Endodontic Topics 2005, 10, 151154

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Copyright r Blackwell Munksgaard

ENDODONTIC TOPICS 2005
1601-1538

Root canal instrumentation with

ProFilet instruments
ADAM LLOYD
The history behind the introduction of rotary nickeltitanium instruments of increasing taper is outlined along
with a logical sequence of crown-down canal that can be applied to a variety of cases. Clinically applicable canal
instrumentation is explained for small, medium and large canals with actual examples prepared with the same
technique.

Background
The introduction of engine-driven instruments in
tapers greater than the standard 2% taper in 1992
by Dr Wm. Ben Johnson substantially changed the
way root canal preparation was accomplished. These
instruments made it possible to create an appropriately
flared canal shape without the need for time-consuming serial stepback shaping procedures. Furthermore,
the use of the ProFile (Dentsply Tulsa Dental, Tulsa,
OK, USA) instrument sequence allowed greater
predictability in canal shape allowing earlier and deeper
penetration of irrigating solutions and increased flow
dynamics when using thermoplasticized obturation
materials, such as ThermaFil (Dentsply Tulsa Dental).

Instrument usage and design

The design of the original ProFile instruments was a
considerable departure from the ISO hand file specification because the tip size corresponded to a uniform
increase of 29% between instruments and accordingly
the nomenclature of each instrument in the series
ranged from 2 to 10. The rationale behind this
paradigm shift provided the operator with more
instruments of smaller tip size to be used in the delicate
apical anatomy, while fewer larger instruments were
necessary coronally, where flexibility is of less concern.
The series also decreased the number of instruments
used in canal preparation. These Series 29 ProFiles

(Dentsply Tulsa Dental) were introduced in 1993 with

a .04 taper, while instruments with .06 taper were
added later. In due course, a more traditional ISO
series of ProFile instruments with conventional sizes
was manufactured and marketed by Dentsply Maillefer
(Ballaigues, Switzerland) along with a series of Orifice
Shapers. The latter instruments are similar to ProFile
but, in general, have large tip diameters, shorter
cutting blades and greater tapers. More recently,
ProFile instruments with a .02 taper were introduced
to provide a comprehensive range of tapers that are
capable of dealing with most canals shapes.
The use of Series 29 instruments initially presented
some difficulties, with the non-standard tip size, the
change in the file numbering system and the use of
metallic colours designating size. These factors produced a system that had a steep learning curve and as
such Series 29 ProFiles were mostly the purview of
specialists. The introduction of ISO tip diameters
simplified their adoption to a wider range of general
dentists and specialists. The flutes of ProFile instruments have radial lands that cut radicular dentine with a
neutral rake angle, planing the walls smooth and
minimizing canal transportation. A tip with no sharp
transitional line angles further enables the instrument to
remain centred around canal curvature virtually eliminating ledge formation. The flutes are cut deep into the
core from tip to shank allowing greater flexibility at
larger cross-sectional diameters, while allowing larger
amounts of debris to be removed. The cross-section of

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Lloyd
the instrument is referred to as a U-blade design, and
hence has passive cutting ability (Fig. 1).

Preparation sequence
The crown-down preparation technique recommended
today for most rotary nickeltitanium systems was

Fig. 1. SEM of ProFile instrument showing radial lands

and safe-ended tip (courtesy of Dr Ove A. Peters).

popularized by ProFile rotary instruments. Gates

Glidden drills were supplemented or replaced with
ProFile Orifice Shapers. Orifice Shapers share the same
U-blade design permitting straight-line access to the
coronal and middle thirds without encroaching on the
so-called danger zone, which may occur with Gates
Glidden drills. The use of viscous chelating agents and
Orifice Shapers can effectively extirpate the vital pulp
from the canal.
After coronal flaring with Orifice Shapers and initial
scouting of the canal shaping with the ProFile
instruments can commence. Several instrumention
sequences have been described for ProFile, including
the variable taper sequence, the variable tip sequence
and a sequence that alternates between .06 and .04
tapers. The technique described here consists of using
decreasing tip sizes and and then decreasing taper in
accordance with current recommendations by the
manufacturer (see concept box in Table 1).
The concept of bringing a predefined taper to the
canal terminus is thus realized through use of ProFile
.06 followed by .04 taper instruments. ProFile instru-

Table 1. Concept box: canal preparation using ProFile rotary files






152

Colours represent ISO instrument sizes

Lubrication with viscous chelator during canal scouting and coronal flaring
Sodium hypochlorite irrigant used throughout cleaning and shaping procedure
Use 17% EDTA during apical preparation and as rinse before canals are dried

ProFile canal instrumentation

with sodium hypochlorite throughout the remainder of
the treatment. The estimated working length (EWL) is
recorded from a well-angulated periapical radiograph
and transferred to the rubber stops of each instrument
or measured at the respective markings on the
instruments shaft.

Small canals

Fig. 2. Maxillary first molar shaped with ProFile Series

29.06 files to canal terminus. Additional flaring in palatal
canal performed with GatesGlidden drills.

Fig. 3. Canal shaping of mandibular second molar with

combination .04 and .06 ProFile Series 29 instruments.
Acute apical curve on distal canal demonstrates ability of
rotary file to negotiate such anatomical variants.

ments with a .06 taper are used to refine and ensure a

more consistent flare once the apical preparation is
complete. By using .06 and then .04 tapers, friction
between root canal walls and the rotating instrument is
reduced and taper-lock is avoided. This phenomenon is
believed to occur when the taper of the file closely
matches that of the canal, producing greater amounts
of torque on the instrument and increasing the risk of
instrument breakage.
Larger tip diameters are chosen initially to prepare
the middle and coronal third of the canal, effectively
decreasing binding of smaller instruments used later in
the sequence. It should be noted that initial canal entry
is aided by the use of a lubricant, with copious irrigation

A size 25 .06 instrument is used between 150

and 300 RPM while allowing the instrument to
progress passively into the canal. A light pecking
motion is recommended, withdrawing and advancing
the instrument until it will not proceed further and
never more than approximately 3 mm short of the
EWL. The flutes are cleaned and inspected for
unwinding. The canal is irrigated and the glide path
confirmed by recapitulating with a small hand instrument, followed by a size 20 .06 rotary instrument that
is advanced with the same technique to working length.
A size 20 .04 ProFile shapes the apical third and is
followed by a size 25 .04 instrument. Hand files are
used to gauge the cross-sectional diameter at the canal
terminus (master apical file, MAF) and confirm the
presence of acceptable taper. Final flaring is completed
with a .06 ProFile with a tip diameter one size smaller
than the hand file that bound at the working length
(MAF, see concept box in Table 1). Again, the use of a
.06 rotary instrument ensures taper in the apical third
and blends the various stages of preparation in an
attempt to create a uniform taper from orifice to apex.
A circumferential movement may be used to flare the
coronal canal third canal further for additional taper.
Examples of the kinds of taper and shape of canals
shaped with ProFile rotary instruments are shown in
Figs 2 and 3.

Other sequences
One sequence for preparation of medium and large
canals is shown in the concept box in Table 1. As stated
earlier, alternative sequences are possible and have been
advocated, including the use of a single taper throughout, varying only the tip diameter, and using the same
tip diameter but alternating the taper. In particular the
use of the five instruments with .06 tapers, ranging
from 0.4 to 0.15 mm tip diameter, is a rapid way
to shape larger and rather straight canals. In sum-

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mary, ProFile instruments with the possibility of
variation in sequences allows for variations in apical
anatomy, with the tip size chosen according to the size
at the terminus.

The Gold standard

The ProFile series has been the most widely researched
nickeltitanium rotary instrument in endodontics over
the last 10 years establishing it as the gold standard
against which others are measured.
Introduction of these rotary instruments has enabled
practitioners to provide a more predictable level of care
to patients in a more timely and reproducible manner
and has caused a paradigm shift in the way endodontic
treatment is accomplished and has raised the standard
of care.

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Further reading
1. Blum JY, Machtou P, Micallef JP. Location of contact areas
on rotary Profile instruments in relationship to the forces
developed during mechanical preparation on extracted
teeth. Int Endod J 1999: 32: 108114.
2. Kavanagh D, Lumley PJ. An in vitro evaluation of canal
preparation using Profile .04 and .06 taper instruments.
Endod Dent Traumatol 1998: 14: 1620.
3. Schrader C, Ackermann M, Barbakow F. Step-by-step
description of a rotary root canal preparation technique.
Int Endod J 1999: 32: 312320.
4. Schrader C, Peters OA. Analysis of torque and force
during step-back with differently tapered rotary endodontic instruments in vitro. J Endod 2005: 31: 120
123.
5. Yared GM, Bou Dagher FE, Machtou P. Influence of
rotational speed, torque and operators proficiency on
ProFile failures. Int Endod J 2001: 34: 4753.
6. Zmener O, Banegas G. Comparison of three instrumentation techniques in the preparation of simulated curved
root canals. Int Endod J 1996: 29: 315319.