12. ROTARY INSTRUMENTS IN ENDODONTICS.pptx

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1. ROTARY INSTRUMENTS IN ENDODONTICS Dr. Aditee Agrawal, DEPARTMENT OF CONSERVATIVE DENTISTRY & ENDODONTICS.

2. CONTENTS INTRODUCTION HISTORY NICKEL TITANIUM ENDODONTIC INSTRUMENTS PROPERTIES OF NiTi Alloy COMPONENTS OF ROTARY FILE CLASSIFICATION OF NITI INSTRUMENTS DIFFERENT ROTARY SYSTEMS

3. INTRODUCTION The principles of root canal treatment consists of thoroughly cleaning, adequate shaping and complete filling of root canal system. In order to accomplish these objectives , many different instruments are available

4. Rotary shaping instruments are replacing the conventional hand file systems to enhance shaping ability of canal, reduce clinical mishaps like blocks, ledges, transportations and perforations. When clinician masters the “ method of use” protocols of rotary shaping instruments unpredictable file breakage, metal fatigue, loss of cutting efficiency, variation in length, diameter in curvature of the canal can be avoided and better shaping of the canals with desired taper will be achieved.

5. HISTORY The manufacture of the first instrument for Endodontic use dates to 1875 . These early instruments, which were made by hand from thin steel wires, performed more or less the function of modern broaches. 1876-1926 : This period showed improvement in procedures and introduction of standardized instruments and cavity preparation. 1885: Gates – Glidden was introduced and it was one of the instruments which gained fame as a rotary instrument.

6. 1889 : The first contra angle for endodontic purpose with a whole circle rotation was introduced by Rollins. 1915 : Kerr manufacturing company obtained the patent for instruments which were later known as K type instruments. 1928: Endocursor handpiece was designed for use with rotary files. 1958 Ingle and Levine first proposed standardization of Endodontic instruments. Early 1960s , nickel titanium alloy was developed by W. F. Buehler , a metallurgist investigating non magnetic, salt resistant, water proof alloys for the space programme at the “Naval Ordinance Laboratory”, in Silver Springs, Maryland,USA .

7. 1971 Anderson and Hilleman first reported potential application of Nickel- Titanium alloys in dentistry. 1988 Walia , Brantely and Gerstein was first to fabricate endodontic files from NiTi orthodontic wires. 1988 The reports of first use of Nickel - Titanium alloys as Endodontic instruments. Since 1991 to present a resurgence of mechanized and rotary NiTi systems with different instrument designs are establishing the market for root canal treatment.

8. Nickel titanium [ NiTi ] Endodontic instruments When using the stainless steel files, occurrence of procedural errors cannot be avoided specially in case of curved canals. Deviation from the original shape, ledge formation, zipping, stripping and perforations are common problems which are seen in such cases. But the superelasticity of NiTi alloy allows these instruments to flex more than the stainless steel instruments before exceeding their elastic limit, thereby allowing canal preparation with minimal procedural errors.

9. NiTi was developed by Buchler 40 year ago. NiTi is also known NiTinol [ NiTi Naval ordinance laboratory in US]. In endodontics commonly used NiTi alloys are called 55 NiTi nol [55% wt Ni and 45% Ti] and 60 NiTi nol [60% wt of Ni, 40% Ti].

10. First use of NiTi in endodontics was reported in 1988,by Walia et al when a 15 no. NiTi file was made from orthodontic wire and it showed superior flexibility and resistance to tortional fracture. This suggested the use of NiTi files in curved canals.

11. Properties of NiTi alloys: 1. Shape memory: The NiTi file comes back to its original straight form without showing any sign of lasting deformation .This is called shape memory. 2. Super elasticity The ability of resisting stress without permanent deformation and going back to the initial lattice form is called super elasticity. 3. Low modulus of elasticity 4. Good resiliency 5. Corrosion resistance 6. Softer than stainless steel

12. COMPONENTS

13. TIP DESIGN:- A rotary cutting instrument may have a cutting or non-cutting tip. Active Tip : have active cutting blades. They have the ability to cut more efficiently, aggressively and tendency to straighten the canal curvature. Passive Tip : These instruments have a radial land between cutting edges and flute. The radial land touches the canal wall on its entire surface, guiding the instrument – stable and balanced with in the canal. at the end of the root.

14. Active cutting blade: - Protaper -Hero 642 - Race file - K3 - Flexmaster Passive cutting blade: -Profile - GT - Lightspeed Semiactive : - Quantec

15. Taper: It is expressed as the amount of file diameter increases each millimeter along its working surface from the tip towards the file handle. SIGNIFICANCE: The ability to determine cross-sectional diameter at a given point on a file can help the clinician to determine the file size in the point of curvature and the relative stress being placed on the instrument.

16. Constant taper with variable tip size e.g. Profile and K3 Common tip size with varying Taper e.g Quantec , Race, System GT No Taper e.g Lightspeed Multiple or Reverse Taper e.g Protaper

17. INSTRUMENT TAPER PROFILE FIXED 2%, 4%, 6% HERO 642 FIXED 2%, 4%, 6% K3 FIXED 2%, 4%, 6% FLEXMASTER FIXED 2%, 4%, 6%, INTRO FILE- 11% RACE FIXED 2%, 4%, 6%, 8%,10% QUANTEC FIXED 2%,3%, 4%, 5%,6%, 8%,10%,12% M TWO FIXED 4%,5%,6%,7% GT FILE FIXED 4%, 6%, 8%, 10%, 12% LIGHTSPEED NO TAPER PROTAPER VARIABLE TAPER

18. RAKE ANGLE – If the instrument is sectioned perpendicular to the long axis, the angle formed by cutting edge and the radius of the instrument is the rake angle. If the angle formed by the leading edge and the surface to be cut (its tangent) is obtuse , the rake angle is said to be positive or cutting. If the angle formed by the leading edge and the surface to be cut is acute , the rake angle is said to be negative or scraping .

19. Positive rake angles will cut more efficiently than neutral rake angles, which scrap the inside of the canal. Most conventional endodontic files utilize a negative or “substantially neutral” rake angle. An overly positive rake angle will result in digging and gouging of the dentin. This can lead to separation. Kᶾ has Positive rake angle. The Profile, ProTaper , Hero 642, RaCe and Flex Master systems exhibit negative rake angle resulting in their optimum cutting efficiency. Light Speed and GT rotary system have neutral rake angle .

20. If the flutes of the file are symmetrical the rake angle and cutting angle will be essentially the same. Only when the flutes are asymmetrical ,the rake angle and cutting angle will be different In some instances, as with some Quantec files, a file may have a blade with a negative rake angle and a positive cutting angle. Both angles may change as the file diameters change and may be different for file sizes.

21. NEGATIVE RAKE ANGLE NEGATIVE CUTTING ANGLE NEGATIVE RAKE ANGLE NEGATIVE CUTTING ANGLE SYMMETRICAL FLUTE PROFILE PROFILE GT

22. NEGATIVE RAKE ANGLE NEGATIVE CUTTING ANGLE NEGATIVE RAKE ANGLE NEGATIVE CUTTING ANGLE SYMMETRICAL FLUTE RACE PROTAPER

23. NEGATIVE RAKE ANGLE LESS NEGATIVE CUTTING ANGLE NEGATIVE RAKE ANGLE LESS NEGATIVE CUTTING ANGLE ASYMMETRICAL FLUTE HERO M TWO

24. NEGATIVE RAKE ANGLE POSITIVE CUTTING ANGLE POSITIVE RAKE ANGLE POSITIVE CUTTING ANGLE ASYMMETRICAL FLUTE QUANTEC K 3

25. RADIAL LAND:- A radial land is a surface that projects axially from the central axis, between flutes, as far as the cutting edge. This reduces the canal transportation and supports the cutting edge.

26. Functions : Prevents ‘‘screwing in’’ of the file Supports the cutting edge Limits the depth of cut Reduces the propagation of microcracks on its circumference. Maintains the file in the centre of root canal. Previously, rotary files either had full radial lands (Profile, GT) or their lands were recessed ( Quantec ). The K3, like the Profile, is a three fluted file with three lands . Profile/GT Radial Land K3 Radial Land

27. HELIX ANGLE:- - It is the angle the cutting edge forms with the long axis of the tooth. File with constant helical flute angle  Debris accumulation.  Screwing down effect. Variable helical angle preferred

28. In the K3, the helical angle increases from the tip to the handle. The RaCe file is unique and utilizes an “alternating helical design” that reduces rotational torque by using spiraled and non spiraled portions along the working length. This design feature also reduces the tendency of the file to get “sucked into” the canal. Variable Helical Angle

29. PITCH:- Pitch is the number of spirals or threads per unit length. The pitch is a distance between the edges or the peaks of two nearby cutting blades measured along the instrument axis.

30. The smaller the pitch, greater the contact area between the instrument and root canal walls. It increases torsional stress and the drawing of the instrument in to the root canal. The pitch may be constant or changing along the long instrument.

31. 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. A progressively larger distance between flute space and blade is required so as to avoid any compaction of debris and also provides an effective channel for its removal.

32. BLADE (CUTTING EDGE):- It is the working area of the file and is the surface with the greatest diameter that follows the flute as it rotates. Significance : The cutting edge forms and deflects chips from the wall of the canal and cut or snags soft tissue. Its effectiveness depends on its angle of incidence and sharpness.

33. CORE: The cylindrical center part of the file having its circumference outlined and bordered by the depth of the flutes. The flexibility and resistance to torsion is partially determined by the core diameter.

34. CLASSIFICATION OF NITI INSTRUMENTS:     First Generation: Profile Lightspeed Quantec Greater taper files     Second Generation : Endosequnce Protaper K3 M-two Flexmaster

35. Third Generation : Hyflex CM Protaper GT Series Twisted files   Fourth Generation: WaveOne Reciproc VDW Self Adjusting File   Fifth Generation : Revo – S One Shape Protaper next

36. ROTARY SYSTEMS

37. The Light Speed System (LS)

38. LIGTHSPEED SYSTEM The LS file was developed by Dr. Steve Stenia and Dr. William Wildey in early 1990s & was known as LS1. The same design principles apply to the recently developed LSX instrument. These instruments are designed for apical preparation while providing the correct shape for a quality obturation .

39. They have a short cutting blade (0.25–2mm in length), with a non-cutting pilot tip and a taperless smooth, flexible shaft . They can negotiate even difficult curvatures and cut dentine from canal walls without fear of coronal over-enlargement.

40. Sizes : LightSpeed /LSI set consist of totals 26 instruments with sizes 20 to 140 and in lengths of 21 mm, 25 mm, and 31 mm. LightSpeed instruments also have half-sizes between 20 and 70 ( 22.5, 27.5, 32.5, 57.5, and 65.5) The half-sizes instruments are color -coded exactly as the previous sizes, but also have white or black markings or engraved rings on the instrument’s handles . LSX does not have half size files and set consist of size 20 – 80 . It can be used with 2500 rpm because of high flexibility.

41. Because of thin non cutting shaft both types of light speed instruments are considerably more flexible than any other instrument on the market. Speed – 1500 - 2000 rpm (LS1) 2500 rpm (LSX)

42. Characteristic features: Cutting Head: A) CROSS SECTIONAL GEOMETRY: Light speed (LS1) cutting heads are short and have 3 radial lands and 3 U shape grooves whereas LSX is shaped like a flat chisel in cross section. B) LENGTH OF CUTTING HEAD Smallest LS instrument ( size – 20) = 0.25 mm Largest LS instrument( size – 140 ) = 2.25 mm

43. Only rotary system whose cutting heads have 3 different geometric shapes. First 5 LS instruments have short, non cutting pilot tip & 75° cutting angle; Size 32.5° instrument has slightly longer tip with 33° cutting angle; All other instruments have longer non cutting pilot tips and 21° cutting angle.

44. LS is the LS is the only rotary system whose instruments have thin, taperless , non cutting shafts . Shanks and Handle: Made of aluminium Color coded Marked with rings to indicate distances from the instrument tips. Thin shafts:

45. Technique: Light speed instruments require a straight line access to mid root areas. Working length be recorded using small sized K files. There are three methods of using light speed instruments: Conventional technique Zurich technique Hybrid technique

46. Conventional technique: Step 1 – Determining initial light speed size A light speed instrument can reach working length if its cutting head is smaller than canal’s diameter at the constriction. For e.g. Size 25 LS instrument if reaches working length indicates that canal’s diameter is larger than size 25. Gauging continues with sequentially larger sizes until a LS instrument doesn’t reach working length. If size 25 reaches working length but size 27.5 doesn’t, then size 27.5 is termed as First Light Speed Instrument.

47. Step 2 – Determining master apical size After determining the FLSI, appropriate size of instrument required for apical preparation is determined. The instrument that takes at least 12 pecks to reach working length is master apical instrument. This is known as ‘12 pecks rule.’ Step 3 – Complete apical instrumentation. After determining the MAI size, complete the apical preparation by using next light speed size that is 4 mm shorter than working length .. Step 4 – Recapitulation The canal is recapitulated using respective master apical instrument to working length.

48. Zurich technique: Step 1 – Coronal pre – flaring After canal orifices are located, their coronal openings are enlarged using Gates glidden drills. Initially 4 – 6 mm coronal preparation is achieved. Step 2 – Determining initial apical instrument Working length is determined using size 15 stainless steel K files. Then, light speed instruments are used. The first few light speed instruments may not bind within the canal. The instrument which first feel resistance in the canal is termed as ‘Initial apical instrument.’

49. Step 3 – Determining master apical instrument All LSI used after initial apical instruments are called ‘binding instruments.’ They are used with controlled forward and backward “ Pecking movement”. The forward motion reams the canal where as backward motion tends to clean as it retreats into fresh irrigant . These instruments are used sequentially from smaller to larger one. The last instrument used to prepare apical area is termed as ‘ Master apical instrument.’

50. Step 4 – Step back and recapitulation After master apical instrument is finalized the step back preparation is initiated. The last step back instrument is termed as ‘ Final instrument.’ Finally canal is recapitulated using respective master apical instrument to working length.

51. Hybrid technique ( LightSpeed technique combined with taper technique): LightSpeed Endodontics recommends this hybrid technique for clinicians wishing to combine both tapered rotary and LightSpeed systems. In this way, canals can be cleaned and shaped in a crown-down fashion according to the technique recommended by the manufacturer of the tapered instruments used. After the crown-down is completed, LightSpeed instruments complete the apical part of the canal.

52. 1500-2500

53. ProFile System

54. PROFILE SYSTEM Profile system was introduced by Dr. Ben Johnson in 1994. Profile instruments are available both in stainless steel and NiTi . Initially hand instruments with 2% taper (series 29) were marketed. Later, rotary instruments with 2%, 4% and 6% taper were developed. The tips of the ProFile Series 29 rotary instruments had a constant proportion of diameter increments (29%).

55. Later on profile series with ISO-sized tips and orifice shaper were also marketed. I] Series 29 a) Hand instruments -0.02 taper. b) Rotary instruments -0.04, 0.06 taper. II] ISO Series a) 0.04 and 0.06 taper hand and rotary instruments. Ⅲ ] Profile Orifice shaper: 0.05- 0.08 taper. IV] Profile GT rotary instruments AND hand files

56. Characteristic features: The cross sectional geometry is made by machining three equally spaced ‘U’ shaped grooves around the shaft of tapered NiTi wire.

57. Central parallel core There is a central parallel core inside that accounts for the enhanced flexibility.   Parallel Core Tapered Core

58. Rake angle It has 20 negative rake angle at the cutting edge. Negative Rake angle - Negative Cutting angle

59. Flat radial lands It has flat radial lands to cut dentin in a planing motion. Radial Land U Shaped Groove U Shaped Groove U Shaped Groove U Shaped Groove U shaped groove

60. Non-cutting bullet-nosed tip Speed – 150-350 rpm. Torque – 2.5 N cm.

61. FOR NARROW CANALS

62. FOR WIDER CANALS

63. Recommended sequences for use of ProFile by the manufacturer Estimate the working length of the canal from a preoperative radiograph.   Create a glide path with a size 10/15 stainless steel K file.   Use Orifice Shapers sizes 4, 3, 2, and 1 in the coronal one third based on canal size and angle of pathway. Perform crown-down preparation. Use ProFile instruments 0.06/30, 0.06/25, 0.04/30, and 0.04/25 to resistance (0.06/35, 0.06/30, 0.04/35, and 0.04/30 for larger canal. Determine the working length with size 15 K file.   Perform apical preparation with ProFile 0.04/25and 0.04/30 instruments. Finish with ProFile 0.06/25 instrument short of working length to blend the coronal and apical preparation.

64. Canal Preparation Method (Colors represent ISO instrument sizes) Canal Preparation Method 32 (Colors represent ISO instrument sizes)

65. Sequence of using ProFile

66. A very recent addition to the ProFile family of instruments is the Vortex . The major change lies in the non landed cross section, whereas tip sizes and taper are similar. ProFile vortex also have varying helical angle to counteract the tendency of non landed files to thread into the root canal. Manufactured using M wire technology.

67. ProFile Vortex is available in ISO tip sizes from 15 to 50 and in .04 and .06 taper.

68. ProSystem GT

69. GREATER TAPER (GT) AND GTX FILES The greater taper or GT file was introduced by Dr Steve Buchanan in 1994. The system was first produced as a set of hand operated files & later as engine driven files. The main difference between GTX and GT files is the M wire technology used for GTX.

70. The instruments came in four tapers (#.06, #.08, #.10, and #.12 ), and the maximum diameter of the working part was 1 mm. The length of cutting flutes was decreased so file has short cutting portion and the taper was increased. GT instruments are available in four basic categories of sizing, 20 Series, 30 Series, 40 Series, 0.12 Accessory Series.  

71. The 20, 30 and 40 Series GT Files have the same range of tapers, 0.04, 0.06, 0.08, and 0.10 in each file set but vary by their designated tip diameters. The 20, 30 and 40 Series GT Files have the same range of designated tip diameters but vary by their taper 0.04, 0.06, 0.08, and 0.10 in each file set. 20 Series GT Files. Note how the tapers vary but the tip and maximum flute diameters are constant through the series of files.

72. The 0.12 Accessory GT Files vary by their tip diameters and have a constant rate of taper within the file set 0.35, 0.50, 0.70, and 0.90 – all with a large 0.12 taper.

73. GT instruments are also available in hand form in sizes 20–0.06, 20–0.08, 20–0.10, 35–0.12, 50–0.12, and 70–0.12. Fig: GT Hand Files, from left to right, 20- 0.06 (white handle), 20- 0.08 (yellow handle), 20- 0.10 (red handle), 35-0.12 (green handle), 50-0.12 (brown handle), 70-0.12 (yellow handle).

74. Characteristic features: This instrument also incorporates the U file design & was marketed as Profile GT. GT Files have passive rounded tip geometry that dramatically reduces the chances of apical ledging .

75. The cutting flutes of GT instruments are landed, adding further safety in apical regions of canals. GT instruments have variable-pitch flutes, meaning that the flute angles, relative to the long axis of the file, are different along their length. The recommended rotational speed for GT and GTX files is 300 rpm.

76. The GT instruments and product identification is simple. The number of black bands on the shank-ends, times two, equals the taper of the file. The color bands on the shanks (or handle color in the case of GT Obturators ) indicate the tip diameters in the ISO convention .

77. QUANTEC 2000 SERIES

78. Quantec system It was introduced by McSpadden & manufactured by Sybron Endo. The original Quantec 2000 series had a 90° tip. This sharp tip appears to predispose problems like zipping, elbow formation and perforations. So, they were replaced. Newer Quantec series are available in both QLX Non-cutting (LX) QSE safe-cutting tip (SC) having 60° tip.

79. The quantec system provides graduated taper technique whereby a series of varying tapers are used to prepare a single canal. It consists of a series of 10 graduated NiTi taper files; taper ranges from 0.02 to 0.12

80. Quantec system had a positive blade angle hence it shave the dentin rather than scraping. T wo wide radial lands are also present along with relief behind the lands. This unique design minimises its contact with the canal thereby – Reduces rotational friction and torque Prevent the crack formation Increases the strength

81. The GT System includes (left to right) GT Hand File, GT Rotary File, GT Gutta Percha , GT Paper, GT Obturator , and GT Post.

82. HERO 642

83. Hero 642, Hero Shaper This technique for rotary instrumentation was introduced by Daryl Green . The Hero 642 is a micro mega instrument developed in 2001 . The very term Hero 642 means- H - High, E - Elasticity, Ro - Rotation with 642 - Available in the tapers of 0.06, 0.04 and 0.02. Used in CROWN DOWN technique between speed : 300 to 600 rpm .

84. First – generation rotary systems had neutral or slightly negative rake angles. Second generation systems were designed with positive rake angles , which gave them better cutting efficiency. HERO instruments( MicroMega , Besancon, France) are an example of a second generation system. The original system known as HERO 642 has now been replaced by HERO Shaper , with very little differences in the instrument design.

85. But in recent Hero file sequence doesn’t have 0.02 taper file. Instead it’s named as HERO Shaper ® for body shaping with ‘adapted pitch’ concept & HERO Apical® for apical finishing root canal. 3 tapers HERO ® 642 2 tapers .04 .06 HERO Shaper ®

86. Characteristic feature:- Cross sections of HERO instruments show geometries similar to those of an H- file, triangular cutting edges with no radial lands . Positive rake angle.

87. Bigger inner core (better resistance to fracture). Safe tip.

88. Varying helical angle (It avoids the screwing effect.) 6 % 4 % 2 %

89. A progressive pitch: The pitch also varies according to the taper: the more tapered an instrument is, the longer is its pitch. This can be described as an ADAPTED PITCH . Instrument performance is increased in terms of efficiency / flexibility /strength. An increased pitch = ADAPTED pitch 6% = long pitch 4% = medium pitch

90. According to the handpiece in which they are used, HERO 642 files are of 2 types:- With Classic shaft (to be fitted on an endo reduction contra-angle handpiece ). With InGeT ( In tegrated Ge ar T echnology ) shaft (to be fitted on the micro head InGeT contra-angle handpiece ).

91. Traditional contra-angle InGeT contra-angle Reduced visibility Wide visibility Less interfaces more reliability. Less vibration. Reduced maintenance. Greater ease of cleaning. Increased safety.

92. HERO 642 NiTi Files are available as: Instruments in 3 taper i.e. 6%, 4% and 2%. 6% taper - these are of length 21, 25mm and sizes 20, 25 and 30. 4% taper - these are available in 21, 25 and 29mm and sizes 20, 25, 30. 2% taper - available in 21, 25 and 29mm and sizes 20, 25, 30, 35, 40 & 45.

93. Canal preparation method :- The instruments are used based on the type of canal. The canals are classified as easy, average or difficult acc or ding to the curvature criteria given by S.W. Schneider :   Easy – Straight and curved < 5 degrees Average – C urved > 10 degrees and < 25 degrees. Difficult – C urved > 25 degrees.

94. CROWN DOWN IN EASY CANALS (Blue Sequence)  Step-1 Place the 0.06 taper Hero No. 30 in a reducing contra - an g le handpiece . Adjust the stopper to one-half to two-third the working length (used with an in and out motion) . Inse r t the instrument while rotating at a constant speed beween 300 to 600 rpm . Proceed apically in short in and out movement. Step-2 Change to a 0.04 taper Hero No. 30 . Place the instrument up to the working length . Use with in and out motion but with slight circumferential filing. The pressure while working should be as if writ i ng with a sharp lead pencil. Frequent irrigation and recapitulation with hand file, if any resistance is met are recommended.

95. Blue Sequence ( Easy canal preparation, low curvature, orifice and canal large enough to allow a n°15 K file to reach the apex)

96. Red Sequence (Canals of average difficulty with a moderate curvature and/or more hypercalcification , making first penetration with a n°10 K file hard to achieve)

97. Yellow Sequence ( Difficult canals , severely curved, possibly with significant hyper calcification, making any first penetration tricky with the finest hand files)

98. HERO APICAL: HERO Apical® are NiTi instruments used to enlarge the apical third of the canal after the canal is prepared with HERO Shaper (ideally) following the normal sequence. Use of HERO Apical® is indicated at the end of canal preparation, with a reducing contra-angle handpiece at a speed of 300 to 600 rpm or manually. 2 instruments are offered: • No- 30 HERO Apical® (black stop) with .06 taper • No- 30 HERO Apical® (red stop) with .08 taper 6 % 8 % 4 mm

99. ProTaper Universal System

100. Pro taper system The ProTaper system ( Dentsply / Maillefer ) represents a new generation of NiTi instruments. This instrument was designed by Prof. Pierre Machtou , Dr. Clifford Ruddle and Prof. John West in coperation with Dentsply / Maillefer . It consists of a set of 6 instruments: three shaping files for crown-down procedure and three finishing files for apical shaping.

101. This set is now complemented by two larger finishing files and a set designed for retreatment procedures. These are available as both hand and rotary files. Speed –150 - 350 rpm Characteristic features: Progressive taper Modified guiding tip Varying tip diameters Modified cross-section Varying helical angle and pitches Shorter handle of the file

102. Progressive taper - The unique design factor is the varying tapers along the instruments' long axes. This progressively tapered design serves to significantly improve flexibility, cutting efficiency and safety.

103. The three shaping files have tapers that increase coronally , and the reverse pattern is seen in the five finishing files. The differences between Shaping and Finishing file shapes

104. Variable helical angle: Protaper files have changing helical angle and balanced pitch over their cutting blades which reduces the potential of an instrument from screwing into the canal.

105. Modified guiding tip and varying tip diameters: Protaper have modified non cutting guiding tip that helps in making the file centred in the canal while rotation and the variable tip diameters allow the files specific cutting action in defined areas of the canal, without stressing the instrument in other sections.

106. Cross section: In cross section, it shows a modified K type convex triangular design with sharp cutting edges and no radial lands that reduces the contact area between the file & dentin.

107. Triangular cross section of Shaping files Cross section of Finishing files

108. Length of the file handle It was reduced from 15 mm to 12.54 mm to allow for better access in difficult posterior areas, which could compromise the treatment result. The files are available in 21 mm and 25mm lengths. Short Handle

109. All protaper shaping files have a progressively increasing taper . SX (D0 to D9) – 3.5% to 19%. S1 (D1 to D14) – 2% to 11%. S2 (D1 to D14) - 4% to 11.5% The finishing files have fixed taper in first 3 mm , D0-D3. F1 – 7% F2 – 8% F3 – 9% F4 – 5% F5 – 4%

110. Shaping instruments Auxiliary Shaping instrument (SX) Golden coloured handle (without any color identification ring, without length ring)

111. Length – 19 mm – shortest (makes access easier in difficult, restrictive areas) Modified, guiding tip D0= 0.19 mm D14 = 1.2 mm D0-D9 – the rate of taper progression is more than in S1, S2 Constant taper of 2% between D9 and D14. Different, progressive tapers 3.5-19% between D0 and D9. D6, D7, D8, D9 – approximate diameter of 0.5, 0.7, 0.9, 1.10 similarly with the GG series

112. The S1 and S2 start at tip sizes of 0.17mm and 0.20 mm respectively and each file gains in taper up to 1.2mm. But unlike the consistent increase of taper per millimeter in the ISO instruments, the ProTaper Shapers have increasingly larger tapers each millimeter over the 14mm blades. This is what makes the instrument unique.

113. Shaping file S1 is designed to prepare the coronal one third of the canal. Shaping file S2 enlarges and prepares the middle third and progressively enlarges the apical third.

114. Finishing instruments The three finishing F1, F2, F3 + 2 Accessory finishing files F4, F5 have been designed to plane away the variation in canal diameter in the apical one third. The finishing files ( Fl, F2, and F3) are marked with a yellow, red, and blue identification ring, respectively and have tip diameters of 0.20, 0.25 and 0.30 mm, respectively. The finishing files have non-cutting tips. F 1 finishing file (size 20) Initial taper of .07 from D1 to D3 Decreased taper of 5.5% from D4 to D14 Maximum flute diameter: 1.13 mm F2 finishing file (size 25) Initial taper of .08 from D1 to D3 Decreased taper of 5.5% - 6.0 % from D4 to D14 Maximum flute diameter: 1.2 mm

115. F3 finishing file (size 30) Initial taper of .09 from D1 to D3 Decreased taper of 5.0% - 7.0% from D4 to D14 Maximum flute diameter: 1.2 mm

116. Technique: Initially 10 or 15 size hand file is used to negotiate the patency of the canal. The working length is established following routine procedures. Coronal shaping is carried out with SX. S2 and S1 are inserted to prepare middle half. They can be carried to apical preparation also. Apical preparation is done with finishing files.

117. Protaper Retreatment files

118. The K-3 rotary Nickel Titanium file system

119. K3 system The K3 system was designed by Dr. John McSpadden . K3 system includes K3 files and K3 body shapers. The files are available in taper 0.02, 0.04 & 0.06, whereas body shapers have taper 0.08, 0.10 & 0.12. Speed: 300-350

120. Characteristic features: A slight positive rake angle provides a more effective cutting surface. A variable core diameter enhances flexibility over the entire cutting length.

121. 2 A series of 3 radial lands with a relief behind 2/3 radial lands to reduce friction on canal walls. Asymmetric flutes of K3 file provides superior canal tracking. A safe ended cutting tip .

122. Simple color coding to distinguish between different tip sizes and tapers

123. Technique: K3 body shapers are used to enlarge coronal one third of the root canal. The initial chosen body shaper is followed by successively smaller body shaper. Used in succession, k3 files may take the operator to the junction of middle & apical third. The apical area is explored first with hand instrument to determine the apical canal diameter, curvatures, calcifications, patency and ease of negotiation.

124. After true working length is established, a glide path for subsequent k3 is established to approximate size of 15 or 20 K files. K3 files are introduced with larger to smaller tip sizes till working length is reached.

125. RACE -Rotary Alternating Cutting Edge Technology

126. RACE SYSTEM The RaCe stands for R eamers with A lternating C utting E dges. The RaCe was manufactured by FKG and was later distributed in the United States by Brasseler (Savannah, GA). In 1999 , 10 years after the first NiTi instruments were introduced, the RaCe (Reamer with Alternating Cutting Edges) system became available.

127. Characteristics:   1. Cutting edges: They have alternating cutting edges . The exclusive patented file design avoids screwing‑in effect and allows a better control of the instrument’s progression.

128. 2. Cross-Section: Triangular cross-section with sharp edges. Cuts better and faster , without any pressure The smaller core grants a higher flexibility and allows a better progression in curved canals. More space for debris removal , improving debris evacuation to avoid instrument blocking.

129. 3. Tip: Exclusive rounded safety tip. Perfect centering of the instrument in the canal Bypasses irregularities. Less risk of perforations and ledges.

130. 4. Electrochemical polishing: Enhanced resistance against fatigue and corrosion. The treatment eliminates surface imperfections , reducing drastically the risk of weak points ( microcracks ). The resulting shiny surface allows better cleaning and disinfection.

131. 5. Silicone Endo stop: ISO Colours - to indicate instruments' length. Speed : 500-600 rpm. Torque: 1 Ncm This instrument is available in 0.02, 0.04, 0.06, 0.08 and 0.10 taper design. The two largest files are also available in stainless steel.

132. 5. Safety Memo Disc:   Quantifies usage and stress to minimize overuse and metal fatigue. Most instrument separations are avoided. Identifies file taper and eight removable petals are available, which indicate the number of use.

133. To master metal fatigue and number of uses, follow the instructions for petals removal of the SafetyMemoDisc (SMD): 1 petal corresponds to Simple cases, that is, straight, slightly curved and/or wide canals. 2 petals correspond to moderately complex cases, that is, more curved or narrow canals. 4 petals correspond to complex cases, that is, canals with extreme curvature or S-shaped, very narrow or calcified. Discard the instrument when all petals have been removed

134. The manufacture has provided the gadget which measures the curvature of the root canal. Only three types of curvatures are recognized, simple, medium and difficult. The gadget is placed over the pre-operative radiograph & coinciding curvature is noted.

135. The colour of SMD denote the following tapers: Yellow : 2% ( RaCe ) and 10% ( Pre RaCe ). Black : 4% ( RaCe ) and 8% ( Pre RaCe ). Blue : 6% ( RaCe and Pre RaCe ).

136. Technique: Preferred sequence that applies to most root canals is as follows: Pre Race: .08 # 35 Crown Down Pre Race: .06 # 30 Crown Down Electronic measurement of root canal length using an apex locator followed by verifying radiograph. Create a glide path to the working length with a stainless steel file #15. Race : .04 # 25 Crown Down Race : .02 #30 Apical preparation Race : .02 # 35 Apical preparation If necessary, additional Pre- Race (.10 # 40) for enlargement of the root canal entrance or further Race ( .02 # 40-60) for apical preparation.

137. FlexMaster

138. FLEXMASTER Manufactured by: VDW It features 0.02, 0.04 and 0.06 tapers. Tip diameters are 0.15 to 0.7 mm for .02 instruments and 0.15 to 0.4 mm for size .04 and 0.6 taper. In addition to the standard set, the Intro file, which has a 0.11 taper and a 9 mm cutting part is available. Speed: 150-300 rpm.

139. Characteristics: The cross sections have a triangular shape with sharp cutting edges and no radial lands. They have rounded passive tips. It has individual helical angle for each instrument size.

140. The manufacturer provides a system box that indicates sequences for narrow, medium size, and wide canals.

141. Technique:

142. Mtwo NiTi System

143. M two Manufactured by: VDW The initial set includes four instruments with variable tip sizes ranging from size 10 to size 25 and taper ranging from .04 to .06. Speed: 300 rpm. Speed: 300 rpm .

144. Characteristic featur e: Coding ring on handle identifies the size. Number of grooved rings on handle identifies instrument taper (1 ring - .04 taper, 2 rings - .05 taper, 3 rings - .06 taper and 4 rings - .07 taper). 1 Ring .04 taper Bands(size) BASIC SEQUENCE FILES (10/.04 , 15/.05, 20/.06, 25/.06)

145. Helical angle is variable. The instrument cross-section, shows the two blade cutting surfaces resulting in an “Italic S” design. Non cutting tip minimizes ledges and transportations.

146. Technique: The glide path is established using small stainless steel K files. The technique employed with Mtwo is designated as simultaneous technique where by crown to apex preparation protocol is followed along with use of smaller instruments before use of larger instruments as is carried out in step-back technique.

147. M two Retreatment files: Mtwo ® retreatment files are designed specifically for removal of root canal filling material. Retreatment of carrier-based fillings (e. g. GuttaMaster ®, GUTTAFUSION®) is also possible. The retreatment files offer the following design features: a cutting tip and a constant helical angle which ensure the instrument‘s easy progression into the gutta-percha filling without the need to exert pressure. Retreatment file with cutting tip

148. Mtwo retreatment files come in two ISO sizes i.e. 15 and 25 with a taper of 0.05. These files have cutting tip for removing gutta-percha fillings. They have a length of 21 mm and working part of 16mm. Recommended speed is 250 - 350 rpm.

149. TWISTED FILE SYSTEM

150. Twisted file In 2008, SybronEndo presented the first fluted NiTi file. Manufactured by plastic deformation , a process similar to the twisting process that is used to produce stainless steel K-files. According to the manufacturer, a thermal process allows twisting during a phase transformation into the so called R-phase of nickel-titanium. The unique production process is believed to result in superior physical properties.

151. TF comes in 5 tapers, .12, .10, .08, .06, .04. All of these tapers have a #25 size tip diameter. TF is packaged in “Large” pack assortments (.10, .08 and .06) and “Small” pack assortments (.08, .06, .04) as well as the individual tapers. TF now also available in larger apical sizes: 30, 35 and 40. Speed : 500 rpm.

152. Characteristic features: Triangular cross-section Variable pitch Safe-ended non-cutting pilot tip One-piece design (the file is made from one piece of metal, the handle is not crimped on the nickel titanium shaft of the instrument) Laser marks Large color bands Special Surface Conditioning

153. Technique: A conventional crown – down technique after securing a glide path with size 15 K file. Specifically for large canal, tapers .10 to .06 should be used, and in small canal tapers .08 to 0.04 are recommended.

154. Newer rotary systems

155. SELF ADJUSTING FILE SYSTEM

156. Self Adjusting File Self-Adjusting file introduced in 2010 is a novel system among the nickel-titanium files operating in a different manner. It is operated with a modified KaVo handpiece that generates in-&-out vibrations with 5000 vibrations per minute & 0.4 mm amplitude. The overall concept is that the compressed file will adapt itself to the root canal walls, applying a uniform cutting action, gradually removing a uniform dentin layer from the canal walls.

157. The unique feature of this file is that it adapts to the shape of the canal not only longitudinally, as every NiTi file does, but also to the cross-section of the canal. Consequently the basic shape of the root canal is preserved.

158. SAF file allows for continuous irrigation throughout the procedure. The irrigation is performed continuously during the operation used a special irrigation apparatus (VATEA Irrigation Device, ReDent -Nova). A special irrigation device is attached by a silicon tube to the irrigation hub on the shaft of the file and provides continuous irrigation flow at a low pressure and at flow rates of 1 to 10 mL /min.

159. The SAF is either 1.5 or 2.0 mm in diameter composed of 120- mm-thick nickel-titanium lattice. The 1.5-mm file may easily be compressed to the extent of being inserted into any canal previously prepared or negotiated with a # 20 K-file. The 2.0-mm file will easily compress into a canal that was prepared with a #30 K-file

160. Characteristic features: A hollow file; Elastic; Compressible; Made of nickel-titanium lattice with slight abrasive surface.

161. The SAF is used as a single instrument to achieve complete 3D root canal shaping, cleaning and Irrigation. Compression  The hollow design enables the SAF to be elastically compressed along its cross section when inserted into a canal previously negotiated with a no. 20 K file.

162. Gradual Expansion : Attempting to expand, the SAF applies light continuous pressure along the entire circumference of the root canal wall.

163. Safety in Use : Safety in Use High Durability : No File Separation. The SAF is available in three standard lengths: 21mm, 25mm and 31mm

164. ONESHAPE FILE SYSTEM

165. One shape Quality root canal shaping with one single instrument with remarkable design. Availabe in size 25 mm and 6% taper. Speed : 400 rpm.

166. The instrument presents a variable cross-section along the blade. The first zone presents a variable 3-cutting-edge design. The second, prior to the transition, has a cross-section that progressively changes from 3 to 2 cutting edges. The last (coronal) is provided with 2 cutting edges.

167. Technique: ENDOFLARE® Efficiently removes coronal constraints, improves access to canal entrances and facilitates the insertion of preparation instruments .

168. If the glide path development with a K-File until 15 is not possible, use the G-Files™ (G1+G2) to establish the glide path and to achieve the estimated working length. Then determine the working length with a K-File n°15.

169. G files: The G-Files™ are rotary NiTi files that safely enlarge the glide path in preparation for RCT with rotary instrumentation systems.

170. HYFLEX SYSTEM

171. Structure of nickel–titanium: The crystal structure of NiTi alloy at high temperature ranges (100°C) is a stable, body- centred cubic lattice which is referred to as the austenite phase or parent phase. When it is cooled through a critical transformation temperature range (TTR), the alloy shows dramatic changes in its modulus of elasticity (stiffness), yield strength and electric resistivity. By reducing or cooling the temperature through this range, there is a change in the crystal structure which is known as the martensitic transformation

172. The martensitic phase , gives rise to twinned martensite . The martensite shape can be deformed easily to a single orientation by a process known as de-twinning to detwinned martensite The deformation can be reversed by heating the alloy above the TTR (reverse transformation temperature range. The alloy resumes the original parent structure and orientation as the body- centred cubic, high temperature phase termed austenite with a stable energy condition. RTTR

173. This phenomenon is termed shape memory. Figure:Diagrammatic representation of the shape memory effect of NiTi alloy .

174. Hyflex CM Hyflex is a new NiTi rotary file for root canal preparation that has been commercialized since 2011 . HyFlex ® Controlled Memory NiTi files have been manufactured by Coltene Endo , utilizing a unique process that controls the material’s memory, making the files extremely flexible but without the shape memory of other NiTi files.

175. No Rebound + Extreme Flexibility = Superior Canal Tracking 58 No Rebound + Extreme Flexibility = Superior Canal Tracking Standard NiTi File Material Hyflex CM NiTi file Material

176. HyFlex NiTi have a built-in shape memory. They prevent stress during preparation by changing their spiral shape. They regain their shape after heat treatment. A normal autoclaving process is enough to return the files to their original shape and to regenerate the crystal structures and resistance to fatigue.

177. The shape and strength of files with straightened spirals can be restored during autoclaving and reused.

178. HYFLEX® CM NiTi Files come with a recommended sequence of 4-6 files depending on the size of the root canal. The HyFlex ™ CM set with 6 Instruments of the following sizes:- Speed: 400 rpm Torque: 2.5 N cm File Size Taper 1 25 .08 2 20 .04 3 25 .04 4 20 .06 5 30 .04 6 40 .04

179. Cross section: Hyflex files have triangular cross section.

180. Canal preparation method:- HYFLEX® CM Files may also be used with Crown-down and Step-back techniques.   Coronal patency: After gaining straight-line coronal access, assess working length (WL) with an electronic apex locator and create an apical glide path to a K file 02/20 hand file size.

181. Step 1 : Start with the 08/25 file. Use as an orifice opener. Move slowly forward without pressure in a pecking motion. Once resistance occurs, go to step 2. Check patency with 02/20 hand file. Irrigate and lubricate. Step 2 : Use the 04/20 file for anatomical inspection to the WL. Move slowly forward without pressure in a pecking motion. If resistance occurs, use a 02/20 hand file to check patency. Irrigate and lubricate.

182. STEP 3: Insert 04/25 file for apical enlargement to the Working Length. STEP 4: Use the 06/20 file to shape middle part of the root canal.

183. STEP 5: Take 04/30 file to Working Length to enlarge the apical part of the canal. STEP 6: Finish treatment with 04/40 file to Working Length.

184. Optional step: In Step 1, if WL is reached in large canals, it may be possible to go directly to Step 4.

185. HyFlex ® EDM Electrical Discharge Machining The new HyFlex EDM files constitute the 5th generation root canal files. HyFlex EDM NiTi files have completely new properties due to their innovative manufacturing process using electric discharge machining. Workpieces are machined in the EDM manufacturing process by generating a potential between the workpiece and the tool. The sparks generated in this process cause the surface of the material to melt and evaporate.

186. This creates the unique surface of the new Niti files and makes the HyFlex EDM files stronger and more fracture resistant. This entirely unique combination of flexibility and fracture resistance makes it possible to reduce the number of files required for cleaning and shaping during root canal treatments. Just like HyFlex CM files, HyFlex EDM files have the already familiar controlled memory effect (CM). This results in very similar properties in terms of material flexibility and regeneration .. Up to 700% higher fracture resistance

187. HyFlex™Introkit Compact

188. WAVE ONE SYSTEM

189. Wave-one The new WaveOne NiTi single-file system has been recently introduced by Dentsply Maillefer in 2011 . . The system is designed to be used with a dedicated reciprocating motion motor is a SINGLE-use, SINGLE-file system to shape the root canal completely from start to finish. The specially designed NiTi files work in a similar but reverse “balanced force” action using a pre-programmed motor to move the files in a back and forth “reciprocal motion”.

190. The files are manufactured using M-Wire technology, improving strength and resistance to cyclic fatigue. At present, there are three files in the WaveOne single-file reciprocating system available in lengths of 21, 25 and 31mm.

191. The WaveOne Small file is used in fine canals. The tip size is ISO 21 with a continuous taper of 6%. 2. The WaveOne Primary file is used in the majority of canals. The tip size is ISO 25 with an apical taper of 8% that reduces towards the coronal end. 3. The WaveOne Large file is used in large canals. The tip size is ISO 40 with an apical taper of 8% that reduces towards the coronal end.

192. Characteristic features: The instruments are designed to work with a reverse cutting action. All instruments have a modified convex triangular cross-section at the tip end and a convex triangular cross-section at the coronal end. WaveOne apical cross-section, modified convex triangular WaveOne coronal cross-section, convex triangular.

193. The tips are modified to follow canal curvature accurately. The variable pitch flutes along the length of the instrument considerably improve safety. The tips are non cutting modified to follow canal curvature accurately. The variable pitch flutes along the length of the instrument considerably improve safety.

194. All brands of NiTi files can be used with the WaveOne motor, as it has additional functions for continuous rotation. However, as WaveOne files have their own unique reverse design, they can ONLY be used with the WaveOne motor with its reverse reciprocating function. Speed and Torque: Speed : 300 rpm Torque : 5Ncm

195. FILE SELECTION: Which Waveone file to use for preparation??? This id decided by inserting a 10 – K file into the canal using a glide path. If 10 – K file is very resistant, than use small Waveone file. If 10 – K file moves to the full canal length easily, is loose or very loose, then use primary Waveone file. If the 20 – K file or larger goes to the canal length, use large Waveone file.

196. Obturation of the root-canal system is the final step of the endodontic procedure. The WaveOne system includes matching paper points, gutta-percha points and Thermafil WaveOne obturators . The matching gutta-percha points can be used in conjunction with the Calamus Dual 3-D Obturation System.   Paper points Gutta-percha points Thermafil WaveOne obturators

197. WAVEONE GOLD With WaveOne ® Gold, DENTSPLY Tulsa Dental Specialties promotes a comprehensive treatment solution and optimizes predict able, successful outcomes.

198. PROTAPER NEXT SYSTEM

199. PROTAPER NEXT PROTAPER NEXT™ is the successor to the PROTAPER UNIVERSAL system, which has been the gold standard in endodontics for many years. The convergence of a variable tapered design on a given file ( ProTaper Universal), innovative M-Wire technology , and a unique offset mass of rotation.

200. Off-centred, rectangular cross section giving the files a unique, snake-like swaggering movement. This improved action creates an enlarged space for debris removal, optimises the canal tracking and reduces binding.

201. M-Wire technology : Improves the resistance to cyclic fatigue by almost 400% when comparing files of the same tip diameter, taper and cross-section. Offset mass of rotation : Asymmetrical rotary motion and, at any given cross-section, the file only contacts the wall at 2 points.

202. X1, X2, X3, X4, and X5 Corresponding to sizes: 17/04, 25/06, 30/07, 40/06, and 50/06, respectively . Recommended speed is 300RPM with a torque from 4-5.2Ncm.

203. NEONITI SYSTEM

204. NEONITI SYSTEM Recently a new file system, NeoNiTi ( Neolix , France), has been introduced. It is made of NiTi alloy and is intended for the root canal treatment till the apex. The NeoNiTi file system ( Neolix , France) is an efficient file system to shape the root canal completely to a continuously tapering funnel shape.

205. This file has been developed using a newly developed wirecut electrical discharge machining (EDM) process. This manufacturing process entails the melting, evaporation and ejection of material within a dielectric field. EDM naturally produces a rough surface on the workpiece , resulting in abrasive properties that greatly enhance the cutting speed of the NiTi rotary files.

206. Characteristic Feature: It has non- homothetic rectangular cross section. Neolix rotary files have a progressive flexibility to better negotiate the curves and respect the canal anatomy. The built-in abrasive properties of the flutes and edges associate a greater and cutting action, avoiding smear layer risk

207. Available as: This file system consist of two files NeoNiTi C1 for coronal enlarging and NeoNiTi A1 for canal shaping upto the apex. NeoNiTi C1 : to widen and reposition the canal orifice. Size 25 - Length 15mm - Taper 12%   NeoNiTi A1 : to shape the canal to the apex. Size 25 - Length 25mm - Taper 8% Speed and Torque:  S peed : 350-550 rpm Torque : 1.5Ncm

208. Canal Preparation Method:

209. REFERENCES Cohen’s – Pathways of the pulp 10 th edition. Ingle’s endodontics – 6 th edition. Grossman’s endodontic practice 13 th edition. Castelucci endodontics volume 1. Design features of rotary instruments in endodontics The Journal of Ahmedabad Dental College and Hospital; 2(1), March 2011 - August 2011. Design features of rotary root canal instruments. ENDO ( Lond Engl ) 2012;6(1 ):29-39. Modern Endodontic NiTi Systems: Morphological and Technical Characteristics Part I: “New Generation” NiTi Systems. Endodotic therapy vol. 5 no. 1.

210. Nickel–titanium: options and challenges. Dent Clin N Am 48 (2004) 55–67. Endodontic rotary nickel-titanium instrument systems. Clinical Update. Vol. 25, No. 8. Fred Barbakow . The lightspeed system. The Dental Clinic of North America 48(2004) 113-135. Adam Lloyd. Root canal instrumentation with Profile instruments. Endodontic Topics 2005, 10, 151-154. Syngcuk Kim. The Profile system. Dental Clinic of North America 48(2004) 69-85. Preparation of the Root Canal System 2. Rotary Instrumentation. Quantec ™ System Brochure. L. STEPHEN BUCHANAN. ProSystem GT: design, technique, and advantages. Endodontic Topics 2005, 10, 168–175.

211. Profile GTX instrumentation technique Tulsa. http://micromega.com/anglais/produits/heroshaper/images/heroshaperlivret.pdf . http://micro-mega.com/en/hero-shaper/ www.endodonziamauroventuri.it/...Ti/ Hero %20 Apical %20-%20Brochure.pdf http://www.fkg_race_family_brochure_en.pdf . David sonntag . Flexmaster : a universal system. Endodontic topics 2005, 10, 183–186. Clifford j. Ruddle . The Protaper technique. Endodontic topics 2005, 10, 187–190

212. ARACENA, D.; BETANCOURT, P.; BORIE, E.; GUZMçN , M. & FUENTES, R. WaveOne : a simple and safe way to perform an endodontic treatment. Int. J. Odontostomat., 8(2):207-210, 2014. Dr Julian Webber et al. The WaveOne single-file reciprocating system. Roots 2011. Anurag Singhal et al. Waveone single file system. Review article. Journal of Dental Sciences and Oral Rehabilitation, July- Sept 2012. http://pdf.medicalexpo.com/pdf/neolix-sas/flyer-en-neoniti/102856-149564.html.