ENDODONTIC

INSTRUMENTS
INTRODUCTION

• Instruments play a very important role in the success of a root

canal treatment therefore a basic knowledge of endodontic
instruments is essential.
• General guidelines exist for root canal preparation, but due to the
complex and varied canal anatomy each case presents unique
challenges.
• A variety of instruments are thus available for this purpose
CLASSIFICATION OF ENDODONTIC
INSTRUMENTS
CLASSIFICATION OF CLEANING AND SHAPING
INSTRUMENTS
CLINICAL CLASSIFICATION
[Link] FOR DIAGNOSIS
DG 16
JW 17
[Link] FOR ACCESS OPENING

6. Endo access burs

[Link] USED FOR CANAL
PREPARATION:
[Link] USED FOR ROOT CANAL
OBTURATION
DIAGNOSTIC TESTS

• In addition to basic examination instruments (mirror, explorer and

tweezer) a number of specialized devices are necessary for
evaluating the status of the teeth and the surrounding tissues.
VISUAL AIDS

Magnification
• Magnifying loops -2.5X.
• Surgical microscopes -2.5-20X together with fiber optic
illumination.
• Operator can work through the eyepiece or a monitor.
VITALITY TESTING

• Clinical assessment of pulp vitality is considered an important

aspect in reaching proper diagnosis.
• This can be achieved by stimulating the neural element or by
measuring the vascular conductance.
[Link] test
[Link] tests
Thermal testing:
• This includes a group of testing agents either cold or hot.
Cold testing:
• Ice - 0 o C
• Ethyl chloride -7 o C
• CO 2 snow -78 o C
Heat testing: Rubber wheel
Hot instrument
Gutta-percha stopping
Electrical Testing:
This includes -devices that deliver a very low electrical current to the enamel
surface through the presence of an electrolyte- Electric pulp tester (EPT).
VASCULAR TESTS
Although the thermal and the electric pulp testers -popular -it is the
testing of the vascular element, which reflects the true vitality of any
tissue rather than its neural supply.
These include :
- Laser doppler flowmetry
- Pulse oximetry
 Laser Doppler Flowmetry

LDF-INFRARED
LIGHT-780-820

infrared light beam –scattered -passes through

the pulp tissue.

The Doppler principle states that the light beam

will be frequency-shifted -moving red blood
cells -remain unshifted as it passes through
static tissue.

The average Doppler frequency shift will

measure the velocity at which the red blood
A diode is used to project an infrared light beam through cells are moving..
the crown and pulp chamber of a tooth
 PULSE
OXIMETRY
designed - measure the oxygen concentration in the blood and
the pulse rate.
works by transmitting two wavelengths of light, red and infrared,
through a translucent portion of a patient’s body (e.g., a finger,
earlobe, or tooth).
Some of the light is absorbed as it passes through the tissue; how
much is absorbed depends on the ratio of oxygenated to
deoxygenated haemoglobin in the blood.
On the opposite side of the targeted tissue, a sensor detects the
absorbed light,

difference between -light emitted and the light received, a microprocessor calculates the pulse rate and
oxygen concentration in the blood.
RADIOGRAPHS
• Root canal therapy relies on accurate radiographs and focuses on minimizing
the amount of radiation the patient is subjected to, different radiographic
devices were introduced in the specialty, which includes: -

• Plain radiography
• Xeroradiography
• CT-Scan / MRI
• Ultrasound
• Cbct
• Radiovisiography (RVG)
EXTIRPATING INSTRUMENTS

Barbed (nerve) Broaches

manufactured -soft removal of intact pulp Because of its weak
steel -series of These incisions are tissue being slowly design (sharp
introduced into the projections), this
extrusive incisions then elevated forming canal, rotated full turn instrument is limited for
along the shaft sharp projections. to entangle the pulp 3 usage in large size
(parallel to the shaft). tissue then withdrawn. canals to avoid fracture.
ENLARGING INSTRUMENTS

Hand-driven enlarging instruments

• K files
• K reamers
• Headstrom files
K FILES AND REAMERS:

• Files -produced -Kerr Manufacturing in the early 1900s, hence the

name K-type file (or K-file) and K-type reamer (K-reamer).
• K-files and K-reamers originally were manufactured -same process.
• The number of sides and the number of spirals determine -filing or
reaming.

Three-sided configuration with Three- or four-sided

fewer spirals is used for configuration with more
reaming; spirals is used for filing
HEADSTROM FILES-H FILE

• H-FILES are made by cutting the spiraling flutes onto the shaft of a piece of
round, tapered stainless steel wire.
STANDARDISATION OF ENDODONTIC
INSTRUMENTS
• Before 1958, endodontic instruments
were manufactured without benefit of
any established criteria.
• The numbering (1 to 6) was entirely
arbitrary.
• An instrument of one company rarely
coincided with a comparable
instrument of another company.
 INGLES
RECOMMENDATION
• Cutting blades 16 mm in
length
• 2 % Taper.
• The diameter of the
instrument at tip (D1) is
determined by size in
hundredths of millimetres.
• Diameter 2 (D2) is uniformly
0.32 mm greater than D1.
• Length- 21, 25, 31 mm.

Ingle’s Original Recommendation

INGLE AND LEVINE’S STANDARDISATION
• Instruments –numbered -10-100
• Numbers advance by 5units to size 60 and then by 10 to size
100
• Each number –representative -diameter of the instrument in
100ths of a mm at the tip D1
Example–no 10 file is 10/100 or 0.1mm at tip D1
• The diameter of D16 -32/100 or 0.32mm >than that of D1
Example-no 20 reamer –diameter of 0.2+0.32 0r 0.52mm at
D16
MODIFICATION OF INGLE’S ORIGINAL
RECOMMENDATION

• The Tip Angle -Instrument

Size- 75  150
• Instrument sizes should
increase by 0.05 mm at D1
between nos. 10 and 60
Eg : Nos: 10, 15, 20, 25
• Instruments should increase by 0.1 mm from nos. 60 to 150
EG: NO. 60,70, 80.
• Nos. 6 and 8 have been added for the increased instrument selection.
• Instrument handles have been color coded for easier recognition.
ISO-COLOR CODING
With the exception of Pink, Gray and Purple,
all the colors are repeated every six instruments
ALLOYS USED FOR MANUFACTURING
ENDODONTIC INSTRUMENTS
METALLURGY OF ENDO
INSTRUMENTS
MANUFACTURING OF ENDODONTIC
INSTRUMENTS
• A hand operated instrument reamer or file begins as a
round wire which is modified to form a tapered instrument
with cutting edges.
• These are manufactured by two techniques:
ROTARY
INSTRUMENTS
CLASSIFICATION

GENERATIONS OF MOTORS
• a) First generation motor without torque control.
• b) Second generation motor with torque limiter.
• c) Third generation motor with simple torque control.
• d) Forth generation motor with apex locator and torque control
 B
A

C
D
CLASSIFICATION OF ROTARY
HANDPIECE
They are 3 types-
• Micromotor
• Reduction gear handpiece
• Vertical stroke handpiece
CLASSIFICATION OF ROTARY
INSTRUMENTS
1. Low-Speed Rotary Instruments
• Gates-Glidden burs
• Peeso instruments
11. Rotary Instruments for Canal Preparation
GATES – GLIDDEN DRILL

• This has a long, thin shaft ending in a flame-

shaped head with a non-cutting safe tip to
guard against perforation.
• It is made of hardened carbon steel.
• The flame shaped head cuts laterally and is
used with a gentle, apically directed pressure.
• These instruments come in sizes 1 to 6-
(0.5mm,0.7,0.9,0.11,0.13,0.15)
PEESO REAMER
• It has long sharp flutes with a safe tip connected to a thick shaft.
• It is most often used in preparing the coronal part of the root canal for a post
and core.
• 6 instruments starting from 70 size to 170 size
R O TA R Y N I T I
INSTRUMENTS FOR
C A N A L P R E PA R AT I O N
DYNAMICS OF ROTATIONAL MOTION

DEFINITION:
• WHEN A PARTICLE OR PARTICLES OF A RIGID BODY MOVE IN CONCENTRIC
CIRCLE ROUND A COMMON CENTRE,THE MOTION IS CALLED ROTATIONAL
MOTION.
WHAT IS R.P.M?

• THE ROTATIONAL SPEED IS EXPRESSED IN REVOLUTION PER MINUTE,

• ABBREVIATED AS r.p.m.
• If N be the r.p.m. then in 1minute there is N complete revolution.
• So ,for one complete rotation it takes=60/N second.
IMPORTANCE OF SPEED

• In endodontics, speed varies from 150-400,000 rpm

• Greater the speed, more the cutting efficiency.
• But at higher speed, there are more disadvantages such as :
• 1) loss of tactile sensation
• 2) breakage of instruments preceded by flute distortion
• 3) change in anatomical curvature of canal
• 4) loss of control
 TORQUE
• According to Marzouk, torque is the ability
of the handpiece to withstand lateral
pressure on the revolving tool without
decreasing its speed or reducing its cutting
efficiency
• Torque is dependent -type of bearing used
and the amount of energy supplied to the
handpiece

Torque -measure of how much force acting on an object cause

that objects to rotate.
Torque -moment of force, a tendency of force to rotate an
object on axis, fulcrum, or pivot, just as a force is a push or a
pull.
• Torque -parameter -controllable in root canal
preparation -different instruments, which have
been used-need different values of torque.
• In root canal preparation, safety usage of
instrument depends on considering the torque at
failure of instrument.
• In the canal instruments are subjected to different
of torsional torque, if the level of torque is equal
to or greater than the torque at failure (fracture),
the instrument will separate.
NICKEL-TITANIUM ROTARY
ENDODONTIC INSTRUMENTS
• The greatest innovation in endodontics- introduction of nickel titanium rotary
instruments .
• Nickel-titanium alloy (Nitinol) was discovered by Buehler and Wang at the US
Naval Ordinance Laboratory in the early 1960s.
• The name Nitinol was derived from the elements that make up the alloy, nickel
and titanium, and “nol” for the Naval Ordnance Laboratory.
DESIGN OF ENDO INSTRUMENTS:
• TAPER
• It is expressed as the amount of file diameter increases each millimeter
along its working surface from the tip towards the file handle.
 INSTRUMENT TAPER

INSTRUMENT HERO 642 2%, 4%, 6%

DESIGN
TAPER K3 2%, 4%, 6% 4%, 6%

FLEXMASTER 2%, 4%, 6%,

PROFILE 2%, 4%, 6%

INTRO FILE 11%

RACE 2%, 4%, 6%, 8%,10%

QUANTEC SC 2%,3%, 4%, 5%,6%, 8%,10%,12%

M-TWO 4%,5%,6%,7%
GT FILE 4%, 6%, 8%, 10%, 12%

LIGHTSPEED NO TAPER

PROTAPER VARIABLE TAPER

INSTRUMENT
DESIGN
CORE
• It is the cylindrical
center part of the file
having its
circumference
outlined and
bordered by the
depth of the flutes.
FLUTE
• It is the groove in the working surface used to collect soft tissue and dentin
chips removed from the walls of the canal.
• The effectiveness of the flute depends on its depth, width, configuration, and
surface finish.
TIP DESIGN
• It can affect file control, efficiency, and outcome in the shaping of root canal
systems.
• The tip of the original K-file resembled a pyramid.
• Instrument tips have been described as cutting, non-cutting, and partially
cutting, although no clear distinction exists among the three types
TIP DESIGN
• Powell et al -when this tip “angle” is reduced, the file stays centred within the
original canal and cuts all sides (circumference) more evenly.
• This modified-tip file has been marketed as the Flex-R-file.
CUTTING EDGE
• The surface with the
greatest diameter that
follows the groove
(where the flute and land
intersect) as it rotates,
forms the leading
(cutting) edge, or the
blade of the file.
LAND/MARGINAL WIDTH
• The surface that projects axially from the central axis as far as the
cutting edge between the flutes
HELIX ANGLE
• The angle formed by the cutting
edge with the long axis of the file.
• Helps in removing debris
collected in the flute from the
canal
PITCH
• The pitch of the file is the distance between a point on the leading edge and
the corresponding point on the adjacent leading edge.
• OR It may be the distance between corresponding points within which the
pattern is not repeated.
RAKE ANGLE
• The angle formed by the leading edge and the
radius of the file when the file is sectioned
perpendicular to its long axis.
CUTTING ANGLE
• The cutting angle, or the effective rake angle- indication of a file’s
cutting ability and is determined by measuring the angle formed by
the cutting (leading) edge and the radius when the file is sectioned
perpendicular to the cutting edge.
• If the flutes -symmetric, rake angle =cutting angle
ROTARY ENDODONTIC
FILES
PHASES IN NITI ROTARY FILES
• NiTi alloy-temperature-dependent, microstructure phases:
austenite, martensite, and R-phase .
• Austenitic NiTi is strong and hard, while martensitic and R-phase
NiTi are soft and ductile and can be easily deformed.
• The conventional NiTi alloy is primarily -austenite phase at room
temperature.
• Thermomechanical treatments -alloy in the martensite phase, R-
phase, or mixed form by altering the transformation temperature
and consequently changing the characteristics of the alloy
• M-wire -higher flexibility than that of the conventional NiTi alloy.

• The R-phase -thermally treated NiTi alloy which is transformed

from the austenite phase into the martensite phase during the
manufacturing process.

• CM-wire -controls the memory of the material and makes the alloy
extremely flexible; it does not rebound to its original shape like the
conventional NiTi alloy
FIRST GENERATION

• Introduced -mid-1990s.
• passive cutting radial lands
• fixed 0.04–0.06 tapers over the full working lengths LightSpeed (1992),
Profile-Dentsply (1993),
Quantec-Sybron Endo
smooth root canal (1996)
walls which centered GT system-Dentsply (1998)
in the middle and
caused low requiring numerous files
procedural errors.
 Lightspeed instruments

GT SYSTEM

Quantec system
SECOND GENERATION
• introduced into the market in 2001
• active cutting edges with greater cutting
efficiency
• number of instruments required to achieve
complete cleaning and shaping -less in
comparison with the previous generation
ProTaper Universal-Dentsply,
faster preparation K3-SybronEndo,
preserving the original canal Mtwo-VDW,
shape of canals transportations Hero Shaper-Micro-Mega,
tendency for I Race, I Race Plus-FKG
curved and calcified Dentaire
challenging cases breakage more
PROTAPER UNIVERSAL

I RACE PLUS

I RACE
THIRD GENERATION
K3 XF Files-SybronEndo,
• late 2007 -manufacturers -the heating and Profile GTX Series–Dentsply,
cooling technologies on NiTi alloys to (CM) Files (HyFlex CM)–
improve the safety of these instruments, Coltene,
Vortex Blue (Dentsply Tulsa)
especially in the curved root canals.

M-wire and R-phase

reduction of the cyclic technologies and
fatigue of the files electrical discharge
reduction -separation risk of methods -high
the instruments memory shapes and
low risk of separation
 Hyflex coltene

The files -extremely flexible -without the shape memory

of conventional NiTi Files.
25 8% - C ,M follow the anatomy of the canal very closely, reducing the
20 4% -C,M,A
risk of ledging, transportation or perforation.
25 4%-
20 6%
30 4% files can be pre-bent, similar to the way of stainless steel.
40 4%
Regains shape after heat treatment = Multi-use
FOURTH GENERATION

• Reciprocation : repetitive back and forth • Wave One-Dentsply,

or up and down motion -Blanc, a French • Reciproc-VDW
dentist, in the late 1950s.
• movements -clockwise and
counterclockwise degrees of rotation
are quite equal.
can efficiently reduce the
• use -single file technique -thorough
bacterial number in the root
cleaning and shaping goals at this phase - canal along with preserving
success the original shape of it
Reciproc VDW
FIFTH GENERATION
• offsetting the center of rotation:
Revo-S-Micro-Mega,
• mechanical wave of motion that One Shape Micro-Mega,
distributes along the full length of the ProTaper Next-Dentsply
NiTi file –
• improves cutting and removing the
debris in comparison with a centered
mass rotating instrument.
• reduces the taper lock or the
screwing effect which causes
instrument separation.
 SINGLE-FILE ROTARY SYSTEMS
classified to groups: based on type of their motions
• continuous rotating
• reciprocating files
Neoniti–Neolix,
• Self adjusting files One Shape-Micro-Mega,
• One curve HyFlex/EDM-Coltene,
XP-endo shaper–FKG
Wave One–Dentsply Swiss
Reciproc-VDW,
Germany,
SAF –SELF ADJUSTING FILES
ULTRASONICS IN ENDODONTICS
MECHANISM OF ACTION

• Acoustic streaming
• Cavitation
ACCESS REFINEMENT, FINDING CALCIFIED
CANALS, AND REMOVAL OF ATTACHED PULP
STONES
• ultrasonic tips are useful for access
refinement, location of MB2 canals in upper
molars and accessory canals in other teeth,
location of calcified canals in any tooth, and
removal of attached pulp stones
• advantages -do not rotate, thus enhancing
safety and control, while maintaining a high
cutting efficiency -risk of perforation is high.
REMOVAL OF INTRACANAL
OBSTRUCTIONS
• Ultrasonic energy has proven effective as an adjunct in the removal
of silver points, fractured instruments, and cemented posts.
INCREASED ACTION OF IRRIGATING
SOLUTIONS-PASSIVE ULTRASONIC
IRRIGATION

• Acoustic streaming-to produce

sufficient shear forces to dislodge
debris in instrumented canals
• US -disinfection of root canals
probably because organic tissues
entering the streaming field that is
generated are disrupted.
• US as an adjunct with various
irrigating solutions -removal of the
smear layer
SURGICAL ENDODONTICS: ROOT-END
CAVITY PREPARATION AND
REFINEMENT AND PLACEMENT OF ROOT-
END OBTURATION MATERIAL
• an optimal cavity preparation is an essential prerequisite for an adequate root-end filling after
apicoectomy
ROLE OF
M AG N I FI CAT I O N
IN
EN D O D O N T I CS
• Dentists feel- can do so much work blindfolded; simply because
there is “nothing to see”.
• There is a great deal in doing endodontic therapy with right tools in
order to achieve good success rate

“You can treat what you see and won’t what you don’t”
• Magnification is the process of enlarging something only in
appearance, not in physical size.
• This enlargement is quantified by a calculated number also called
"magnification“
The various magnification devices:
• loupes,
• operating microscope,
• endoscope
• oroscope
NEED FOR MAGNIFICATION IN
DENTISTRY?
Restorative dentists and endodontists -
perform procedures requiring resolution well
beyond the 0.2- mm limit of human sight.

Crown margins, incisions, root canal location,

caries removal, furcation and perforation repair,
post placement or removal, are a few of the
procedures that demand tolerances well
beyond the 0.2-mm limit.
LOUPES
• Magnifying loupes were developed -problem of proximity, decreased depth of
field, and eyestrain occasioned by moving closer to the subject.
• Depth of field- is the ability of the lens system to focus on objects that are
near or far without having to change the loupe position.
• As magnification increases, depth of field decreases.
• The smaller the field of view, the shallower the depth of field.
• For a loupe of magnification 2X, the depth of field is approximately 5 in [12.5
cm];
• for a loupe of magnification 3.25X, it is 2 in [6 cm];
• and for a loupe of magnification 4.5X, it is 1 in [2.5 cm].
• Loupes are classified by the optical method by
which they produce magnification.
• There are 3 types of binocular magnifying
loupes:
• (1) a diopter, flat-plane, single lens loupe,
• (2) a surgical telescope with a Galilean system
configuration (2-lens system), and
• (3) a surgical telescope with a Keplerian system
configuration (prism roof design that folds the
path of light)
ADVANTAGES

• All systems produce superior magnification and

correct spherical and chromatic aberrations,
• have excellent depth of field- capable of
increased focal length (30–45 cm), thereby
reducing eyestrain and head and neck fatigue.
• These loupes offer significant advantages over
simple magnification eyeglasses.
DISADVANTAGES

• The disadvantage of loupes is that the practical maximum

magnification is only about 4.5X.
• Loupes with higher magnification are available, but they are heavy
and unwieldy, with a limited field of view.
• Such loupes require a constrained physical posture and cannot be
worn for long periods of time without producing significant head,
neck, and back strain.
OPERATING
MICROSCOPE DOCUMENTATION

‘An optical instrument

that uses a lens or a
combination of ACCESSORIES ILLUMINATION

lenses to produce
magnified images of
small objects;
especially of those MAGNIFICATION

too small to be seen

by the unaided eye.’
The operating microscope consists of three primary components:
• The supporting structure –floor, ceiling or wall mounted
• The body of the Microscope,
• The light source.
The body of the microscope is the most important component of
the instrument and it contains the lenses and prisms responsible of
magnification and stereopsis.

The body of
• Eyepieces- powers -10x,12.5x, 16x, and [Link] most used are 10x
and 12.5x.
• binoculars,
• magnification changer factor
• the objective lens
EYE PIECES:
• Eyepieces are generally available in powers of 10x, 12.5x, 16x, and 20x.
• The most used are 10x and 12.5x.
• The end of each eyepiece has a rubber cup that can be turned down for
clinicians who wear eyeglasses
• Eyepieces also have adjustable diopter settings.
• Diopter settings range from -5 to +5 and are used to adjust for
accommodation, which is the ability to focus the lens of the eyes .
BINOCULARS

• The binoculars contain the eyepieces and allow the adjustment of

the interpupillary distance.
• Their focal length is 125 or 160 mm.
• They are aligned manually or with a small knob until the two
divergent circles of light combine to affect a single focus.
• Binoculars are available with straight, inclined, or inclinable tubes.
MAGNIFICATION CHANGERS

• Magnification changers are available as 3-, 5-, or 6- step manual

changers, or a power-zoom changer.
• They are located within the head of the microscope.
• Manual step changers consist of lenses that is connected to a dial
located on the side of the microscope.
• The magnification is altered by rotating the dial.
OBJECTIVE LENS
• final optical element - its focal length determines the working
distance between the microscope and the surgical field.
• The range of focal length varies from 100 mm to 400 mm.
• A 200 mm focal length allows approx 20 cm (8 inches) of working
distance, which is generally adequate for utilization in endodontics.
• The objective lens, as well as all the other lenses of the microscope
all have several layers of an anti-reflective coating on both surfaces -
absorb only a minimum amount of light in order not to decrease
the illumination of the operative field.
LIGHT SOURCE
• The light source -most important features.
• Responsible for operating in operative fields that are small and deep like the
root canal.
• microscope -powerful coaxial illumination, which means that the light is coaxial
with the line of sight and eliminates the presence of any shadows.
• The light source -100- to 150- watt halogen light bulb that is connected to the
microscope with a high efficiency fiber-optic cable.
• The light passes through a condensing lens, a series of prisms, and then through
the objective lens to the surgical site.
ACCESSORIES

• In order to deflect a certain percentage of

the light from the eyepiece towards the
accessories, a beam splitter can be placed
between the binoculars and the magnification
changer.

• A photo or video adapter can be connected

to the beam splitter.
• The video camera: it allows the assistants
to follow the procedure precisely and assist
efficiently, and it can also be used for
documentation using video prints or
recordings.
ADVANTAGES

• Improved precision of treatment

• Enhanced ergonomics
• Ease of digital documentation
• Increased ability to communicate through
• integrated video.
APPLICATIONS:

• In clinical diagnosis :Cracks and microfracture ,Locating the canal orifices,

Managing calcifying canals, Intracanal medicament ,Obturation of root canal,
Retrieval of broken instruments
• In non surgical treatment: Removal of post, Perforation errors, Final
examination of the canal preparation
• In surgical treatment: Isthmus identification and preparation, Retro preparation
QUIZ

• Name the instrument used to locate the openings of small canal orifices for
endodontic procedures.
• A)Endodontic long-shank spoon
• B)Endodontic explorer
• C)Endodontic reamer
• D)Endodontic file
• The instrument used to help prepare an endodontic tooth for a post that
attaches to a slow-speed contra-angle handpiece is the:
• A)Reamer.
• B)Peeso reamer.
• C)K-type file.
• D)Lentulo spiral.
• E)Gates Glidden.
• For a 20# k file what is d16 measurement ?
• 0.52
• 0.32
• 0.64
• 0.20
• What does the cross section of a K -reamer resemble?
• Square
• Triangle
• Circle
• Trapezoid
• What are the three phases in NiTi rotary files?
• What is ‘pitch’ and ‘flute’ referred to in the design of an endodontic
file?
• What is torque?