• Standardized.
• Conventional.[flexible]


3) Root canal pluggers

Used for vertical condensation technique [flat end].

Are handled or finger type.

4) Heat carriers:

Hand instruments used to carry heat to gutta

percha in the canal.
Used for vertical & warm lateral condensations.

New devices were developed to heat soften

the gutta-percha electrically and condense it in
the canal.
Examples:
- Touch’ N Heat device
- Endotec device
Where the same tip is used for heating and condensation.

5) Thermo-mechanical compactors:
[McSpadden Compactor] are engine driven with
flutes that resemble inverted “H” file.
Mechanism: Frictional heat softens G.P. in the
canal and compact G.P. by its flutes.
Disadvantages.
- possible over heating. - breakage in the canal.


6) Ultrasonic Spreaders:
Resemble regular spreaders but are mounted on an ultrasonic
unit. The vibrating spreader thermo-mechanically softens G.P.
and is used for warm lateral condensation

Sonic & Ultrasonic Instruments

Ultrasonic:
Frequency 25 – 30 KHz use “K” files and diamonds
(Peizo ultrasonic system).
Sonic:
Frequency 2 – 3 KHz use special instruments as Rispi
sonic, shaper file, Heliosonic.
Ultra Sonic Instruments
• Ultrasonic files are attached to the hand piece used for
canal preparation.
• Ultrasonic R.C. diamonds for canal flaring.
• Ultrasonic R.C. spreaders used for thermo-mechanical
condensation of G.P

Other uses of endosonics:

In addition to the use of endosonic files to clean and shape the

root canals, they play valuable roles in:
1. Access refinement (canal location and identification).
2. Root canal retreatment (fractured instruments, silver points , or
posts).
3. Apical surgery (access to the root ends).


 V. Miscellaneous Instruments

1) Devices for R.C. length measurement

[Electronic apex locators]
 Traditionally, root canal measurements depend on
radiograph.
 However, electric devices have been developed that the
apical foramen could be localized with the use of an electric
current.
 A lip clip is attached to the patient’s lip, and another
electrode is attached to the file.
 When the apex is reached, a different beep is heard and
a light illuminates in the device indicating apex.
 Sunada(1962) considered electrical resistance between
the mucosa and PDL to be constant.
 Resistance is similar as the measuring probe reaches the
PDL through the canal.
 Electric resistance when a metal instrument reaches the
apex was consistently 6.50 ohm


2) Endodontic locking tweezers:
Allows easy handling of materials as paper points, gutta-percha
etc. in 4 handed transfers.

3) Endodontic Rulers:
For file length measurements. They have different designs and
should be autoclavable for sterilization and infection control.

4) Irrigation syringes

For introduction of the irrigation solution inside the root canal.

The needle should have many designs that would not allow the
irrigating solution to be forced apically.


5) Paper points:
Come in standardized sizes used for
drying, carrying medication or taking
cultures.

6) Length stops:

Rubber or silicon stops.

Metal stops.

Test handles
It is an adjustable handle that can be moved on the
instrument shaft and locked at a specific length.

Pastes, zinc oxide petroleum jelly rubber dam material
were used to place marks on the file.
N.B.
When placing a stop on the instrument, it is important to avoid
angulations of the stopper ,which might measure different lengths
as the file is rotated.

7) Laser Endodontics

Three main areas in endodontics for the use of lasers:

(1) the periapex,
(2) the root canal system, and
(3) hard tissue, mainly the dentin.



Attempt to retroseal the apical orifice of the root canal using
an
Nd:YAG and
a carbon-dioxide laser.

8) Rubber dam
Device utilized to isolate the tooth under treatment from the oral
environment to prevent contamination and aspiration or
swallowing of instruments by the patient.

9) Magnifying Devices

Access and visibility are severely limited by the nature of the

irregular and branching canal spaces within the roots.
Enhanced lighting and magnification have resolved visual access
problems to some extent.

10) Endodontic file organizer ( endo-box )

Organizing files according to size and length

through holes vertically in a sponge which
sometimes be saturated with a
disinfectant solution that maintains instrument
sterility.


11) Transfer sponge

A sponge in a glass or plastic dish soaked A special storage and measuring device is
with alcohol is ideal for organizing, cleaning, conveniently fit on the index finger.
storing files and Gates-Glidden burs during

the appointment.

Motions of Endodontic Instruments ( reamers and files )

Several motions are useful for cleaning and shaping of root canal
walls.

The motions of manipulation useful for generating or controlling

the cutting activity of endodontic files which include:
1) Reaming
2) Filing
3) Combined reaming and filing
4) Watch-winding
5) Balanced force


 Motions Description

An instrument is rotated in a clockwise direction and

withdrawn passively from the canal without applying
any pressure on the canal walls.
Reaming It is used in the apical part of the canal to produce a
circular cross section that match the cross section of
gutta-percha points.
An instrument is used in and out of the canal
applying pressure in the canal wall during the out
Filing stroke.
All types of files can be used in such motion with
care when applying pressure on the labial, palatal,
mesial and distal walls and on all the line angles.
An instrument is rotated in a clockwise direction and
Combined withdrawn while applying pressure in the canal wall
reaming during the out stroke.
and
filing

Motions Description

The instrument is rotated ¼ turn in a

clockwise direction, then rotated 1/2 turn in
Watch- an anti-clockwise direction.
winding This motion tend to keep the file centralized
inside the canal with less possibility to
cause deviation or change in canal shape
may with pull.

Balanced The instrument is rotated ¼ turn in a

force clockwise direction, then rotated 1/2 turn in
an anti-clockwise direction with apical
pressure.
There evidence that using flex-R file in such
motion is the best method to keep the file
cen tral ize d in th e ca nal wi th mi n imu m
deviation or transportation

1) Reaming motion
An instrument is rotated in a clockwise direction and withdrawn
passively from the canal without applying any pressure on the
canal walls.
It is used in the apical part of the canal to produce a circular cross
section that match the cross section of gutta-percha points.

2) Filing motion

An instrument is used in and out of the canal applying pressure in

the canal wall during the out stroke.
All types of files can be used in such motion with care when
applying pressure on the labial, palatal, mesial and distal walls
and on all the line angles.

3) Combined reaming and filing

An instrument is rotated in a clockwise direction and withdrawn

while applying pressure in the canal wall during the out stroke.

4) Watch-winding

The instrument is rotated ¼ turn in a clockwise direction, then

rotated 1/2 turn in an anti-clockwise direction.
This motion tend to keep the file centralized inside the canal with
less possibility to cause deviation or change in canal shape may
with pull.


5) Balanced force

The instrument is rotated ¼ turn in a clockwise direction, then

rotated 1/2 turn in an anti-clockwise direction with apical
pressure.
There evidence that using flex-R file in such motion is the best
method to keep the file centralized in
the canal with minimum
deviation or transportation.

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