CLINICAL ARTICLE

Step-by-step description of a rotary root canal

preparation technique

C. Schrader1, M. Ackermann2 & F. Barbakow1

1 Department of Preventive Dentistry, Periodontology and Cariology, Oral & Dental Center, Division of Endodontology, University
of Zurich, Zurich, and 2 Private practice, Zurich, Switzerland

Abstract Zurich Dental School, in a step-by-step procedure using

primarily photographs of radiographs. The intention is to
Schrader C, Ackermann M, and Barbakow F. Step-
give any interested clinician a better idea of the
by-step description of a rotary root canal preparation technique.
technique using radiographs taken from both the bucco-
International Endodontics Journal, 32, 312±320, 1999.
lingual (clinical) perspective and the mesiodistal
Clinical technique Since the introduction of projection. Basically, the technique involves preparing
nickel-titanium in endodontics, several canal the coronal portion of the root canal using Gates-Glidden
preparation techniques involving the use of rotary burs and the ProFile instruments. Only when any con-
instruments have become popular. Such engine-driven stricting coronal parts of the canals have been removed
rotary instruments rotate between 150 and is the working length established using conventional
2000 r.p.m. and may be high or low torque orientated. files. Finally, the apical part of the canal is prepared using
This paper describes one such engine-driven system only the ProFile instruments. Three clinical cases are also
called the ProFile technique. The instruments are of a briefly described, in order to illustrate the potential of the
different specification to that used for conventional technique in cases treated generally by clinicians.
endodontic files and reamers. This paper describes a
Keywords: ProFile, technique.
technique employed by the Division of Endodontology,

Introduction Preparation techniques are classified as manual or

engine-driven types. The latter frequently require the
The number of root canal treatments is increasing
use of modified handpieces, whilst sonic or ultrasonic
annually, and more than 40 million were carried out in
techniques are also available. The basic design of
the USA during 1995 (Endodontic Trends 1996 cited by
stainless steel endodontic files and reamers used
C. Ruddle). Each treatment includes canal preparation, dis-
manually was patented in 1917, and they are used
infection and obturation, with the former generally being
with either watch-winding, quarter-turn and pull, or
the most difficult and time-consuming. Procedural errors
push-pull movements. Specifications and tolerances for
occur whilst cleaning and shaping curved root canals and
files and reamers were accepted in 1976 by the ANSI/
may compromise the success. The potential for failure in
ADA after Ingle & Levine (1958) first suggested stan-
root canal treatment is aggravated by the complexity of
dardization. Subsequently, specification no. 28 for files
the root canal systems (Hess & ZuÈrcher 1925). Conse-
and reamers was again revised in 1981 and the
quently, many techniques and various instruments have
revision covered criteria such as diameter, length,
been developed in an attempt to improve the quality of
taper, stiffness, sampling and inspection procedures.
root canal treatment in curved canals.
Almost all files and reamers had a 0.02 taper, implying
that they increased in diameter by 0.02 mm every mm
Correspondence: Dr Fred Barbakow, Oral & Dental Center, Department
of Preventive Dentistry, Periodontology and Cariology, University of further from the tip of the file. In 1985, Roane et al.
Zurich, Plattenstrasse 11, CH-8028 Zurich, Switzerland. (1985) described the principles of the balanced force

312 International Endodontic Journal, 32, 312±320, 1999 q 1999 Blackwell Science Ltd
 Schrader et al. ProFile technique

technique using Flex-R-Files (Union Broach, Ennisville, direction and efficiency of the rotary instruments
PA, USA) to reduce apical transportation. negatively, are removed.
During the late 1980s and early 1990s, significantly Pulp chambers are usually opened whilst preparing
modified endodontic instruments were designed, tested access cavities, and when a cylindrical diamond drops
and marketed. At that time Walia et al. (1988) through the pulp chamber roof, no further cutting
described the first highly flexible nickel-titanium files. should be allowed to occur apically. The aim is to have
New geometric designs were described for cutting a direct view to the canal orifices without overextend-
heads and non-cutting shafts (Canal Master, Brasseler, ing the access cavity. Subsequently, any obstructions,
Savannah, GA, USA; and Lightspeed, Lightspeed Inc, other foreign materials and vital or necrotic pulp
San Antonio, TX, USA) (Wildey & Senia 1989). The tissues are removed from the pulp chamber before
latter have short cutting heads with three geometric entering the canals.
patterns depending on the instrument size, non-cutting When using ProFile instruments, the canal orifices
pilot tips and broad radial lands. Other instruments are enlarged and, after preparing the canals coronally,
with broad radial lands and non-cutting pilots, but the working lengths are determined. Canal orifices and
with long cutting surfaces, include the ProFile .04 the initial 2±4 mm of the canals are enlarged using
(Dentsply Maillefer, Ballaigues, Switzerland) and the Gates-Glidden burs (GGB). The procedure ensures that
Quantec (Tycom, Irvine, CA, USA) instruments. The larger volumes of disinfecting irrigants reach the canal
tapers of ProFile .04, Lightspeed and Quantec walls. Simultaneously, the vital or necrotic pulp tissue,
instruments do not conform to those stipulated by spe- with or without infecting microorganisms, is removed
cification no. 28 and the corresponding instruments before preparing the apical portion. More importantly,
have larger and/or variable tapers. clinicians have a better tactile awareness in the apical
Depending on the preferred technique, ProFile .04 third after removing all dentine constrictions from the
instruments can be used in varying sequences. This coronal part of the canal.
paper describes, step-by-step, a method to prepare an
apical stop using ProFile .04 instruments. Radiographs
Step-by-step description
taken buccolingually (clinical) and mesiodistally
(mesial) detail the steps during the canal preparation The two canals in the extracted maxillary premolar
in an extracted premolar with two canals. The had both primary and secondary curvatures and both
technique is visualized using schematic diagrams to were prepared using only ProFile .04 instruments.
clarify distances between the radiographic apex of the After preparing a standard access, the canal orifices
root and the selected working length of the root canal. were located and enlarged using GGBs whose
Although both canals were cleaned and shaped, diameters were slightly larger than the diameters of
instruments were only placed in one canal when the orifices. The pulp chamber was flooded with 5.25%
taking the radiographs. sodium hypochlorite, and initially a size 110 GGB was
used in a slow-speed handpiece (10E, Micro-Mega,
Geneva, Switzerland). The GGB progressed only 1 mm
Access
into the canal and was immediately backed out
Successful root canal treatment is influenced by (Fig. 1a). Subsequently, GGBs (sizes 090 and 070)
cleaning and shaping, disinfection and obturation. The were used, each preparing an additional 1 mm so that
access cavity affects cleaning and shaping so much the coronal 3±4 mm of the canals was shaped by GGBs
that predictable, repeatedly successful root canal (Fig. 1b). These procedures facilitate subsequent use of
therapy begins with good access cavity preparations. the ProFile instruments. After using each GGB, the
Time spent on the access cavities minimizes the time canal was irrigated with 2 mL 5.25% sodium hypo-
required for the subsequent treatment and optimizes chlorite to help flush out the accumulated debris.
the quality of canal preparation. Access cavity Before determining the working lengths of the root
preparation is all the more important when using canals, a crown-down-like technique was performed
engine-driven rotary instruments, irrespective of the using ProFile .04 instruments in an `r.p.m.-reducing'
technique. Rotary instruments can fracture and the dental handpiece. ProFile .04 instruments rotate
risk increases if the access cavity is inadequate. A good clockwise, progressing apically with a pecking motion,
access cavity ensures that dentine and enamel with distinct forward and backward movements. The
overhangs, which may influence the cutting force, backward movement takes place as soon as resistance

q 1999 Blackwell Science Ltd International Endodontic Journal, 32, 312±320, 1999 313
 ProFile technique Schrader et al.

Figure 1 Radiographs showing Gates-Glidden burs no. 110 (a) and no. 090 (b) in the buccal canal of an extracted lower
premolar taken buccolingually (left) and mesiodistally (right), detailing a step-down procedure with each bur progressing about
1 mm further into the canal than the previous bur.

is felt whilst moving the rotating instrument forwards. In the current example, the first ProFile .04
The force applied with ProFile instruments, irrespective instrument used was the size 60. This instrument, in
of their size, is no more than that required to snap a the buccal canal, attained the length shown in
sharp lead pencil point. Ignoring this simple yet basic Fig. 2(a) and it was removed from the canal as soon as
rule will unnecessarily increase the risk of instrument resistance was felt whilst the instrument was rotating
fracture. The pecking motion is crucial whilst using continually. It is important that ProFile instruments
ProFile instruments and must be continued until the enter the canals rotating constantly at their optimal
desired penetration into the canal for that particular speed (150±300 r.p.m.), remain rotating whilst in the
instrument is attained. canals, and only stop rotating once they are

Figure 2 Radiographs showing ProFile .04 instruments, sizes 60 (a) and 45 (b), in the buccal canal of an extracted lower
premolar taken buccolingually (left) and mesiodistally (right); the first two stages of the crown-down procedure are seen. Each
instrument was progressed apically until resistance was felt and then the next smaller ProFile instrument was used.

314 International Endodontic Journal, 32, 312±320, 1999 q 1999 Blackwell Science Ltd
 Schrader et al. ProFile technique

withdrawn from the canals. After removing the size 60

instrument, the canals were irrigated firstly with 2 mL
5.25% sodium hypochlorite and then flooded with
17% EDTA. At this point the next smaller ProFile
instrument, size 45, was used to prepare the canals
(Fig. 2b). Subsequently, this procedure was repeated
sequentially for the size 40 and 35 ProFile instruments,
progressing 1±2 mm apically per instrument. The
canals were irrigated with 2 mL 5.25% NaOCl and
flooded with 17% EDTA after using each instrument.
Working lengths for both canals were then
determined with size 15 K-Flexofiles (Dentsply
Maillefer). The apical stop was confirmed with
radiographs at 0.5 mm from the apical foramen
(Fig. 3). From this point, ProFile instruments, sizes 30±
15, were used, progressing apically with each
successive instrument (Fig. 4). The first ProFile
instrument to reach the predetermined working length
was the size 15 (Fig. 4b). The schematic flow chart
(Fig. 5) details the distances recorded in the buccal
canal between the radiographic apex and the tip of
each ProFile .04 instrument used.
From this point, increasing sizes of ProFile .04
instruments successively enlarged the diameter of the
apical stops. ProFile instrument sizes 20, 25, 30, 35
and 40 (Figs 6 and 7) were used in the current canals
and their positions at the working length were verified

Figure 4 Radiographs showing ProFile .04 instruments, sizes

30 (a) and 15 (b), in the buccal canal of the extracted lower
premolar taken buccolingually (left) and mesiodistally (right),
detailing the continuation of the crown-down procedure. Each
ProFile instrument was progressed apically until resistance
was felt and then the next smaller instrument was used. The
first instrument to reach the working length in this case was
the size 15 and is called the initial apical rotary (IAR). The
size 15 ProFile instrument follows the primary and secondary
canal curves.

radiographically for the current description. The last

Figure 3 Radiographs showing the position of a size 15 K-
Flexofile in the buccal canal of the extracted lower premolar
ProFile instrument used to prepare the apical stops is
taken buccolingually (left) and mesiodistally (right), detailing termed the `master apical rotary' (MAR) and in the
the required working length for the current specimen. Note current example it was size 40 (Fig. 6b).
the primary and secondary curves, which are only visible in After preparing the apical stops, the canals were
the mesiodistal view. then flared using the step-back technique. The next

q 1999 Blackwell Science Ltd International Endodontic Journal, 32, 312±320, 1999 315
 ProFile technique Schrader et al.

Figure 5 Schematic flow chart detailing the sequence in which the ProFile.04 instruments were used during the crown-down
procedure. Initially, sizes 60, 45, 40 and 35 were used, and then the working length was set using a size 15 hand K-File. Finally,
the next four ProFile instruments (sizes 30, 25, 20 and 15) were used, progressing apically until the required working length was
reached. The horizontal lines indicate the approximate depths attained by each instrument during the crown-down procedure.

Figure 6 Radiographs showing ProFile .04 instruments, sizes 20 (a) and 40 (b), in the buccal canal of the extracted lower
premolar taken buccolingually (left) and mesiodistally (right), detailing the preparation of the apical stop. Sizes 20±40 were used
at the working length, increasing the diameter of the apical stop. The last instrument used to prepare the apical is termed the
master apical rotary (MAR). The curvature on the size 40 ProFile instrument follows the primary and secondary canal curves.

larger ProFile .04 instrument after the MAR, namely In summary, the suggested technique for using
size 45, was stepped-back by 1 mm (Fig. 8a). Succes- ProFile .04 instruments is as follows:
sively larger instruments were used sequentially
without skipping a single size. During this stage each 1 Establish good access and locate canal orifices.
instrument was advanced only until a distinct 2 Prepare initial 2±4 mm of the canal using Gates-
resistance was felt and then the instrument was Glidden burs.
withdrawn from the canal (Figs 8 and 9). The last 3 Prepare coronal two-thirds using sizes 60-35
step-back ProFile instrument was size 60. Finally, the ProFile .04 instruments (crown-down).
canals were recapitulated with the MAR to ensure that 4 Determine the canal's optimal working length
the selected working lengths were maintained. using size 15 K-Flexofile.

316 International Endodontic Journal, 32, 312±320, 1999 q 1999 Blackwell Science Ltd
 Schrader et al. ProFile technique

Figure 7 Schematic flow chart detailing the preparation of the apical stop using five ProFile instruments: sizes (from left to right)
20, 25, 30, 35 and 40. The horizontal lines indicate that the instruments were sequentially used to the same working length.

Figure 8 Radiographs showing ProFile .04 instruments, sizes 45 (a) and 60 (b), used in a step-back procedure in the buccal
canal of the extracted lower premolar taken buccolingually (left) and mesiodistally (right).

5 Prepare apical part using sizes 30±15 ProFile .04 pulpitis. After taking diagnostic radiographs, standar-
instruments. dized access cavities were prepared, the canal orifices
6 Prepare apical stop using sizes 15±40 ProFile .04 were located and the canals stepped-down using GGBs,
instruments, each to working length. sizes 110, 090 and 070, as described. Subsequently,
7 Flare the canal, stepping-back with ProFile .04 ProFile .04 instruments, sizes 60, 45, 40 and 35, were
instruments, sizes 45±60. used in a crown-down fashion. The canals were
irrigated after each instrument with 2 mL 3% NaOCl
and 17% EDTA using a 27 gauge needle. Radiographs
Case reports
were taken to confirm the selected working lengths and
Three clinical cases, treated by MA, are presented as the crown-down technique was continued with sequen-
examples in which the canals were prepared with apical tially smaller ProFile .04 instruments. The first ProFile
stops as described and then obturated using laterally instrument to reach working length in all the canals in
condensed cold gutta-percha. The three teeth had the three teeth was the size 15. Apical stops were
severe caries and were diagnosed as having irreversible prepared by sequentially using ProFile .04 instruments,

q 1999 Blackwell Science Ltd International Endodontic Journal, 32, 312±320, 1999 317
 ProFile technique Schrader et al.

Figure 9 Schematic flow chart detailing, from left to right, the three ProFile instruments, sizes 45, 60 and 90, used in a step-
back procedure. The fourth ProFile instrument (size 40) is used last to recapitulate the prepared canal. The horizontal lines
indicate the approximate depths attained by each instrument during the step-back procedure Note that the size 90 ProFile
instrument was not used for this extracted tooth as the preparation by the size 60 ProFile instrument merged into the canal
shaped by the Gates-Glidden burs.

Figure 10 (a) Radiograph showing the cone fit in each of the three canals in a maxillary first and second molar in which the
master apical rotaries (MARs) for the buccal and palatal canals were shaped to sizes 35 and 45, respectively. (b) Radiograph
detailing the laterally condensed canals in the maxillary first and second molars shown in Fig. 10(a).

sizes 15±45. Figures 10(a) and (b) show, respectively, in a second maxillary molar. ProFile instrument sizes
the cone fit and final radiographs after obturating the 35 and 45 were designated as MARs for the buccal
three canals in each of the first and second maxillary and palatal canals, respectively, and the canals were
molars. The canals were laterally condensed using AH also laterally condensed.
Plus (Dentsply, De Trey, Konstanz, Germany) and
gutta-percha cones (Roeko, Langenau, Germany).
Discussion
ProFile instrument sizes 35 and 45 were designated as
MARs for the buccal and palatal canals, respectively. Se- Procedural errors (zipping, apical transportation,
quentially larger ProFile instruments were then used, elbow, etc.) are the consequences of preparing curved
each stepped back 1 mm per instrument or until a canals with files and reamers with limited flexibility.
resistance was felt, until size 60, to produce a tapered However, the use of nickel-titanium hand files has
canal. improved the quality of canal preparations in curved
Figures 11(a) and (b) show, respectively, the cone fit canals. Furthermore, the flexibility of nickel±titanium
and final radiographs after obturating the four canals enables newly designed engine-driven rotary

318 International Endodontic Journal, 32, 312±320, 1999 q 1999 Blackwell Science Ltd
 Schrader et al. ProFile technique

Figure 11 (a) Radiograph showing the cone fit in the four canals in a maxillary second molar in which the master apical
rotaries (MARs) for the buccal and palatal canals were shaped to sizes 35 and 45, respectively. (b) Radiograph detailing the
laterally condensed canals in the maxillary second molar shown in (a).

instruments to optimize the preparation of curved root 1998). Fractures of rotary instruments occur when
canals (Glosson et al. 1995, Peters et al. 1997, Short principles of the specific technique are neglected, parti-
et al. 1997). Such rotary instruments prepare curved cularly when too much pressure is used. Other reasons
canals with less transportation in the apical third and for fracture include unexpectedly complex canal
with less dentine removal coronally (Short et al. 1997). anatomy in the final 2±3 mm of the canals or insuffi-
ProFile instruments are also available in a .06 taper, ciently frequent replacement of the instruments.
and recently Kavanagh & Lumley (1998) showed that The taper of conventional instruments favours the
no significant differences were found in canal transpor- extrusion of pulpal tissue through the apical foramen
tation when using the .04 or .06 ProFile instruments. during root canal treatment. Subjectively, clinicians
The size 90 ProFile instrument was not used as the report that they suspect that greater amounts of tissue
final rotary in the case described because the step- are transported coronally when using ProFile .04
down technique using GGBs adequately prepared the instruments. Supporting this theory, Reddy & Hicks
coronal part of the canals. (1998) demonstrated that engine-driven rotary nickel±
During the last year an engine-driven rotary titanium instruments caused less debris to be extruded
system has been marketed in Europe by Dentsply apically than a manual push-pull or filing action. In
Maillefer. The European ProFile instruments have the that study, only the balanced force technique yielded
typical .04 taper, but are sized differently from those similar amounts of apically extruded debris to the
manufactured in the USA. Because of the European engine-driven rotary techniques. Beeson et al. (1998)
specifications, diameters of the apical stops are more showed that coronal flaring resulted in less apical
readily prepared to the conventional ISO sizes (35, extrusion of debris by reducing the amount of dentine
40 and 45). Sufficient scientific proof is available available to push apically. In addition, the distance of
which indicates that canals in most teeth should at the apical stop from the apical foramen influences the
least be prepared to size 35 or 40 instruments amount of extruded debris. Finally, the engine-driven
(Kerekes & Tronstad 1977, Miyashita et al. 1997). In NiTi instruments not only facilitate cleaning and
support of this, a study has shown that increased shaping of root canals, but also reduce the time
master apical file sizes improved the cleaning of root required to prepare canals compared with manual
canals (Wu & Wesselink 1995). filing techniques (Short et al. 1997).
Irrespective of the technique or the alloy used, any
rotary instrument can fracture when the modulus of
elasticity of the metal is exceeded. The frequency of References
instrument fracture has been documented for some, Barbakow F, Lutz F (1997) The Lightspeed preparation
but not all, rotary techniques, whilst wear of technique evaluated by Swiss clinicians after attending
Lightspeed instruments has been documented. (Zuolo continuing education courses. International Endodontic
et al. 1992, Barbakow & Lutz 1997, Marending et al. Journal 30, 46±50.

q 1999 Blackwell Science Ltd International Endodontic Journal, 32, 312±320, 1999 319
 ProFile technique Schrader et al.

Beeson TJ, Hartwell GR, Thornton JD, Gunsolley JC (1998) Miyashita M, Kasahara E, Yasuda E, Yamamoto A, Sekizawa
Comparison of debris extruded apically in straight canals: T (1997) Root canal system of the mandibular incisor.
conventional filing versus ProFile.04 taper series 29. Journal Journal of Endodontics 23, 479±84.
of Endodontics 24, 18±22. Peters O, Eggert Ch, Barbakow F (1997)
Endodontic trends reflect changes in care provided (1996). WurzelkanaloberflaÈchen nach Lightspeed-PraÈparation im
Dental Products Report 30, 94±8. (Cited by C. Ruddle). REM dargestellt: eine Pilotstudie. Endodontie 3, 225±31.
Glosson CR, Haller RH, Dove SB, del Rio CE, (1995) A Reddy SA, Hicks ML (1998) Apical extrusion of debris using
comparison of root canal preparations using NiTi engine- two hand and two rotary instrumentation techniques.
driven, and K-Flex endodontic instruments. Journal of Journal of Endodontics 24, 180±3.
Endodontics 21, 146±51. Roane JB, Sabala CL, Duncanson MG Jr (1985) The balanced
Hess W, ZuÈrcher E (1925) The Anatomy of the Root Canals of force concept for instrumentation of curved canals. Journal
the Teeth of the Permanent and Deciduous Dentitions. New of Endodontics 11, 203±11.
York: William Wood. Short JA, Morgan LA, Baumgartner JC (1997) A comparison
Ingle JL, Levine M (1958) The need for uniformity of of canal centering ability of four instrumentation
endodontic instruments, equipment and filling materials. In: techniques. Journal of Endodontics 23, 499±502.
Grossman LI, ed. Transactions of the Second International Walia H, Brantley WA, Gerstein H (1988) An initial
Conference on Endodontics. Philadelphia: University of investigation of the bending and torsion properties of nitinol
Pennsylvania Press, pp. 123±40. root canal files. Journal of Endodontics 14, 346±51.
Kavanagh D, Lumley PJ (1998) An in vitro evaluation of Wildey WL, Senia ES (1989). A new root canal instrument
canal preparation using ProFile .04 and .06 taper and instrumentation technique: a preliminary report. Oral
instruments. Endodontics and Dental Traumatology 14, 16± Surgery, Oral Medicine, Oral Pathology 67, 198±207.
20. Wu MK, Wesselink PR (1995) Efficacy of three techniques in
Kerekes K, Tronstad L (1977) Morphometric observations on cleaning the apical portion of curved root canals. Oral
root canals of human molars. Journal of Endodontics 3, 114±8. Surgery, Oral Medicine, Oral Pathology 79, 492±6.
Marending M, Lutz F, Barbakow F (1998) Scanning electron Zuolo M, Walton RE, Murgel CA (1992) Canal master files:
microscope appearances of Lightspeed instruments used scanning electron microscopic evaluation of new
clinically: a pilot study. International Endodontic Journal 31, instruments and their wear with clinical usage. Journal of
57±62. Endodontics 18, 336±9.

320 International Endodontic Journal, 32, 312±320, 1999 q 1999 Blackwell Science Ltd