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Original Article

Comparison of dentinal damage induced by different

nickel-titanium rotary instruments during canal
preparation: An in vitro study
Shiwani Garg, Pardeep Mahajan, Deepa Thaman, Prashant Monga
Department of Conservative Dentistry and Endodontics, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India

Abstract
Aim To compare dentinal damage caused by hand and rotary nickel-titanium instruments using ProTaper, K3 Endo, and Easy
Aim:
RaCe systems after root canal preparation.
Materials and Methods:
Methods One hundred and fifty freshly extracted mandibular premolars were randomly divided into five
experimental groups of 30 teeth each and biomechanical preparation was done: Group 1 with unprepared teeth; Group 2
were prepared with hand files; Group 3 with ProTaper rotary instruments; Group 4 with K3 rotary; Group 5 with Easy RaCe
rotary instruments. Then, roots were cut horizontally at 3, 6, and 9 mm from apex and were viewed under stereomicroscope.
The presence of dentinal defects was noted.
Statistical analysis:
analysis Groups were analyzed with the Chi-square test.
Results Significant difference was seen between groups. No defects were found in unprepared roots and those prepared with
Results:
hand files. ProTaper, K3 rotary, and Easy RaCe preparations resulted in dentinal defects in 23.3%, 10%, and 16.7% of teeth,
respectively. More defects were shown in coronal and middle sections, and no defect was seen in apical third.
Conclusion The present study revealed that use of rotary instruments could result in an increased chance for dentinal defects
Conclusion:
as compared to hand instrumentation.
Keywords: Dentinal damage; hand files; rotary nickel-titanium files; stereomicroscope

INTRODUCTION
Successful endodontic therapy depends upon triad of proper
diagnosis, thorough biomechanical preparation and threedimensional obturation of root canal system. Biomechanical
is one of the most important factors for successful root canal
treatment and determines the efficacy of all subsequent
procedures.[1] It is done to completely remove organic
tissue, microorganisms and debris by enlarging the canal
diameter and creating a shape that allows a proper seal.[2]
Stainless steel root canal instruments clean the canal
superficially and can create canal aberrations such as
ledges, zips, and elbows.[3] To eliminate these shortcomings
of stainless steel instruments, nickel-titanium (Ni-Ti)
instruments have been developed.
Canals prepared by rotary Ni-Ti instruments show increased
canal cleanliness and less straightening, apical canal
Address for correspondence:

Dr. Shiwani Garg, Department of Conservative Dentistry

and Endodontics, King George Medical University, Lucknow,
Uttar Pradesh, India.
E-mail: [email protected]

transportation and perforations. These benefits are because

of greater flexibility and specific design features of NiTi instruments allowing the natural canal curvature to be
maintained.[4] Rotary instrumentation also requires less time
to prepare canals as compared to hand instrumentation.[5]
Furthermore, rotary Ni-Ti instrumentation could potentially
cause dentinal defects in the walls of the canal which may act
as areas of stress concentration and crack initiation. These
Ni-Ti instruments increase the risk of dentinal damage to root
in the form of complete cracks, incomplete cracks, craze lines
or fractures. Craze lines can later propagate into vertical root
fracture (VRF) if the tooth is subjected to repeated stresses
from endodontic procedures.[6] And VRF is a significant
clinical problem which often leads to tooth extraction.[7]
However, several factors like force of instrumentation and
obturation; retreatment procedure and high concentration
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Date of submission : 25.02.2015

Review completed : 02.04.2015
Date of acceptance : 29.05.2015

302

Journal of Conservative Dentistry | Jul-Aug 2015 | Vol 18 | Issue 4

Website:
www.jcd.org.in

DOI:
10.4103/0972-0707.159730

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Garg, et al.: Comparison of dentinal damage by Ni-Ti rotary instruments

of hypochlorite may also be responsible for the formation

of dentinal defects in different degrees.[8-10] A debilitated
root, as a result of flaring and instrumentation, could suffer
VRFs during obturation procedures.[11]
The goal of this study is to compare the damage observed
in root dentin after endodontic preparations with different
Ni-Ti rotary file systems.

captured under stereomicroscope. Each specimen was

checked by for the presence of dentinal defects. Defects
were categorized as Figure 1.
No defect was defined as root dentine devoid of any lines
or cracks where both the external surface of the root and
the internal root canal wall had no defects [Figure 1a].
Fracture was defined as a line extending from the root
canal space to the outer surface of the root [Figure 1b].

MATERIALS AND METHODS

One hundred and fifty freshly extracted mandibular
premolars were selected and cleaned with periodontal
scaler and stored in purified filtered water. The coronal
portions of all teeth were removed with diamond disk,
leaving roots 16 mm in length. All root surfaces were
observed with stereomicroscope (Trinocular Stereo Zoom
Microscope, Nikon, NY, USA) under 12 to exclude cracks.
Group 1: Left unprepared and served as Group 1.
Group 2: Prepared using stainless steel K-files (Dentsply
Maillefer, Ballaigues, Switzerland) up to apical
size 25 at the working length and step-back
technique was used till file no. 60.
In the remaining three groups, canal patency was
established with a #10 K-file. Then, a size 15 K-file
was introduced into the canal until it was visible at the
apical foramen. The working length was determined
by subtracting 1 mm from this measurement.
Group 3: Prepared using ProTaper rotary system (Dentsply
Maillefer, Ballaigues, Switzerland) sequentially
at the speed of 300 rpm using a crown-down
technique. Canal preparation was finished with
F2 (25/.08) till working length.
Group 4: K3 rotary system (SybronEndo, Orange, CA, USA)
sequentially at the speed of 300 rpm using a
crown-down technique. Canal preparation was
done with file 25/.06 till working length.
Group 5: Easy RaCe rotary system (FKG Dentaire, La Chauxde-Fonds, Switzerland) sequentially at the speed
of 300 rpm. Canal preparation was done with file
25/.06 till working length.

Other defects were defined as all other lines observed

that did not extend from the root canal to the outer root
surface. For example, craze line line extending from the
outer surface into the dentine that did not reach the canal
lumen [Figure 1c], or partial crack extending from the canal
wall into the dentine without reaching the outer surface of
the root [Figure 1d].
Then, dentinal defects produced by these hand and
different rotary systems were compared with each other.
Defects at different horizontal sections in each group were
also compared.
Roots were classified as defected if at least one of three
sections showed either a craze line, partial crack or a
fracture. Results were expressed as number and percentage
of defected roots in each group.
Then, the data collected were put to statistical analysis
to compare the appearance of defected roots between
experimental groups.

Statistical analysis
The data were analyzed using statistical software
SPSS 17.0 program (SPSS Inc., Chicago). A Chisquare test was performed to determine statistically
significant difference in the appearance of defected

In all groups, each canal was irrigated with 3% sodium

hypochlorite between each instrument used in canal
preparation. In groups with preparation with rotary system,
Dolo Endogel (17% EDTA with 10% carbamide peroxide) was
used between each sequential instrument. In all groups,
EndoActivator (Dentsply Tulsa Dental, Tulsa, OK, USA) was used
with no. 25 tip for 30 s to agitate the solution vigorously to
clean the canals efficiently. All roots were kept moist in purified
filtered water throughout the experimental procedures.

Examination of roots
The roots of all the teeth were sectioned horizontally at 3,
6, and 9 mm from apex. Digital images of each section were

Figure 1: Classification of dentinal defects (a) no defect

(b) vertical root fracture (c) craze line (d) partial/incomplete
crack

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Garg, et al.: Comparison of dentinal damage by Ni-Ti rotary instruments

roots between the experimental groups. Chi-square

test was also performed to determine the defects at
different horizontal sections in each group. The level of
significance was set at P < 0.05.

RESULTS
Groups were significantly different from each other
(P = 0.007). Group 1 and Group 2 showed no defected
roots. Dentinal defects were found in the ProTaper,
K3 SybronEndo, and Easy RaCe rotary groups. But the
difference was nonsignificant among all rotary systems
used in this study [Table 1 and Graph 1]. Results showed
that nonsignificant differences were present for the
presence of dentinal defects (at coronal and middle thirds).

DISCUSSION
In this present study, dentinal defects occurred in around
10% of samples tested, and these may develop into fractures
following any additional procedure such as preparation,
obturation, and retreatment or by repeated stress of
occlusal forces. Bier et al. reported that craze lines occurred
in 4 to 16% samples.[2] Onnink et al. were the first to report
dentinal defects as a consequence of canal preparation but
only found small defects entirely within dentin that did not
communicate with the canal wall.[8]
Sectioning method using diamond disk used in the present
study could also result in dentinal defects. However,
because both the control and the hand file group did not
show any defect, we may conclude that the defects seen
were not due to sectioning procedure used.
Table 1: Comparison of number and percentage of teeth
showing defects
Defect

Control
Hand
ProTaper- K3-Rotary Easy RaCe- Total
group (%) file-K (%) Rotary (%)
(%)
Rotary (%)

Absent 30 (100) 30 (100)

Present

Total
30
30

23 (76.7)
7 (23.3)
30

27 (90)
3 (10)
30

25 (83.3) 150
5 (16.7)
15
30
150

P = 0.007

Graph 1: Comparison of defects in % (P = 0.007)

304

Irrigation done using EndoActivator (Dentsply TulsaDental)

which is a sonically driven system and comprised of a
handpiece and variously sized polymer tips, can lead to
dentinal damage of root. As in the current study, all teeth
were irrigated following the same protocol and roots
prepared with hand files did not show any dentinal defects,
we may consider that EndoActivator did not contribute to
the appearance of dentinal defects.[12]
As NaOCl being an alkaline material reacts with organic
tissue and can change the chemical structure and the
mechanical properties (elastic modulus and flexural
strength) of dentine.[10] It was observed that there was
marked decrease in microhardness of dentin when irrigation
was done with NaOCl.[13] It may affect crack propagation.
In the current study, 3% sodium hypochlorite was used for
irrigation. As all teeth were irrigated following the same
protocol and roots prepared with hand files did not show
any dentinal defects, we may consider that the irrigation
using sodium hypochlorite in this study did not contribute
to the appearance of dentinal defects seems justified.
Stainless steel hand instruments clean the canals
superficially and have also been shown to create canal
aberrations, such as ledges, perforations, zips, and elbows.[3]
But hand instrumentation does not appear to induce much
damage to root canal wall. As in this study, instrumentation
with hand files did not demonstrate damage to the root
canal wall. This is in agreement with several other studies
given by Yoldas et al.,[14] Hin et al.[15] and could be attributed
to the less aggressive movements of the hand files in the
canal compared with engine-operated files and less taper
(0.02) as compared to rotary Ni-Ti instruments.[14,15]
However, in the present study, a uniformed tapered
preparation (0.06-0.08) was attempted in all rotary
instrumentation groups. The observation that all groups
prepared with rotary Ni-Ti files showed various degrees
of damage supports the idea that greater tapered files
may generate an increased stress on the dentin wall. This
observation is supported by Sathorn et al. who concluded
that by maintaining the canal size as small as practical, a
reduction in fracture susceptibility could be expected.[16]
The amount of material removed from the root canal
depends on the shape of the rotary instrument and the
penetration depth in the canal. Because the roots prepared
with rotary files that had a taper of at least 0.06 in this
study showed defects, it should be realized that these
instruments removed more dentin as compared with hand
files that had a taper of 0.02. Furthermore, significantly
more rotations in the canal are necessary to complete a
preparation with rotary Ni-Ti files as compared with hand
files. This, in itself, may contribute to the formation of
dentinal defects.[5]

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Garg, et al.: Comparison of dentinal damage by Ni-Ti rotary instruments

File design, however, is also likely to affect the shaping

forces on the root dentin. Forces generated during
instrumentation have been linked to an increased risk of
root fracture. During preparation, a canal is shaped by
the contact between instrument and dentin walls. These
contacts create many momentary stress concentrations
in dentin. Such stress concentrations may leave dentinal
defects in which VRF can initiate. Higher stresses in the
root during instrumentation can be expected to increase
dentinal defects and thus increase VRF risk.[4]
ProTaper had 23.3% of dentinal defects as compared to
other rotary systems which was significantly different.
ProTaper rotary files are with progressive taper design which
increases stiffness and facilitates active cutting motion and
removes relatively more dentin coronally compared with
other systems.[17] ProTaper file F2 has a large taper of 0.08
which could explain the higher incidence of damage than
other tapered rotary files. Bier et al. observed cracks in
the horizontal sections of 16% of the roots instrumented
with the ProTaper system and reported that ProTaper
rotary files created more dentin damage than other rotary
instruments.[2] Liu et al. observed cracks at the apical root
surface in 25% of the roots instrumented with the ProTaper.[18]

canal preparation. Reasons may be the greater taper,

more rotations and aggressive cutting which can generate
increased stresses on the dentin wall and subsequent
formation of dentinal defects. In this study, it is seen that
ProTaper rotary system causes more dentinal damage as
compared to other rotary systems (K3, Easy RaCe).

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CONCLUSION
Although Ni-Ti rotary instruments have many advantages
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How to cite this article: Garg S, Mahajan P, Thaman D, Monga

P. Comparison of dentinal damage induced by different nickeltitanium rotary instruments during canal preparation: An in vitro
study. J Conserv Dent 2015;18:302-5.
Source of Support: Nil, Conflicts of Interest: None declared.

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