Endodontic instruments

Instrument Design and ISO Standardization

A- The length of the instrument:
1. The position where the cutting edges begin on the instrument is called D0 (tip diameter), The
flutes extend up the shaft for at least 16 mm to stop at position D16.
2. The rest of the shaft has no flutes.
3. The length of the whole instrument from tip to handle is either 25 mm (most common) or 21 mm
or 31 mm. Short instruments (21 mm) afford improved operator control and easier access to
posterior teeth, third molar and in patients who cannot open widely. The longer instrument (28 or
31mm) is used for longer roots as canines.
Remember: The length of the blade with cutting flutes (working part between D0 and D16) is 16
mm regardless of total instrument length.

B- The numbering of the instrument:

The standardized instruments are manufactured from sizes 6 to 140. The number expresses the
instrument diameter at tip flute D0 in hundredths of millimeter.
Example:
Instrument number 30 has a diameter at D0 =30/ 100= 0.3 mm, and instrument number 6 has
diameter at D0 = 6/100 = 0.06 mm.

C- Incremental increase in size:

Instrument sizes facilitate the placement of the next instrument size in the canal up to the working
length.
In small sizes from # 10 up to 60, the increment is 5/100 (0.05 mm or 50 microns) separating one
instrument from the next.
In large sizes from # 60 up to 140, the increment is 10/100 (0.1 mm or 100 microns) separating one
instrument from the next.
While from # 6 up to 10, the increment is 2/100 (0.02 mm or 20 microns).
A total of 21 instruments exist with the following sequence according to the above mentioned
incremental increase in instrument diameter at D0:
6, 8, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 70, 80, 90, 100, 110, 120, 130, 140.
Remember: The name of the instrument is its width at D0 in hundredths of millimeter.

D- Six colour codings:

White, yellow, red, blue, green, black are used sequentially on the handle of for easier identification
of sequence of size.
Colour coding begins with white ( #15), and then yellow (#20), red (#25), blue (#30), green (#35 )
and black (#40). Colour coding is repeated up to instrument size 140, such that no. 15 and no. 45
and no.90 are all white.
In addition, no. 6 is pink, no. 8 is gray and no. 10 is purple.

13.1

E. The taper of the instrument (increase in diameter/mm along its working length):
1. The taper (flare) of the instrument is the same regardless of the size of the instrument.
Standard taper allows easier placement of instruments in small or curved canals.

2. A standard ISO taper is set at 0.02 mm per mm (2%). At the coronal-most part of the working
flutes, the instrument is 0.32 mm thicker than at D0. This is calculated by multiplying 16 mm
(length of cutting flutes) by 0.02 mm = 0.32 mm.
Example: Instrument #15 with 0.02 taper would have 0.17 mm diameter after 1 mm from tip (D1),
0.19 mm diameter 2 mm from tip (D2) and 0.21 mm diameter from 3mm from tip.
At the end of 16 mm working part, it has a diameter= D0 + 0.32= 0.15+ 0.32= 0.47mm

3. Newer instruments made from nickel-titanium may exhibit other tapers in addition to 2% taper as
4%, 6%, 8%, 12%. This means that for every gain in length of the cutting blade the diameter
increase by 0.04, [Link],0.12 mm, respectively.

F. The tip angle, is standardized to be 75º ± 15º. This design provides cutting efficiency without an
excessively sharp transition angle.
It is made of carbon steel (susceptible
to corrosion during autoclaving).
150 Textbook of Endodontics

tear-drop or
comma-shaped
cross-section
Fig. 13.4 Schematic representation of cross section of different files.

Fig. 13.7 Line diagram showing square cross section and more
number of flutes in file.

Fig. 13.5 Schematic representation of working of reamer-

penetration, rotation and retraction.

Fig. 13.8 Schematic representation showing that three point

contact of file has more flexibility and more space for debris removal
when compared to four point contact which has more cutting
efficiency but less space for debris removal.

‰ File is predominantly used with filing or rasping action

in which there is little or no rotation in the root canal. It
Fig. 13.6 Triangular cross section and lesser is placed in root canal and pressure is exerted against the
number of flutes in reamer. canal wall and instrument is withdrawn while maintain-
ing the pressure (Fig. 13.9).

‰ Tighter twisting of the file spirals increases the number K-Flex File
of flutes in files (more than reamer) (Fig. 13.7) ‰ It was seen that square blank of file results in total
‰ Triangular cross-sectioned file shows superior cutting decrease in the instrument flexibility. To maintain shape
and increased flexibility than the file or reamer with and flexibility of this file, K-flex file was introduced
square blank (Fig. 13.8) (Fig. 13.10)
 Endodontic Instruments 151
Flexo File
‰ It is similar to the K-flex file except that it has triangular
cross section (Fig. 13.12). #is feature provides more
flexibility and an ability to resist fracture
‰ Tip of file is modified to noncutting type
‰ It is more flexible but has lesser cutting efficiency.

Triple Flex File

‰ It is made up of stainless steel and has triangular cross
section
‰ It has more flutes then reamer but lesser than K-file
‰ Triangular cross section provides better flexibility and
cutting efficiency.

Fig. 13.9 File is worked along the canal wall in rasping action. Flex-R File/Roane File
‰ Flex-R file is made by removing the sharp cutting edges
from the tip of the instrument (Figs. 13.13). Noncutting
tip enables the instrument to traverse along the canal
rather than gouge into it
‰ #is design reduces the ledge formation, canal transpor-
tation, and other procedural accidents when used with
balanced force technique
Fig. 13.10 Photograph showing K-flex file. ‰ Another feature of flex-R file is presence of triangular
cross section which provides it flexibility to be used in
curved canals
‰ by of
It is made up milling
NiTi and cuts during anticlockwise rotary
motion.

Fig. 13.12 Photograph showing flexo file.

Fig. 13.11 Schematic representation of K-flex file showing

rhomboidal cross section.

‰ K-flex file is rhombus in cross section having two acute

angles and two obtuse angles (Fig. 13.11)
‰ Two acute angles increase sharpness and cutting effi-
ciency of the instrument
‰ Two obtuse angles provide more space for debris
removal
‰ Decrease in contact of instrument with canal walls pro-
vide more space for irrigation Fig. 13.13 Schematic representation showing non cutting tip
‰ It is used with filing and rasping motion of Flex R file.
152 Textbook of Endodontics

Hedstroem File (H-File) ‰ Noncutting side is directed to the side of canal where
cutting is not required
‰ H-file has flutes that resemble successively triangles set ‰ Noncutting side of safety file prevents lodging of the
one on another (Fig. 13.14) canals (Fig. 13.15).
‰ It is made by cutting spiral grooves into round, tapered
steel wire in the same manner as wood screws are made.
S-File
#is results in the formation of a sharp edge which cuts
on removing strokes only ‰ It is called “S” file because of its cross-sectional shape
‰ H-file cuts only when instrument is withdrawn because ‰ S-file is produced by grinding, which makes it sti%er than
its edges face handle of the instrument H-file. #is file is designed with two spirals for cutting
‰ When used in torquing motion, its edges can engage blades, forming double helix design (Fig. 13.16)
in the dentin of root canal wall, causing H-files to ‰ S-file has good cutting efficiency in either filling or
fracture reaming action, thus this file can also be classified as a
‰ Rake angle and distance between the flutes are two hybrid design.
main features which determine working of the file.
H-file has positive rake angle, that is, its cutting edge is A-File
turned in the same direction in which force is applied ‰ It’s a variant of H-file
which makes it to dig the dentin, thus more aggressive ‰ Its cutting edges are at an acute angle to long axis of the file
in cutting When used in curved canals, flutes on the inner edge col-
‰ H-file should be used to machine the straight canal lapse, so no dentin is removed. On the outer edge, flutes
because it is strong and aggressive cutter. Since it lacks open, filling the dentin on outer curvature.
the flexibility and is fragile in nature, the H-file tends to
fracture when used in torquing action
Advantages of H-files
‰ Better cutting efficiency
‰ Push debris coronally

Disadvantages of H-files
‰ Lack flexibility
‰ Tend to fracture
‰ Aggressive cutter

Clinical Tips
One should use Hedstroem files in only one direction, i.e., retrac-
tion. It should not be used in torquing motion as it tends to
fracture.

Fig. 13.15 Schematic representation of safety Hedstroem file.

Modifications in H-Files
Safety Hedstroem File
‰ #is file has noncutting safety side along the length of the
blade which reduces the chances of perforations

Fig. 13.14 H file resembles successive triangles Fig. 13.16 Schematic representation of H and A- file.
set on one another.
 Endodontic Instruments 153
Unifile mounted on long thin shaft attached to a latch-type
‰ It is machined from round stainless steel wire by cutting shank (Fig. 13.18)
two superficial grooves to produce flutes in double helix
‰ Flame head cuts laterally, therefore used with gentle,
design apically directed pressure. It has safe tip to guard against
‰ ItItresembles
is manufactured
H-file inbyappearance
milling. perforations
‰ ItItishas S-shaped
less efficient cross-section.
‰ Gates-Glidden drills are available in a set from 1 to 6 with
N.B/‰ Unlike
Less prone the diameters from 0.5 to 1.5 mm (Fig. 13.19)
Unifile,tothe
fracture.
depth of flutes increases from tip to
handle in S-file.
‰ Due to their design, Gates-Glidden drills are side cutting
instruments with safety tips
C+ File ‰ #ey should be used in brushing strokes at the speed of
‰ C + file is made from specially treated stainless steel so 750–1,500 rpm
have amazing sti%ness and strength to be used for diffi- ‰ Safety design of Gates-Glidden drills is that its weakest
cult and calcified canals. It has better buckling resistance part lies at the junction of shank and shaft of the instru-
than K-file (Fig. 13.17) ment (Fig. 13.20). If its cutting tip jams against the canal
‰ Twisted file design provides greater strength wall, fracture occurs at the junction of shank and the shaft
‰ It is available in size 8, 10, and 15 and in length 18, 21, but not at the tip. #is makes removal of fractured drill
and 25 mm. from the canal by grasping with pliers easy
‰ GG drills can be used both in crown down as well as step
Golden Medium File back fashion.
‰ Golden medium file was described by Weine. It comes
under intermediate files provided with half sizes between
conventional instruments
‰ It is available in sizes from 12 to 37 like 12, 17, 22, 27, 32,
and 37
‰ It is used for narrow canals since it provides more gradual
increase in size than conventional files
‰ It is formed by cutting 1 mm from the tip of instrument.
In this way No. 10 file can be converted to No. 12 and
Nos. 15–17 and so on.

Group II Low Speed Instruments

with Latch-Type Design
Fig. 13.18 Photograph showing Gates Glidden drill. Note the
Gates-Glidden Drills flame shaped head with latch type shank.
‰ Traditional engine-driven instruments include Gates-
Glidden drills which have flame-shaped cutting point

Fig. 13.17 Photograph showing C+ files Fig. 13.19 Gates Glidden drills are numbered from 1 to 6 with
Courtesy: Dentsply India. diameter ranging from 0.5 to 1.5.
154 Textbook of Endodontics

Number Diameter at cutting tip (mm)

‰ For removal of lingual shoulder during access prepara-
tion of anterior teeth
1 0.50 ‰ During retreatment cases or postspace preparation for
2 0.70 removal of gutta-percha
3 0.90 ‰ For preparing space while removal of separated
4 1.1 instrument
‰ If used incorrectly, for example, using at high rpm, incor-
5 1.3
rect angle of insertion, forceful drilling, GG drills can
6 1.5 result in procedural accidents like perforations, instru-
ment separation, etc.
Uses of Gates-Glidden Drills
‰ For enlargement of root canal orifices (Fig. 13.21) Flexogates
‰ For coronal flaring during root canal preparation
‰ Flexogates are modified Gates-Glidden drills. #ey are
made up of NiTi and have noncutting tip (Fig. 13.22)
‰ #ey are more flexible and used for apical preparation
‰ Flexogates can be rotated continuously in a handpiece
through 360°
‰ These instruments have many advantages over
traditional instruments in that they allow better
debris removal because of continuous rotation and
smoother and faster canal preparation with less clini-
cian fatigue

Advantages of 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

Fig. 13.20 Safety design feature of Gates Glidden drills showing non Peeso Reamers (Fig. 13.23)
cutting flame shaped head and weakest portion at the junction of ‰ Peeso reamers are also stainless steel instruments
shank and shaft of the instrument.
like Gates-Glidden drills but they di%er in that blades
spread over a wide surface and their shape is cylindrical
(Fig. 13.24)
‰ #ese are rotary instruments mainly used for postspace
preparation
‰ #ey have safe ended noncutting tip
‰ #eir tip diameter varies from 0.7 to 1.7 mm
‰ #ey should be used in brushing motion.

Fig. 13.21 Gates Glidden used for enlarging the

root canal orifices. Fig. 13.22 Flexogate is modified Gates Glidden.
 Endodontic Instruments 155

Fig. 13.23 Photograph showing 1 to 6 numbers Peeso reamers Fig. 13.25 Peeso reamer is used for removal of gutta-percha
from tip diameter of 0.7 to 1.7 mm. during post-space preparation.

Disadvantages
‰ #ey do not follow the canal curvature and may cause
perforation by cutting laterally
‰ #ey are sti% instruments
‰ #ey have to be used very carefully to avoid iatrogenic
errors.

Clinical Tips
Gates-Glidden drills and Peeso reamers are inflexible and aggres-
sive cutting instrument. They should be used at slow speed with
contra-angled handpiece with extreme caution to prevent per-
forations and overinstrumentation.
Fig. 13.24 Schematic representation showing difference in head
design of Gates Glidden and Peesso reamer.

Group III Engine-Driven Instruments

Number Diameter at cutting tip (mm) NiTi Rotary Instruments
1 0.70
NiTi was developed by Buchler 60 years ago. NiTi is also known
2 0.90 as the NiTinol (NiTi Navol Ordinance Laboratory in US). In
3 1.1 endodontics, commonly used NiTi alloys are 55 NiTinol (55%
weight Ni and 45% Ti) and 60 NiTinol (60% weight of Ni, 40%
4 1.3
Ti). It was also called equiatomic NiTi alloy due to 1:1 atomic
5 1.5 ratio of nickel to titanium. NiTi alloys with equiatomic ratio
6 1.7 possess superelasticity and shape memory e%ect due to nar-
row solubility range of NiTi phase at 500° or below.
First use of NiTi in endodontics was reported in 1988 by
Uses Walia et al. when a 15 No. NiTi file was made from ortho-
Peeso reamer is primarily used for postspace preparation dontic wire and it showed superior flexibility and resistance
when gutta-percha has to be removed from obturated root to torsional fracture. #is suggested the use of NiTi files in
canal (Fig. 13.25). curved canals.
Spreaders
- The main instrument used for cold lateral compaction is the spreader, which is used
to laterally compact and adapt gutta percha and create space for accessory cones.
- Two types of spreaders are handled spreaders and finger spreaders (Fig. 13.17).
- Finger spreaders provide better tactile sensation and are less likely to induce fractures
in the root when compared with the handled spreaders.
- Both stainless steel and nickel-titanium spreaders are available.
- Nickel-titanium spreaders provide increased flexibility, reduced stress, and deeper
penetration when compared with stainless steel instruments.

Pluggers
- Pluggers are used for warm vertical compaction to push softened gutta percha filling
material into the root canal system (compact compact the obturation material
vertically).
- Two types of spreaders are handled spreaders and finger pluggers.

Lentulo Spiral
- Lentulo spirals are twisted wire instruments used in a slow-speed handpiece.
- used for applying intracanal medications (e.g calcium hydroxide) and sealers to canal walls.
- Available in lengths of 17, 21 and 25mm.