Endodontic Instruments

Dr AREEJ ELORFY
BDS, Benghazi ,Libya
MDS in endodontics, Cairo university
Lecturer at Department of conservative dentistry and endodontics Benghazi
university
 CONTENT

• INTRODUCTION
• Classification of instruments and devices
• STORAGE AND STERILIZATION OF E
NDODONTIC INSTRUMENTS
 INTRODUCTION
• Using the correct instrument for each step is a basic rule for success

and prevention of procedural errors.

• Released onto the market, often promising simpler, quicker and better

results, the hope is that it will allow the management of even the most

challenging cases.
 Classification of instruments and devices according to
• BASED ON FUNCTION sequence of use:

I. Diagnostic instruments
[Link] used during access preparation
[Link] instruments
[Link] instruments
[Link] canal enlarging instruments
[Link] materials, instruments and devices
[Link]
[Link] instruments
1-Basic instruments 2- Specialized devices
“BASIC INSTRUMENT PACK”
[Link] aids.
• Mouth Mirror
[Link] testing.
• Explorer
C. Radiographs
• Cotton Pliers
• Periodontal Probe
 [Link] instruments

• MOUTH MIRROR,
FUNCTION: To view tissues of the oral cavity and reflect light for better visibility
FEATURES: Front surface or plane reflective surface.
Mirror sizes #2–#5
Magnifying and double-sided also available
Reusable handles in cone socket or simple stem design
CLINICAL APPLICATION: Also used to retract and protect tongue and cheek
EXPLORER
FUNCTION: To examine tooth surfaces

for caries, calculus, or defects using

sense of touch (tactile)
FEATURES: Thin, sharp working end

comes in different designs. Common styles are the #1, 2 (pigtail), 11/12, 17, and 23
(Shepard’s hook) .May be single- or double-ended (different design on each side)
CLINICAL APPLICATION: Also used to:

• Check fit of margins of restorations

• Evaluate root surfaces and furcation area
• Remove excess material or cement from restoration
DG 16

DG 16/23
COTTON PLIERS
FUNCTION: To place and remove small objects from the oral cavity.

FEATURES: Serrated or non-serrated beaks, locking or non-locking handles

CLINICAL APPLICATION: Also used to retrieve materials from drawers and

containers to avoid cross-contamination

PERIODONTAL PROBE
FUNCTION: To measure depth of gingival sulcus

CLINICAL APPLICATION: Also used to measure gingival recession

 Note
 Other materials usually
required are isolation materials:
• gauze
• cotton rolls
• a rubber dam
• cotton pellets
• Occlusion paper
• Evacuation devices
(high speed and saliva ejector)
 2- Specialized devices
A- Visual aids:

1-Magnifying loups(2-6X)

3-Transilliumination

2-Surgical microscope(2-20X)
B- Pulp testing I- Sensitivity tests:
1- thermal test
II- vitality test: A- cold test
A- laser Doppler flowmetry B-hot test
B-pulp oximetry 2-electric pulp tester
C- Radiographs:
1- Plain radiograph
2- Digital radiograph
3-Cone beam computed tomograp
hy CBCT)
INSTRUMENTS FOR ACCESS CAVITY PREPARATION
The first stage of root canal treatment is to gain entry into
the pulp chamber.
Friction grip burs
Friction grip tapered or cylindrical fissure burs, IS
O 010 or ISO 012, are used in the initial stages of
access preparation to establish the correct
outline form. For penetrating ceramic or
Composite materials, diamond-coated burs are
needed.
Care should be taken when they are used
not to cut on to the floor of the
pulp chamber.
No. 557 carbide, Great White, Beaver bur, Transmetal, Multipurpose bur
Round burs”rose head round bur”

Round burs, normal and extra-long, sizes ISO 010, 014

and 018, in a contra-angle handpiece are used to lift the

roof off the pulp chamber and eliminate overhanging

Dentine.
Safe-ended burs
Following initial access to the pulp space, a safe-
ended or non-cutting tip, tapered diamond or tung
sten-carbide bur (e.g. Endo Z bur, Dentsply Maillefer,
Ballaigues, Switzerland) can be used to remove the
entire roof of the pulp chamber. The non-cutting
tip prevents ‘gouging’ of the pulpal floor.

Endo Z bur, and Endo Access bur.

 .

Gates – Glidden Drills

The Gates-Glidden bur has a cutting bulb and a pilot-tip mounted on long thin
shaft attached to A latch type shank operated at low-speed
• Due to their design, gates-glidden drills are
Side cutting instruments with safety tips
• Gates-gliddens are available in A set from 1 to 6 with
the diameters from 0.5 to 1.5 mm.
• They are also available in different lengths, a
standard 32 mm, a shorter 24 mm and a longer 36 mm.
TO BE NOTED
• 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..
Uses of Gates-Glidden drills
used for coronal root canal enlargement but there is
a risk of furcal perforation in mandibular molars;6
they have largely been superseded by rotary nickel-
titanium instruments
for this purpose. In retreatment cases,
Gates-Glidden burs may also be used to remove
gutta-percha in the coronal part of the root canal,
Mueller burs have a round cutting head attached to

a Long shank. The long shank is not designed to drill

deep into the root, but rather to extend

the head of the slow-speed handpiece

away from the tooth and permit better visibility.

PulpOut Bur
The bur is a friction-grip #4 round carbide
with a plastic stop fixed at 7 mm. ""critical
depth"" from the
cusp tip to the pulp chamber that
allows access without perforation
PulpOut Bur is a diamond shaper
bur for widening of the access
opening. The diamond is non-end
cutting
• Endo excavator:

• "larger than conventional excavator"

• its shape allows curettage of the pulp chamber when conventional
one will not reach the floor of the chamber
• used as surgical aid to excavate periapical
lesion.
 III- Exploring instruments
Endodontic Explorers : These instruments are very stiff and
should not be inserted into canals. Explorers should never
be heated. This double ended instrument with long tapered
tines is designed to facilitates the location of canal orifice.
Micro-opener &micro debrider
Ultrasonic tips
 IV- Extirpating instruments

• Barbed broach
• Machined from soft steel
• have numerous hooks as part of the blade
• It should fit loosely inside the canal
• The B.B must only be used in the straight part of the canal, wide canals
• Insertion…….quarter rotation……gentle pull
Functions
• Used to remove the intact pulp
• ‘Barbs’ on the broach snag the pulp to facilitate removal
.Retrieve a paper point or cotton pellet trapped in the canal
 V- Root canal enlarging instruments
 Hand driven instruments
 Modified instruments design
 Engine driven enlarging instruments
Classifications:
o According to ISO:
Group I: Hand driven instruments (broaches, files, reamers).
Group II: Engine driven (low speed HP) o According to power delivered :
Group III: Engine driven ( GG- PR) • Hand powered
• Engine driven
Group VI: filling materials
o According to material of construction: o According to method of manufacturing
• Counterclockwise twisting
• Carbon steel
• Machine grinding
• Stainless steel
• Diamond coated points( S& US)
• Nickle titanium
 • Standardization of Instruments
In [Link] established a logical nomenclature for the standardization of root
canal instruments, so all manufacturers could conform to length ,width, and taper i
n specific standards. The international standard organization (ISO) further
developed the system.
Landmarks of standard instruments
i. Length of the instrument
ii. Numbering of the instruments
iii. Incremental increase in size
iv. Color coding
v. Instrument taper
vi. Tip angle
 i. Length of the instrument

• 4 shaft lengths 21,25,28 & 31 mm. Shorter instruments offer improved operator
control & easier access to posterior teeth, to which limited mouth opening impairs
access. Longer roots, such as canines, are served by 31 mm instruments.
• The length of instrument blade is to be 16 mm, the rest of the blade has
no flutes
 ii- Numbering of the instruments

• The instruments are available in sizes 6 to 140 .Each number represent diameter of
instrument in 100th of millimeter at the tip.
• File tip diameters increase in 0.05-mm increments up to size 60 files (0.60 mm at D
0), and then by 0.10-mm increments up to size 140.
• For example, instrument No. 25 has a diameter at D0 =25/100 = 0.25 mm.
 iii- Color coding”6”

• Instrument handles should be color coded

for their easier recognition ( white, yellow,
red, blue, green, black) and repeated up to
instrument no 140.

• In addition, no 6 is Pink, no 8 is gray,

and no10 is purple
 Iv- Incremental increase in size

• Size 6, 8,10 ,
Incremental increase by 0.02 mm
• In small files 10- 60 ,
Incremental increase by 0.05 mm
• In large files 60 -140 ,
Incremental increase by 0.1 mm
 V _Instrument taper

• Taper can be defined as the rate of change of cross-sectional diameter

• The file diameter increases at a standard rate 0.02mm/mm Starting at D0 ,this m
eans that the difference in diameter between D0 and D16 regardless the instru
ment size is always 32mm ( 0.02 X 16= 0.32 ).
• E.g. in file size 15, the tip diameter (D0) =0.15, the diameter at 1 mm from the tip
(D1) = 0.15 + 0.02= 0.17, & D 16= 0.15 +0.32 =0.47 and so on.
• Greater taper instruments (0.04, 0.06, 0.08, 0.10, 0.12) have also been
made available.
 VI. Tip angle
• Tip angle of an instrument should be 75° ± 15°.

Nowadays ..noncutting tips may involve less engagement of dentin than sharp
tips. The intent is to “guide” the file through the curve rather than cutting only
the outer canal wall.
VII. Torsional limits
It is the amount of rotational torque that can be applied to (locked)
instrument to the point of failure (separation). Obviously an
instrument should have sufficient strength to be rotated & worked
vigorously without separation
Golden mediate intermediate file sizes:

• The temptation to force larger instruments into cana1s may be avoided, and a smoother
progress through file sizes be achieved, by creating, intermediate file sizes.
• DR Weine, 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 such technique are that files are made disposable & the edges
may be difficult to smooth, which therefore creates ledges during preparation of the canal.
A recent innovation by “Maillefer” company overcomes these problem
s using the “golden medium” intermediate files. We will have golden
white (size 17), golden yellow (size 22) ...etc.
 Hand enlarging instruments

• Basic “traditional” • Modified ”hybrid’

1. K-Reamer. I. Changing geometric dime ii. Method of
nsions and designs construction
2. K- file.
1- Change in cross section
3. Hedstroem File (H-file)
2- Depth & angle of blades

3-Tip design

4- Taper modification
1. K-Reamer
• Reamer is K-type instrument (manufactured by Kerr
company), which is used to ream the canals. It cuts by
inserting into the canal, twisting clockwise one quarter to half tur
n and then withdrawing, i.e. penetration, rotation and retraction
.
 instruments can be manufactured by twisting triangular blank
reamer used in shaping the canal
• Reamer has triangular blank and lesser
number of flutes than file
• Number of flutes in reamer are 0.5 to 1/mm, whil
e in file, the flutes are 1.5 to 2.5 /mm
• Though reamer has fewer numbers of flutes
than file, cutting efficiency is same as that of
files because more space between flutes
causes better removal of debris
2- K- file
Its manufactured by twisting a square blank by machine the blank is
twisted into a tighter series of spiral than
reamer also K- file are more flexible than reamer .
• K -Files with a triangular cross-section tend to
have superior cutting characteristics and are more flexibl
e, and hence less likely to transport the canal
during preparation. .

• Mode of Action : filing (push and pull )

Watch-winding motion
3- Hedstroem File (H-file)
• Hedstroem file has flutes which resemble succe
ssively triangles set one on another
• Manufactured by grinding a conical steel wire.
• Cut in one direction – retraction (Cutting while
pulling)
• Cross-section – single helix teardrop
• Very aggressive
Hedstrom File: Recommended use

• can be used both in straight canals and curved canals.

• must always fit loosely in the canal to avoid risk

for fracture.

• Small sizes up to #25 can be used down into full

preparation length while bigger sizes are often used

1 - 3 mm short.

• Useful for removal of Gutta-percha in re-treatment cases

• To remove /retrieve broken instruments

 K-reamer K-file Hedstrom file

Cross-section Triangle Square Comma-shaped

Method of Wire is pulled & twisted By machine grinding

manufacturing ”counter clockwise
Flutes Widely separated Close to one Several cones above each other.
0.5-1flute/mm another
Loose twist 1.5-2.5flute/mm
Flexibility More Less More flexible than k-file or Reamer
Because no work hardening is
induced by machine
BREAKS EASILY
Cutting less More Most aggressive
efficiency
Mode of action Rotational cutting (enter- Universal instrument Filling action only
rotation-retraction) Reaming & filing (push &pull)
Clearance space Large small

Clogging tendency Less More

Use In round canals In oval canals Coronal2l3 &straight canals

Apical part Coronal &Apical part Immature teeth
 Modified instruments design
The preparation of curved canals requires:
• Flexible instrument
• Increased cutting efficiency
• Increased debris loading
• Decreased procedural mishaps
  Modified instruments design
I. Changing geometric dimensions and designs

2- Depth & angle of blades 3-Tip design

1- Change in cross section 1. Safety H file

2. A file 4- Taper modification
1. K-FLEX
2. Flexo File Modified K file
3. Flex-R-file/Roane File
4. S-file &uni file
5. Helifile & Triocut Modified H file

ii. Method of construction

• Modification of K-file + rhombus in cross section
• The two acute angles increase sharpness and cutting efficiency.
• two obtuse angles provide more space for debris removal.
• decrease in contact of instrument with canal walls provide
more space for irrigation.
• Diamond shape …… reduce the diameter …….Increase flexibility.

• Modification of K-file + triangular in cross section

• The acute angles increase cutting efficiency.
• cross section …… reduce the metal size…….Increase flexibility
• Modification of K-file + triangular in cross section,
provides it flexibility to be used in curved canals.
• The noncutting tip enables the instrument to traverse
along the canal rather than gouge into it. reduces procedural accident
s
• It is made up of NiTi
• It is called ‘S’ file because of its cross-sectional shape.
•double helix: doubles the number of cutting edges .
Increased strength but decreased flexibility :less depth of flutes ….great
er bulk at core

3 blades …..more cutting efficincy

 2- Depth & angle of blades

 Safety Hedstroem File

• This file has noncutting safety side along the length o
f the blade which reduces the chances of perforations.

 A file
• Modification of H file
• Steep depth of the flutes ,when used in curved
canals ..collapse of the blades in inner curve ..less aggressive cutting…outer curve ..less zippin
g
 3-Tip design
Non-cutting tip……keeps the file centered and cuts
all circumference evenly ……less risk of transportation.
A-FILE, FLEX-O, FLEX-R

4- Taper modification

Increased taper: 0.04, 0.06……….

More flared prepration
 ii. Method of construction

Manufacturing of Hand Instruments

1. By first grinding graduated sizes of round “piano” wire into various
shapes and then twisting counterclockwise to produce cutting edges.
K-file, K-reamer, K-flex file
2. By grinding spirals into tapered wire rather than twisting, e.g. H-file, safety H
, flex-R and NiTi instruments are machined
  Material of construction

• Kerr manufacturing company was the first to produce files in the early 1990s,
hence the name K-type file and K-type reamer.
• At first, root canal instruments were manufactured from Carbon steel- contain less than 2.
1% of carbon . However chlorine and steam sterilization caused significant corrosion.
They are used only in initial penetration of narrow canals..

C+ File
• it is used for calcified canals.
• It is made up of stainless steel
and has square cross-section.
• The use of Stainless steel instruments (contain 18% chromium, 8-10% nickel, 0.1

2% carbon) improved the quality of the instruments as they where Corrosion res

istant and Stiff in nature, but unfortunately they

were prone to fracture and distortion.

• They are precurved to the desired form to facilitate

insertion in curved canals and used in anti curvature

filling technique
• Recently. Nickel titanium – (contain 55% Ni and 45% Ti) was used to aid maintaining canal s
hape. They are Super elastic, Corrosion resistant, Softer, good resilience, biocompatible and
have the Shape memory property.
• However , they don’t show signs of fatigue before they fracture , Poor cutting efficiency and
Poor resistance to fracture

Stainless steel NiTi

Harder Softer
• High modulus of elasticity( Not flexible) Have low modulus of elasticity (Flexible)

Don't show shape memory Show shape memory

• Don't show elasticity Show super elasticity
• More cutting efficiency Less cutting efficiency
• Gives indication of fracture Fractures without any indication
 Engine – Driven instruments

1- Reciprocating Handpiece
2- low Speed Rotary Instruments.
3- Sonic & Ultrasonic Instruments.
4- Nickel-Titanium Rotary Instruments
Engine Driven Instruments:

1- Reciprocating Handpiece

Commonly used reciprocating hand piece is Giromatic handpiec

e. It rotates with quarter turn motion at 3000 rpm Eg ..Endo-EZE
,
Wave one.

Wave One system

 Note

While using engine driven reciprocating instru

ments, accessibility

to the apical foramen must be made

first with hand instruments.

2- low Speed Rotary Instruments

1-Gates – Glidden Drills

Safe tip (side cutting )

2- Flexogates

• Safe noncutting guiding tip

• Safety design, i.e its breakage point is 16 mm from the tip, so
once fractured, it can be easily retrieved.
• Flexible so used in curved canals.
3. Peeso Reamers
They are rotary instruments used mainly for post space preparations.
• They have safe ended noncutting tip.
• Their tip diameter varies from 0.7 to 1.7 mm.
• They should be used in brushing motion.

Disadvantages
Are aggressive and might rapidly over prepare the
canal or cause perforations if used incorrectly..
3- Sonic & Ultrasonic Instruments :

• Ultrasonic and sonic devices activate an oscillating sinus wave-lik

e fashion in the file with frequency of 25-30KHZ and 2-3 KHZ resp
ectively.
• Ultrasonic devices use regular type of instruments(k-file)whereas
sonic devices use special instruments.
Advantages of sonic and ultrasonic instruments

• Due to constant irrigation, lesser chances of debris extrusion beyond the apex

• Produces clean canals free of smear layer and debris.

• Enhanced action of NaOCl because of increased temperature and ultrasonic energy

Disadvantages
• Walls of prepared canals are rough.

• Chances of transportation are more in curved canals

Uses of Endosonics

1. Access enhancement
2. Orifice location (Locating and opening of calcified root canals)
3. Irrigation
4. Sealer placement
5. Gutta-percha obturation
6. MTA placement
7. Endodontic retreatment(Elimination of root obturation materia
l and Removal of broken instruments)
8. Pulp stone removal.
4- Nickel-Titanium Rotary Instruments
NiTi Rotary Instruments
NiTi was developed by Buchler since 1960. NiTi is also
known as the NiTinol.

Generations of rotary instruments

• First generation : Profiles, Quantec

• Second generation : Profile GT
• Third generation : K3, RACE Protaper
• Fourth generation : V-tape
 gear Reduction handpiece with
torque control

Electric endo motor

VI- Obturation materials, instruments and devices
 Obturation materials:)
• Zinc oxide eugenol
 Gutta Percha as CORE MATERIAL and Root canal sealers: • Calcium hydroxide
• Resin sealers
• Non-soluble, non-irritant points that are condensed into the pulp ch
amber during obturation
• Standardized type: follows same ISO classification as
endodontic files
• Non-standardized: have a greater taper than the standard
ISO type
 Resilone/Epiphany obturation material
Instruments for root canal Filling
1. Root canal spreaders: • Hand spreader

• Finger spreader
Root canal spreaders:
Used for lateral condensation [pointed end]
• Hand spreaders ( stiff )
• Finger spreaders (Flexible )
• Standardized.
 2- Root canal Pluggers:

• Hand Plugger

• Finger Plugger
 • Endodontic Pluggers

• Used for vertical condensation of the

gutta percha

• (Flat end)
 3- Lentulo spirals (paste carriers)

• Small flexible instrument used to place materials into the canal

• Fits into the conventional hand piece
• Use with caution as it can be easily broken
Obturation devices
VII- Miscellaneous
 Endodontic ruler

• Instrument organizer (endodontic kit)

Transfer sponge or Endodontic block •
• ABSORBENT PAPER POINTS:
Slender cones made of paper or other abs
orbent material.
Uses – drying the canal
Conveying medicaments
Obtaining canal cultures
Available in standardized sizes
• Endodontic syringe (Irrigation needles)
 • Electronic Apex Locators

An electronic instrument used to determine the

distance to the apical foramen

87
Mode of Use
A lip clip is attached to the patient’s lip and another electrode is attached to the file.
When the apex is reached, a beep is heard and
a light illuminates in the device indicating the apex.
Electric pulp tester •

Used to test the vitality of a tooth using electric stimulus

• Electric stimulus is increased in small increments until the
patient can feel the stimulus
• Toothpaste or prophy paste is used to conduct the current
from the pulp tester to the tooth

89
Instrument stands and storage systems
• Root canal instruments such as files, unless labelled sterile when supplied, should
be cleaned and sterilized beforehand.
• They may be stored in:
 small boxes with stands ([Link]-Stand or in Pyrex glass test tubes with different
coloured covers for instrument identification .
 Complete sets of instruments can be pre-arranged, sterilized and kept, ready for use.
Metal or plastic boxes with lids, in a variety of sizes are available.
 transparent autoclave bags and laid out on an open plastic tray, with a sponge for files.
 the Endoring II
(A) Plastic tray containing instruments in a
transparent sterile bag; (B) files can be stored an
d sterilized in Pyrex glass test tubes.
 Endoring II, comprising a sponge for
instruments in a plastic holder incorpo
rating a ruler

• Disposable wells for medicaments may be attached to the sponge holder

• a ruler incorporated.
• an autoclavable thermoplastic resin sponge
• Allows easy access to root canal instruments within the operating
field, eliminating the time-consuming action of picking up
instruments from the bracket table.
• Files and other instruments are likely contaminated, even when new.

• Sterilization is recommended prior to initial or subsequent use.

• During endodontic procedures, instruments are exposed to and may

retain blood, soft and hard tissue remnants, and viruses and bacteria and

their byproducts. Therefore, they must be cleaned and disinfected and then sterilized

.
Different sterilization techniques are available

• Cold sterilization “least desirable.

• Steam or chemical autoclave. Instruments that have been wrapped in gauze
should be autoclaved for 20 minutes at 121°C and 15 [Link] kills all bacteria,
spores, and viruses.

• Pressure sterilizers using a chemical rather than water have the advantage
of causing less rusting. However, both steam and chemical autoclaving dull
the edges of all cutting instruments, owing to expansion with heat and
contraction with cooling, resulting in some degree of permanent edge
deformation
 There is some debate as to which method is most effective for sterilizing
endodontic files.

Several papers agree that although cleaning files is difficult, it can be done
effectively with adequate attention
The best protocol would include mechanical, chemical, and ultrasonic cleaning
of instruments.

There is also some debate about whether these instruments can actually be
adequately sterilized between uses; some suggest that they be considered
single-patient use only. Each manufacturer has guidelines for each
instrument type
Certain physical properties of some nickel-titanium rotary files are unaffected by
sterilization processing.
The effects of the disinfection and sterilization processes on some physical properties
have not been tested. Therefore, caution should be exercised when using files in a m
ultiple-use protocol.

current United Kingdom guidelines advising

dentists to ensure that endodontic
files and reamers are treated as single use.