ORIGINAL ARTICLE

An in vitro comparison of root canal system

prepared with either hand or rotary instruments

Azza A Dafalla1, Neamat Hassan Abubakr2*, Yahia E Ibrahim3

1. Department of Conservative Dentistry, School of Dentistry, Africa University of Medical Science, Khartoum, Sudan
2. Department Professor of Conservative Dentistry, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
3. Department of Conservative Dentistry, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
Abstract
Introduction: The aim of the present study was to compare hand stainless steel K-files and
Nickel-Titanium Profile 0.04 taper 29 series rotary instruments for their efficiency, procedural
errors and time consumed in preparation of root canal system.
Materials and Methods: A total of 46 maxillary and mandibular first premolars extracted
for orthodontic purposes were collected (two contralateral teeth from each individual). The
samples were divided into two groups of 34 canals each. Teeth in the first group were prepared
with stainless steel hand K-files while the second groups were prepared with profile 0.04 taper
series 29 rotary files. Preparation period was recorded for both groups. Impression material was
introduced into the prepared canals so that the replica of prepared canals was achieved. These
were assessed under stereomicroscope to assess the efficiency in preparing canals in respect to
canal smoothness, ability of impression material to flow and quality of taper.Statistical analyses
were performed using t-test, Chi-square and Fishers exact tests.
Results: Results showed significantly shorter preparation time for Profile than K-file. 8.8% of
the canals prepared with K-files showed canal blockage, while all canals prepared with Profile
remained patent. Alterations in working length working distance appeared in 23.5% of canals
prepared with K-file and 11.7% in canals prepared with Profile. Failed instruments in K-files
were significantly higher, mostly deformation (P<0.001). Profiles failed instruments were in the
form of fracture and no deformation was detected. Both systems showed unsatisfactory walls
smoothness and flow.
Conclusion: Within the limitation of this study it was concluded that Profile 0.04 taper series
29 rotary systems prepare canals more rapidly, and have lower incidences of fracture and
blockages, and only limited loss of working length. Canal preparation with K-file was time
consuming and showed higher incidence of deformed instruments; overall, rotary instruments
seem to offer greater advantages. [Iranian Endodontic Journal 2010;5(4):167-73]

Keywords: Root canal preparation, K-file, NiTi rotary files, permanent teeth.

Received: 10 March 2010; Revised: 11 Jun 2010; accepted: 28 Jun 2010

*
corresponding author at: Neamat Hassan abubakr, Faculty of Dentistry, University of Khartoum,
Khartoum, Sudan. Email: [email protected]

healing (1). To improve the speed and

Introduction efficiency of the treatment stainless steel
The technical demands and level of precision instruments have been used in a variety of
required for successful performance of preparation techniques, in an attempt to
endodontic procedures have traditionally been produce the appropriate canal shape. However,
achieved by careful manipulation of hand studies have shown that procedural incidents
instruments within the root canal space and by occur commonly, producing aberrations such
strict adherence to the biologic and surgical as formation of hourglass-shaped canals, zips,
principles, essential for disinfection and elbows and canal transportation (2-4). Nickel-

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Azza A Dafalla et al.

Titanium (NiTi) rotary instruments are thought keeping the apex out of the resin. Access
to reduce such aberrations. cavities were prepared; working length (WL)
Furthermore, NiTi instruments maintain the of each canal was determined by introducing
original canal shape during preparation and a size 10 K-file into the canal until it was just
have a reduced tendency to transport the apical visible at the apical foramen; WL was taken
foramen (5-7). With all these apparent 1mm short of this point. Subsequently,
advantages, the use of NiTi rotary systems has instrumentation was performed. For canal
increased considerably since their preparation in group 1, modified double flare
introduction. However, their cost, instrument technique by stainless steel K-files was used.
fracture (8-10) and their tendency to straighten Instrumentation started with size 15 file then
in severely curved canals leading to loss of enlarged to size 45 as the master apical file.
original canal shape (11-14) are notable Copious irrigation with 2.5% NaOCl (hyposol,
disadvantages. Although few studies have ST Decon Labs, Inc, USA) was used
been carried out into the shaping ability of throughout the preparation and patency was
rotary NiTi files, they have been shown to be maintained in all the canals by recapitulation
faster than hand preparation, potentially using a size 15 K file.
reducing patient and dentist fatigue (11,15,16). In group 2, teeth were instrumented with profile
Recently there had been a total shift from 0.04 taper 29 series rotary instruments. The
manual root canals preparation to rotary instruments were used according to
instrumentation due to its accuracy and shorter manufacturer instructions in a torque controlled
preparation time. On the other hand, the motor and handpiece (Endo-Mate DT. NSK,
conventional hand instruments are still Japan). The Profile instruments were used in a
commonly used for canals preparation in crown-down technique. Commencing with a
dental schools and general dental practices. size 4 Profile 0.04 Taper, the instrument was
The aims of the present study are to assess used at 280-300 rpm with a slow apical
efficiency of one of the rotary instruments and progression to 1/2-2/3 of the estimated length of
to compare it with hand stainless steel K-files the canal. The process was repeated with a files
for their efficiency, procedural errors and time size 5, 6 and 7. A size 3 file was then used to
consumed in preparation of root canal system. reach 2/3-3/4 of the estimated length of the
canal. The definitive WL was then determined
Materials and Methods with a size 10 K-Flex file. A size 3 file was
used to reach the WL and the canal was
Bilaterally premolars extracted for sequentially enlarged so that a size 7 file
orthodontic reason were collected and reached the WL. The definitive WL was then
immediately stored in 10% formalin solution determined with a size 10 K-Flex file. Copious
(17,18).The teeth were with complete apex irrigation was used throughout the procedure
formation and showed total of 68 canals. with 2.5% NaOCl. Patency filing was checked
Canals curvature was measured according to at the end of the instrumentation procedure. In
Schneider (19). It measures the degree of the all groups a new set of files was used to
curvature in order to categorize root canals as instrument five teeth and then discarded.
straight (5 curvature or less), moderately The internal three-dimensional shape of all
(10-20) or severely curved (>20). Samples canals was determined from intracanal
were randomly divided into two experimental impressions. A small amount of canal
groups. Each group had a total of 34 canals. lubricant, RC-prep (Premier Products Co.
Group 1 was prepared by conventional USA) was introduced into the canal lumen.
methods with stainless steel hand K files Light bodied condensation silicone impression
(Mani, Japan) and group 2 with the rotary material (Oranwash Zhermack, Badia
method using NiTi Profile 0.04 taper 29 Polesine, Italy), was injected carefully into
series (Dentsply, Tulsa Dental, Tulsa, OK, each canal, and followed by the introduction
USA). All teeth were embedded in acrylic of a fine barbed broach (Mani, Utsunomiya,
resin blocks (Egypharma, Cairo, Egypt) Tochigi, Japan) to act as a support for the

168 IEJ -Volume 5, Number 4, Fall 2010

 Hand and rotary root canal preparation

Figure1. Comparison of canals means Figure2. Comparison of instruments failure

preparation time between K-file and profile 0.04 between K-file and Profile in canals reparation
taper (rotary)

preparations and mean time of 07:213:04

SD for rotary Profile preparations, which was
statistically significant (P=0.02).
Canal blockage:
In hand prepared canals using K-file the results
have shown that 3 canals (8.8%) were blocked
by debris. Following rotary instrumentation
Figure3. Final canal impressions for single with profile system, all the 34 canals
rooted and double rooted first premolars
remained patent (P=0.11) (Table 2).
Change of working distance:
coronal part of the impression and to facilitate In hand preparation method, eight canals
removal. The impressions of the prepared (23.5%) were associated with loss of working
canals were removed and assessed under the length due to canal blockage.
40 magnification of stereomicroscope Instruments failure:
(Micros, Austria) using Abou-Rass and Jastrab Hand preparations with K-file showed total of
criteria (20) (Table 1). 19 failed instruments, 18 of them (94.7%)
Other factors were also recorded i.e. were permanently deformed and only one
preparation time, canal blockage, loss of instrument (5.3%) was fractured. Rotary
working distance and instruments failure. preparation with Profile system reported two
Software of Statistical Package for Social canals with instruments fracture (failure) of
Sciences (SPSS) was used to analyze the data at files size 3 and size 5. These two canals
a confidence level of 95%, using unpaired t-test showed curvature of 40 at 8mm from the
for preparation time analysis, Chi square and orifice. No deformed instrument was reported
Fishers exact tests for canal form analysis. (Figure 2). Hand instrumentation showed
Differences were considered significant when 90.5% failure (18 files deformed) compared
the probabilities were equal or less than 0.05. to 9.5% (2 files fractured) failure occurred in
Profile 0.04 file. The difference was highly
Results significant (P<0.001).
Canal form:
Preparation time: Quality of prepared canal was assessed from
There was a significant difference between the intracanal impression (Figure 3). Table 3,
the two methods in term of preparation time showed the quality of the apical stop,
(Figure 1). Canal preparation time measured smoothness of the canal; together with the
in minutes and seconds showed a mean time presence and absence of vertical grooves,
of 10:023:34 SD for hand K-files flow and taper of the assessed canals.

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Azza A Dafalla et al.

Table1. Categorization of canal form

Canal form Categorization
Apical stop Absent, poorly defined, well defined
Apical half smoothness Poor, good
Coronal half smoothness Poor, good
Horizontal/longitudinal grooves Absent, present
Good (continuous blending of the canal from orifice to apical stop), poor
Flow
(abrupt changes in direction and the presence of ledges)
Taper Good (conical shape), poor (hourglass or cylindrical shapes)

Table2. Canal blockage with debris following Table 3. Assessment of canal form from
instrumentations with K-files and Profiles intracanal impression
Canal status K-file Profiles Category K-file Profiles P-value
Apical stop 10 (29.5%) 14 (41.2%) 0.38
Blocked 3(8.8%) 0 Apical
12(35.3%) 15(44.1%) 0.310
Patent 31(91.2%) 34(100%) smoothness
Total 34 34 Coronal
20(58.8%) 33(67.7%) 0.308
smoothness
Discussion Horizontal and
18(53%) 19(56%) 0.5
vertical grooves
Bilaterally extracted humans first permanent Flow 18(53%) 17(50%) 0.50
premolars were used in this study. Previous Taper 22(64.8%) 14 (41.2%) 0.044
studies used simulated canals constructed in
clear resin block with standardization of inherent metal stiffness which is confounded
degree, location and radius of root canal by instruments design and canal shape (24,29).
curvature, this guaranteed high degree of In the present study, the time taken to prepare
reproducibility and standardization of the the canals with K-file was significantly longer
experimental design in assessment of with K- than that taken by the 0.04 taper Profile. Many
files and Profiles prepared canals preparation studies reported more rapid preparation for
procedures and instruments performance. rotary instruments than hand ones (13,30,31);
However, regarding micro-hardness and while other studies have shown no difference
abrasiveness of acrylic resin when compared (32-35). It is likely that working time is
to dentin, it has been expressed that dentin more dependent on operator factors and the
usually requires double the preparation forces used preparation technique rather than the
(21,22). In this study, extracted human teeth instruments themselves. Mesgouez et al.
were used to simulate the clinical situation. reported that time required for canal
The ProFile series has been set as the gold preparation with Profile was inversely
standard (23) of NiTi rotary instruments. Some related to operator experience; the
investigations have reported that rotary NiTi inexperienced operator demonstrated a
instruments do not clean root canal walls significant linear regression between canal
effectively, particularly the apical part of number and preparation time (36). Overall,
curved canals (24,25). Additional concern has NiTi rotary preparation is efficient to reduce
been expressed about the comparatively high patient and operator fatigue whilst providing
incidence of fractures in rotary NiTi safe handling of instruments in the
instruments (26). On the other hand, shaping handpiece (37). Stainless steel K-files
of curved canals with stainless steel K-files showed significantly higher incidences of
manipulated in a linear filling motion proved a instruments failure. This high deformity may
satisfactory method to maintain the original be due to the low modulus of elasticity of
canal curvature (27). the material that makes it bend within canals
Stainless steel files were well known for (31). The Profile instruments showed failure
creating aberrations in canals (28), but it in the form of fracture; only two instruments
appeared that this was the result of their were fractured without prior evidence of

170 IEJ -Volume 5, Number 4, Fall 2010

 Hand and rotary root canal preparation

plastic deformation at the fifth use (38). Thompson reported that Profiles produced
Findings in this study were in contrast to Al- tapered preparation in all of the specimens
Omari et al. who reported that the larger prepared in study and positive
Profiles size were associated with more characteristics are presumably a reflection
deformation contrary to what was noted with of their planing action during rotation; such
stainless steel files (39). However, the low a canal shape would appear to facilitate
incidence of profile instruments fractures obturation (44).
was also reported by Defoire et al. who
suggested its continuous use in root canal Conclusion
treatment even by dental students in
laboratories, if preventive methods are used Profile 0.04 series 29 rotary systems prepare
(40,41). Yared et al. demonstrated that canals more rapidly, and showed low
ProFile 0.04 instruments were safe to be incidences of blockage, and only limited loss
used without any fracture with low-torque of working length. Canal preparation with K-
and high-torque motors (42). file was time consuming and showed higher
This study showed an overall change in incidence of deformed instruments probably
working distance in both samples prepared due to low elasticity of the stainless steel
with K-file hand instruments and Profile metal. Both systems showed unsatisfactory
rotary instruments and it was noted that loss results for canal walls smoothness and flow,
of working distance was associated with but K-files showed better canal tapering.
increased canal curvature. Al-Omari et al.
reported that with stainless steel hand
instruments, length was lost following Conflict of Interest: none declared.
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