doi:10.1111/iej.

12197

Effect of reciprocating file motion on microcrack

formation in root canals: an SEM study

V. Ashwinkumar, J. Krithikadatta, S. Surendran & N. Velmurugan

Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi University,
Maduravoyal, Chennai, Tamil Nadu, India

Abstract
Ashwinkumar V, Krithikadatta J, Surendran S,
Velmurugan N. Effect of reciprocating file motion on
microcrack

formation

in

root

canals:

an

SEM

study.

International Endodontic Journal, 47, 622627, 2014.

Aim To compare dentinal microcrack formation

whilst using NiTi hand K-files, ProTaper hand and
rotary files and the WaveOne reciprocating file.
Methodology One hundred and fifty mandibular
first molars were selected. Thirty teeth were left
unprepared and served as controls, and the remaining 120 teeth were divided into four groups. NiTi
hand K-files, ProTaper hand files, ProTaper rotary
files and WaveOne Primary reciprocating files were
used to prepare the mesial canals. Roots were then
sectioned 3, 6 and 9 mm from the apex, and the cut
surface was observed under scanning electron microscope (SEM) and checked for the presence of dentinal
microcracks.

Results The control and NiTi hand K-files groups

were not associated with microcracks. In roots prepared with ProTaper hand files, ProTaper rotary files
and WaveOne Primary reciprocating files, dentinal
microcracks were present. There was a significant difference between control/NiTi hand K-files group and
ProTaper hand files/ProTaper rotary files/WaveOne
Primary reciprocating file group (P < 0.001) with
ProTaper rotary files producing the most microcracks.
No significant difference was observed between teeth
prepared with ProTaper hand files and WaveOne Primary reciprocating files.
Conclusion ProTaper rotary files were associated
with significantly more microcracks than ProTaper
hand files and WaveOne Primary reciprocating files.
NiTi hand K-files did not produce microcracks at any
levels inside the root canals.
Keywords: dentinal microcracks, protaper files,
vertical root fracture, waveone reciprocating file.
Received 5 January 2013; accepted 16 September 2013

Introduction
The aims of the root canal preparation are to facilitate debris removal, bacterial reduction, disinfection
and filling (Yoldas et al. 2012). Vertical root fracture
and crack formation have been reported in root dentine during and after root canal shaping procedures
using NiTi instruments (Yoldas et al. 2012).

Correspondence: Vijayakumar Ashwinkumar, Department

of Conservative Dentistry and Endodontics, Meenakshi
Ammal Dental College and Hospital, Meenakshi University,
Alapakkam Main Road, Maduravoyal, Chennai, 600 095,
Tamil Nadu, India (Tel.: +91-9884450246; e-mail:
m_v_ashwin@yahoo.co.in).

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International Endodontic Journal, 47, 622627, 2014

Vertical root fracture is one of the complications of

root canal treatment that may lead to tooth extraction (Tsesis et al. 2010). During enlarging procedures,
microcracks or craze lines that form could propagate
with repeated stress application by occlusal forces,
which may result in root fracture (Yoldas et al.
2012). Bier et al. (2009) showed dentinal damage
(microcracks) in teeth that were prepared with different NiTi rotary instruments with the exception of
S-Apex rotary files (FKG Dentaire, La-Chaux-de-Fonds,
Switzerland). They found the highest defect ratio
when ProTaper was used, whereas no defect was
observed with hand files. Kim et al. (2010) reported
that rotary instrumentation significantly increased
the stress on dentine as a result of higher torque and

2013 International Endodontic Journal. Published by John Wiley & Sons Ltd

Ashwinkumar et al. Microcrack formation between instruments using SEM

increased taper of these instruments. They concluded

that file design affected apical stress and strain concentrations during root canal instrumentation resulting in vertical root fracture.
Recently, the WaveOne NiTi single-file system was
introduced (Dentsply Maillefer, Ballaigues, Switzerland) (Webber et al. 2011). This system is used with a
dedicated reciprocating motion motor. The files are
manufactured with M-Wire NiTi alloy (Dentsply
Tulsa Dental Specialties, Tulsa, OK, USA) (Johnson
et al. 2008). The WaveOne Primary file has the same
tip size and taper feature as the ProTaper F2, but with
reverse cutting blades. Several studies using WaveOne
reciprocating NiTi system showed better canal centring ability, uniform canal preparation and better
debris and smear layer removal when compared with
continuous rotary NiTi instruments (Berutti et al.
2012a,b, B
urklein et al. 2012). However, reports on
dentinal microcrack formation with WaveOne reciprocating NiTi system are absent in both straight and
curved canals.
The purpose of this study was to compare the
dentinal microcrack formation whilst using NiTi
hand K-files, ProTaper hand files, ProTaper rotary files
and WaveOne Primary reciprocating files in curved
canals. The null hypothesis was that there would be
no significant difference in dentinal microcracks produced between the groups.

Materials and methods

One hundred and fifty freshly extracted mandibular
first molars, with fully formed apices were used.
Mesial roots with 2530 curvature as determined
were selected as the experimental model (Pruett et al.
1997). The collection, storage, sterilization and handling of extracted teeth followed the Occupational
Safety and Health Administration (OSHA, University
of California, San Diego, CA, USA) recommendation
and guidelines (Tate & White 1991).
The crown of each tooth was sectioned at the
cemento-enamel junction, and the distal roots were
then separated from the mesial roots using a diamond
disc using water as a coolant. All the mesial roots
were inspected under an operating microscope (Seiler
Revelation, St Louis, MO, USA) to predetermine the
existence of any craze lines or cracks. Roots with
such findings were excluded. An additional silicon
impression material of putty consistency (Aquasil,
Dentsply Maillefer) was used for coating the cemental
surface of the roots to simulate the periodontal liga-

2013 International Endodontic Journal. Published by John Wiley & Sons Ltd

ment space. The samples were randomly assigned to

the following groups:
Group I: no preparation (control) (n = 30)
Group II: NiTi hand K-files (2% taper) (n = 30)
Group III: ProTaper hand files (n = 30)
Group IV: ProTaper rotary files (n = 30)
Group V: WaveOne reciprocating files (n = 30)

Group I: No preparation
Thirty root canals were left unprepared and served as
controls.
The remaining 120 teeth were subjected to the procedures described below.
The canals were located using a DG-16 endodontic
explorer (Hu-Friedy, Chicago, IL, USA). The patency
and working length of each canal were determined by
passing the size-10 K-file (Mani, Inc., Tochigi, Japan)
to the anatomic foramen. This length was recorded,
and the final working length was established 0.5 mm
short. After confirming apical patency, shaping procedures were performed as follows:

Group II NiTi hand K-files (2% taper)

NiTi hand K-files (2% taper) (Dentsply Maillefer)
were used to enlarge the mesial canals to size 25
using the balanced force technique (Roane et al.
1985). Files were inserted by a quarter-turn clockwise
rotation of 900 with no apical pressure, and cutting
was accomplished by counterclockwise rotation of
120 applying sufficient apical pressure. Irrigation
was performed with 2.5% sodium hypochlorite solution (Prime Dental Product Pvt Ltd, Mumbai, India)
between each instrument. A total of 10 mL of sodium
hypochlorite was used in each canal. Ethylenediaminetetraacetic acid gel (17% EDTA) (Prime Dental
Product Pvt Ltd) was used as a lubricant. Recapitulation was performed with the previous smaller-size
instrument carried to full working length.

Group III ProTaper hand files

The ProTaper hand files (Dentsply Maillefer) were
used to enlarge the mesial canals to a size F2 file (size
25,0.08 taper). Initially, the canals were pre-enlarged
to a size-15 stainless steel K-file, following which ProTaper shaping file no. 1 (or S1), using the balanced
force technique as described above, was allowed to
advance just short of the estimated working length
(EWL). ProTaper S2 and the finishing files F1 and F2

International Endodontic Journal, 47, 622627, 2014

623

Microcrack formation between instruments using SEM Ashwinkumar et al.

were used, subsequently, to the WL. Irrigation was

performed as in Group II.

Group IV ProTaper rotary files

The ProTaper rotary files (Dentsply Maillefer) were
used in a passive manner with an endodontic electric
motor (X-SMART, Dentsply Maillefer). Canals were
pre-enlarged to a size-15 stainless steel K-file. Light
pressure during instrumentation was used together
with back and forth movements of an amplitude of
between 2 and 3 mm. All instruments were used in a
rotational speed of 300 rpm. The first rotary instrument used was the shaping file no. 1 (or S1), which
was carried into the canal and allowed to advance
just short of the estimated working length (EWL) or
where resistance was met. ProTaper S2 and the
finishing files F1 and F2 were then used to the WL.
The mesial canals were enlarged to size F2 file as per
the manufacturers instructions (size 25, 0.08 taper).
Irrigation was performed as in Group II.

gies Co, Tokyo, Japan) individually by two observers for

the presence of microcracks. No defect was defined as
root dentine devoid of any craze lines or microcracks
originating from the canal lumen. Defect was defined
if any craze lines, microcracks or fractures were present
originating from root canal lumen. The observers were
calibrated to identify cracks/no cracks with photographs published previously (Yoldas et al. 2012). A
total of 90 sections were examined in each group.

Statistical analysis
McNemars chi-square test was used to compare interand intragroup values. Kappa statistics was performed
to test for interobserver agreement. Data were analysed using the SPSS 17.0 software (V.17.0; SPSS,
Chicago, IL, USA). The level of significance was set at
P < 0.01. Two-by-two tables were tabulated to compare microcracks formed using two systems. Relative
risk (RR) ratios were estimated by the formula:
RR

Group V WaveOne Primary reciprocating files

The WaveOne reciprocating files (Dentsply Maillefer)
were used with a WaveOne motor (Dentsply Maillefer)
and operated with a 6 : 1 reducing handpiece. The
pre-programmed motor was set for the angles of
reciprocation and the speed for WaveOne instruments
according to manufacturers instructions. The files
were used with a progressive up-and-down movement
no more than three to four times with minimal apical
pressure. The files were then removed and wiped
clean. Irrigation was performed using 2.5% sodium
hypochlorite solution (Prime Dental Product Pvt Ltd).
The same procedure was repeated until the file
reached the working length (WL).
Subsequently, all specimens were sectioned and
viewed under magnification for evidence of microcracks.

Sectioning and microscopic examination

All the roots were sectioned perpendicular to the long
axis at 9, 6 and 3 mm from the apex using a hard tissue microtome using water as coolant. The microtome
blade was changed for every group. The cut sections
were stored in 2% thymol iodide until further processing. Each section was mounted on a specific disc and
was subjected to gold sputtering for 15 minutes. All
the sections were then viewed under scanning electron
microscope (SEM) (Hitachi, S-3400N, High technolo-

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International Endodontic Journal, 47, 622627, 2014

a=a b
c=c d

Results
The no preparation group and NiTi hand K-file (2%
taper) group presented no defects at all the three levels.
Defects were found in roots instrumented with ProTaper hand files, ProTaper rotary files and WaveOne Primary reciprocating files as shown in Table 1. Figure 1
shows the microcracks present in the samples. Kappa
Table 1 Proportion of teeth with microcracks at three different levels of the root canal
No. of samples with microcracks

Groups
No preparation
group
NiTi hand
K-files
ProTaper
hand files
ProTaper
rotary files
WaveOne Primary
reciprocating
files

Coronal
section
(n = 30)

Middle
section
(n = 30)

Apical
section
(n = 30)

Total
(n = 90)

0a

0a

0a

0a

0a

0a

0a

0a

8b

11b

12b

31b

22c

24c

26c

72c

9b

12b

14b

35b

Different superscript letters denotes chi-square rank based on

statistical significance.

2013 International Endodontic Journal. Published by John Wiley & Sons Ltd

Ashwinkumar et al. Microcrack formation between instruments using SEM

(b)

(a)

(c)

(d)

(e)

Figure 1 SEM images of a (no preparation group), b (NiTi hand K-files), c (ProTaper hand files), d (ProTaper rotary files),
e (WaveOne Primary reciprocating files).

statistics for interobserver variation was 0.948 (0.897,

0.971) at 95% confidence interval, which showed
excellent agreement over the microcrack evaluation.
Intragroup comparisons showed no significant differences within groups, suggesting that microcracks were
formed throughout the length of the root canal.
Tables 2, 3 and 4 show relative risk (RR) ratio at 95%
confidence interval (CI) between groups.

Table 2 Relative Risk and 95% CI for ProTaper Rotary Files

and WaveOne Primary Reciprocating files
Cracks

Risk

ProTaper rotary files

WaveOne Primary
reciprocating files

Present

Absent

Total

72
a
35
c

18
b
55
d

90
90

Discussion

RR = 2.06; 95% CI 1.56, 2.72.

P < 0.0001.

The files tested in the study had a similar crosssection and varying taper along their length. The
variables tested in the study were the taper of the

instruments and the motion of instrumentation. Taper

of the instrument had a significant effect on
microcrack formation as previously reported by Rund-

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Microcrack formation between instruments using SEM Ashwinkumar et al.

Table 3 Relative Risk and 95% CI for ProTaper Rotary Files

and ProTaper Hand files
Cracks

Risk

ProTaper rotary
Hand ProTaper

Present

Absent

Total

72
a
31
c

18
b
59
d

90
90

RR = 2.32; 95% CI 1.72, 3.15.

P < 0.0001.

Table 4 Relative Risk and 95% CI for WaveOne Primary

Reciprocating files and ProTaper Hand files
Cracks

Risk

WaveOne Primary
Reciprocating files
Hand ProTaper

Present

Absent

Total

35
a
31
c

55
b
59
d

90
90

RR = 1.12; 95% CI 0.77, 1.66.

P = 0.536.

quist and Versluis (2006). The results of the present

study revealed that there was a significant difference
between the groups in the formation of dentinal
microcracks. Hence, the null hypothesis is rejected.
When instruments with the same taper and crosssection were compared, ProTaper rotary files produced
the maximum number of microcracks at all the three
levels. This may be due to a continuous rotational force
and constant torque applied by the NiTi rotary file on
the root canal walls, which results in significantly
increased microcrack formation. On the other hand,
the reciprocating motion of WaveOne aids in stress
release before the file progresses within the canal
(Berutti et al. 2012a,b). ProTaper rotary files had a 2.4
times higher risk of inducing microcracks as compared
to WaveOne Primary reciprocating files. Moreover, the
time required for root canal preparation per sample
using WaveOne reciprocating files was less than that
for ProTaper rotary files. This might also be responsible
for greater number of microcracks in the latter group.
When ProTaper hand files were compared with
ProTaper rotary files, ProTaper hand files produced
significantly fewer number of microcracks at all three
levels. The balanced force technique employed with
ProTaper hand files uses both clockwise and counterclockwise rotation unlike rotary files that use
continuous rotation. This may be the reason
behind increased microcrack formation with rotary

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International Endodontic Journal, 47, 622627, 2014

files (Roane et al. 1985). ProTaper rotary files had a

2.32 times higher risk of inducing microcracks when
compared with ProTaper hand files.
ProTaper hand files and WaveOne Primary reciprocating files produced similar numbers of microcracks
at all the levels with no significant difference. Similarity between the balanced force and reciprocating
motions may be attributed to the similar motion
between the two techniques with the variation in file
rotation. The RR value indicates equal risk of inducing microcracks with both systems.
In the present study, no defect was observed in the
NiTi hand K-files (2% taper) group. The reason for
this may be due to the fact that: 1) continuous rotational motion was avoided; and 2) less taper (2%) of
the files used for enlarging and shaping. This finding
is in agreement with Bier et al. (2009), in that they
did not observe any defect in the hand file group.
Moreover, microcrack formation was uniform
throughout the length of the root canal with all the
variable taper systems. This could be due to the fact
that the total volume of dentine removed from the
root canals is significantly greater with NiTi rotary
systems in comparison with hand files (Mahran &
AboEl-Fotouh 2008) .
Clinically, the reported failure due to vertical root
fracture is low (Friedman et al. 2003). Vertical root
fracture can result due to one or combination of the
following factors: physical traumatic injury, occlusal
prematurities, repetitive parafunctional habits of
heavy stressful chewing or resorption-induced pathological root fractures (Berman & Hartwell 2011). It
is not clear whether all microcracks would lead to
vertical root fracture, and this needs to be studied
further.

Conclusion
Within the limitations of this study completed in
mesial roots of mandibular molars, the following conclusions can be drawn:
ProTaper rotary files produced the most microcracks at all the three levels of the root canals
when compared with the other groups.
Significantly fewer microcracks were seen with
ProTaper hand files and WaveOne Primary reciprocating files in comparison with ProTaper rotary
files.
NiTi hand K-files (2% taper) did not produce
microcracks in the root canals at any level.

2013 International Endodontic Journal. Published by John Wiley & Sons Ltd

Ashwinkumar et al. Microcrack formation between instruments using SEM

Acknowledgements
The authors would like to thank Professor James L
Gutmann for his valuable comments in preparing the
manuscript. The authors would like to acknowledge
the partial support extended by Meenakshi Academy of
Higher Education and Research (MAHER), Chennai, for
the study. The authors deny any conflict of interests.
I affirm that I/we have no financial affiliation (e.g.
employment, direct payment, stock holdings, retainers,
consultantships, patent licensing arrangements or honoraria) or involvement with any commercial organization with direct financial interest in the subject or
materials discussed in this manuscript, nor have any
such arrangements existed in the past 3 years. Any
other potential conflict of interest is disclosed.

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