INTRODUCTION

Year 1750 – “Fauchard” recommended removal of pulp

Year 1850 - wooden pegs were used for debriding pulp

In early 1900’s - there was availability of variety of tools like path finders,
barbed broaches, reamers, files, etc.

Year 1915 - Kerr manufacturing company obtained patent for all instruments
later known as “k-type” instruments.

Year 1957 - Richman introduced first ultrasonic system.

Year 1958 - hallmark in the history of endodontic instrumentation. Ingle &

Levine 1st proposed standardization.

Year 1959 - new line of standardized instruments and filling materials were
introduced.
1962 - Working committee on standardization .

1964 - Introduction of giromatic handpiece.

1975 - 1st report on potential application of NiTi alloys

1976 - 1st approved specification for root canal

instruments.

1976 to 1984 - Martin and Cunningham provided

instruments that were set for vibration at 25 to 40KHz

1984 - introduction of canalfinder system

1988 -1st use of NiTi in endodontic instruments

1989 - “American National Standards Institute” granted the

approval of “ADA Specification No.28” for endodontic files and
reamers. it established the requirements for diameter, length,
resistance to fracture, stiffness, etc.
CLASSIFICATION OF ENDODONTIC INSRUMENTS :

BASED ON FUNCTION :
(GROSSMAN’S CLASSIFICATION)-

A)EXPLORING - to locate canal orifice and determine patency of root

canal.
eg.smooth broaches and endodontic explorers

B) DEBRIDING - to extirpate the pulp and remove debris from the

root canal.
Eg.barbed broaches

C) CLEANING AND SHAPING - clean and shape root canals laterally

and apically .
Eg.reamers and files

D) OBTURATING - To pack filling material into root canal.

Eg.pluggers, spreaders and lentulospirals
ISO – FDI GROUPING

A) GROUP I - hand use only.

Eg. K and H-files, reamers,broaches

A) GROUP II - engine driven instruments. Same design

as group I but handle is replaced by a latch type
adaptor for insertion in contra-angle hand piece.

C) GROUP III - engine driven latch type drills or

reamers .
Eg. Peezo reamers, Gates- Glidden drills

C) GROUP IV - root canal points like Gutta percha,

silver point, paper point
HAND OPERATED INSTRUMENTS-

ALLOYS USED FOR MANUFACTURING ENDODONTIC INSTRUMENTS-

-carbon steel
-stainless steel
-nickel- titanium

Carbon steel - these alloys contain less than 2.1% carbon.

Advantage - high hardness than stainless steel instruments

Disadvantages - Prone to corrosion, so cant be re -sterilized

eg. Barbed broaches

Stainless steel- contain 18% Cr, 8-10% Ni, 0.12% C

Advantage- corrosion resistant

Disadvantages- stiff in nature, prone to fracture and distortion

Eg. K-file, H-file, reamer

Nickel-Titanium – contain 55% Ni, 45% Ti. They show stress
induced martensitic transformation from parent austenitic
structure. On releasing stress, the material returns to austenitic
and its original shape.

Advantages-
• shape memory
• Super elasticity
• Corrosion resistance
• Softer
• Good resiliency
• biocompatibility

Disadvantages-
• Poor cutting efficiency
• NiTi files donot show signs of fatigue before they fracture
• Poor resistance to fracture as compared to stainless steel

Eg. NiTi hand files, profiles, protapers

MANUFACTURING OF HAND INSTRUMENTS

2 methods:

• By machining the instrument directly on the lathe.

eg- H-file and NiTi instruments are lathed

• By first grinding and then twisting. Here the raw wire is ground into tapered
geometric blanks ie.square, triangular or rhomboid. these blanks are then
twisted counter-clockwise to produce the cutting edges.
Eg.K-files, K-reamers , stainless steel instruments

STANDARDISATION OF INSTRUMENTS GIVEN BY INGLE AND LEVINE

They suggested a few guidelines-

-Instruments are numbered from 10-100. there is increase in 5 units upto size 60
and in 10 units until they are size 100.

-Each number should represent diameter of instrument in 100th of mm at the tip.

-Working blade shall begin at tip(D1) and extend 16mm upto the shaft(D2).
D2 should be 0.32mm greater than D1, ensuring that there is a constant
increase in taper, ie. 0.02 mm per mm of instrument.
-instrument handles should be colour coded for their easy recognition.

-instruments are available in following lengths- 21mm, 25mm, 28mm,

30 mm, 40 mm.
(21mm- commonly used for molars, 25mm for anteriors, 28 and 30 mm
for canines and 40 mm for endodontic implants)

MODIFICATIONS FROM INGLES’S STANDARDISATION

-Instrument sizes 6, 8 and 110 to 140 were added.

-D1 and D2 were changed to D0 and D16 respectively.

-Tip angle of an instrument should be 75 +/- 15 degrees.

- Greater taper instruments have also been made available( 4%,6%,8%)

Colour coding for endodontic instruments

Colour code instrument no.

Pink 06
Gray 08
Purple 10
White 15
Yellow 20
Red 25
Blue 30
Green 35
Black 40
White 45
Yellow 50
Red 55
Blue 60
Green 70
Black 80
BROACHES -They are of two types-

-Smooth : free of barbs. Previously used as path finders.

At present, flexible files are used for this purpose.

-Barbed : ANSI NO.63, ADA specification no.6

Made from round stainless steel wires.
Used to - Extirpate the pulp.
- Removal of cotton or paper points lodged
in the canal.
- Loosen the necrotic debris from the canal.

RASPS – ADA sp.no.63

Have similar design to barbed broaches except in taper and barb size.
Barb size is larger in broach than rasp.
used to extirpate the pulp.

BROACH RASP

-less taper(0.007-0.01 taper/mm) -more(0.015-0.02 taper/mm)

-barbs are fine and longer -blunt, shorter and shallower
BROACHES
REAMERS –

-K-type instruments, used to ream straight

canals.

-reamers less than no.25 are square in cross section while reamers
>25 have triangular cross section.

-They cut by inserting into the canal,

twisting clockwise
one-quarter to half turn and then
withdrawing

(penetration, rotation and retraction)-

Called Reaming the canal.

-Can be identified by a triangle marked on

the handle.
FILES –

-used during cleaning and shaping of the root canals for machining
the dentine.
-Used in filing or rasping motion. (ie. Up and down motion)
-it is placed in root canal,
pressure is exerted against the canal wall and the instrument is
withdrawn while maintaining the pressure.

files reamers

•Flutes more(1.5-2/mm) less(0.5-1mm)

•Flexibility less more
•Cutting motion push and pull rotation and retraction
•Preparation shape usually ovoid round
•Identification square mark triangle
Commonly used files-
-K -file
-K -flex file
-Flexo file
-Flex -R file
-Hedstrom file
-Safety H-file
-S – file

K-FILES

•They are triangular, square or rhomboidal in cross section.

•K-files are produced in sizes 06 - 140, all with a taper of 2%. K-file design is
identified by the square symbol on the handle

•manufactured from stainless steel wire.

•Have 1.5-2.5 cutting blades per mm of their working end.

•Tighter twisting of the file spirals increases the no.of flutes in files.

•Triangular cross sectioned files show

superior cutting and increased flexibilty
than the file or reamer with square blank.
Disadvantages-

•Less cutting efficiency

•extrusion of debris periapically
K-FLEX FILES

•Manufactured by Kerr company in 1982.

•Have rhomboidal cross section with 2
acute and 2 obtuse angles.
•Acute angles increase the sharpness and
cutting efficiency of the instrument
•Obtuse angles provide more space for
debris removal. Also provides more space
for irrigation.
•Used in filing and rasping motion.
FLEXO FILES

•Similar to k-flex files except they have triangular cross section.

This provides them with more flexibility and thus ability to resist
fracture.

•But they have less cutting efficiency.

•Made up of NiTi.

•The tip of the instrument is non-cutting which makes it well suited

for the preparation of evenly curved canals without the risk of ledge
formation
TRIPLE FLEX FILES

•Made up of stainless steel and are triangular in crosssection.

•They have more flutes than reamers but lesser than k-files.

FLEX- R- FILES

•Made by removing the sharp cutting edges from the tip of the
instrument. The non cutting tip enables the instrument to traverse
along the canal.

•They have triangular cross section which provides them flexibility

to be used in curved canals.

•Made up of NiTi and cut during anti-clockwise rotary motion.

H-FILES

•Have flutes which resemble successively triangles

set one on another.

•These files cut only when the instrument is

withdrawn because its edges face the handle
of the instrument.

•When used in torquing motion, their edges can

engage in the dentine of the root canal wall
causing them to fracture.only up and down motion is used

•They have positive rake angle making it more aggressive

in cutting.

•Used to machine straight canals because they

are strong and aggressive cutters.

•Have tear drop shaped cross section.

•It is identified by a circle marked on the handle.

Advantages

•Better cutting efficiency

•Push debris coronally

Disadvantage

•Lack flexibility, tend to fracture

SAFETY HEDSTROM FILES

•It has non-cutting safety side along the length of

the blade which reduces the chance of perforations.
•The non-cutting side is directed to the side of canal
where cutting is not required. It prevents lodging of
the canal.

S-FILE

•It is called so, because of its cross sectional shape.

•It is produced by grinding, which makes it stiffer
than H-file. The file is designed with 2 spirals for
cutting blades, forming double helix design.
•It has good cutting efficiency in either filing or
reaming action, thus it can be classified as a hybrid
design.

C+ FILES

•Used for difficult and calcified canals.

•Available in size 8, 10 and 15 of lengths 18,21 and
25 mm
ENGINE DRIVEN INSTRUMENTS

Gates-Glidden drills - available in sets from 1-6 with

the diameters from 0.5-1.5 mm. the no. of rings on the
shank identifies the drill size.
-they are side cutting instruments with safety tips.
-used at the speed of 750-1500 rpm, in brushing strokes
-used to cut dentin as they are withdrawn from the
canal. only used in straight canals

Flexo gates - modified Gates-Glidden drills.

Made up of NiTi and have non- cutting tips.
More flexible and used for apical preparation.
Can be rotated continuously in a hand piece through 360 degrees.
They allow increased debris removal because of continuous
rotation, smoother and faster canal preparation with less clinician
fatigue

Advantages-

-Safe non-cutting guiding tips

-Safety design i.e, its breakage point is 16mm from the tip, so once
fractured, it can be easily removed.
-Flexible, so used in curved canals.
PEESO REAMERS

-rotary instruments used mainly for post space preparation.

-have safe ended non cutting tip.
-Tip diameter varies from 0.7-1.7mm.
-used in brushing motion.

Disadvantage-
-donot follow the canal curvature as they are stiff

-
ENGINE DRIVEN INSTRUMENTS

1. Rotary handpiece –

eg. micromotor handpiece- slow speed

handpiece used for finishing the walls
of prepared access cavities. it uses GG
drills and Peeso reamers.

• Reduction gear handpiece- engine

driven with torque control. uses rotary
files

•Triauto ZX.-uses NiTi instruments held

by push button check.it starts
automatically when file enters the canal
and stops when its removed. It
automatically stops when file reaches
apical tip.

Tri auto ZX
2) Reciprocating- commonly used is Giromatic handpiece.
rotates with quarter turn motion at 3000rpm.
This handpiece uses latch type instruments.

3) Vertical stroke hand piece- either air/electrically driven handpiece.

4)Random handpiece- delivers both lateral and vertical movements at the speed
of 20,000-25,000 rpm. Uses modified K-files

ISO GROUP II – Instruments with shaft and operating head as separate pieces
ISO GROUP III – Instruments with shaft and operating head as one piece.
PROFILE SYSTEM

-These instruments were one of the first NiTi instruments

available commercially.

-offer maximal security due to their

non-cutting "Radial Line" profile and U shaped section

-recommended rotational speed is 150-300 rpm.

-have negative rake angle(-20 degrees)

-tend to pull debris out of the canal because of 20 degrees

helical angle.
GREATER TAPER FILES (GT FILES)

-GT rotary instruments possess a U-shaped file design with ISO tip sizes of
20, 30 and 40 and tapers of 0.04,0.06,0.08,0.1,0.12mm

-the maximum diameter of these instruments is 1.50mm

-negative rake angle of these files makes them to scrape the dentine rather
than cutting it.

-Made up of super flexible nickel titanium,

so they negotiate curved canals as well
as straight canals.

-recommended speed is 150-350 rpm.

.
GREATER TAPER FILES
PROTAPER FILES

-protaper means progressively taper. 6 sets of files available (Sx, S1,S2, F1,
F2, F3 )

-UNIQUE FEATURE- each instrument has changing percentage tapers over

the length of cutting blades. this design improves flexibility, cutting
efficiency and safety.
-It has a triangular cross-section which increases its cutting efficiency.

-it has a modified guiding tip which allows one to follow the canal better.

-Variable tip diameters allows it to have specific cutting action in defined

area of canal
PROTAPER
SHAPING FILES
They are termed as Sx,S1 and S2

Sx- no identification ring on its gold coloured handle, 19mm long

D0 = 0.19 mm, D14 = 1.2 mm
there is increase in taper upto D9 and then taper drops off upto D14 which
increases its flexibility. variable taper of 3.5 to 19%.

S1- has purple identification ring on its handle. D0= 0.19 mm and D14= 1.2 mm
used to prepare coronal part of the root. Taper of 2-11%
S2- has white identification ring.
D0=0.2 mm and D14= 1.2 mm. variable taper of 4 -11.5%
Used to prepare middle third of the canal.

Files with 6% and 4% taper are used for canal orifices and preparation of
coronal and middle third preparation of root canals.

Files with 2 % taper are used for apical 3rd preparation.

FINISHING FILES

3 finishing files are used to prepare and finish apical part of the root
canal.

F1- yellow identification ring. D0 = 0.20mm and apical taper = 0.07 mm

F2- red identification ring. D0 = 0.25mm, taper = 0.08 mm

F3 - blue identification ring. D0 = 0.30 mm, taper= 0.09 mm

Each instrument has decreasing percentage of taper from D4- D14.

this improves flexibility.
SONICS AND ULTRASONICS IN ENDODONTICS

Sonic handpiece-
•uses compressed air line at a pressure of 0.4 MPa

•It has an adjustable ring to give oscillating range of 1500-3000 cycles/sec.

•It uses 3 types of files-Heliosonic.shaper sonic, Rispi sonic.

•All these instruments have safe ended non cutting tip 1.5-2mm in length.

•Instruments oscillate outside the canal which is converted into vibrational up and
down movement in root canal.
Advantages-
•Better shaping of canals compared to ultrasonic
preparation.

•Due to constant irrigation, amount of debris extruding

beyond apex is less.

•Produces clean canals free of smear layer and debris.

Disadvantage-

•Walls of prepared canals are rough.

ULTRASONIC HANDPIECE

•Called endosonics. Introduced by Richman.

•Help in removing gutta percha and silver points from the canals.
•Ultrasonics with copious water irrigation along with gentle up and
down strokes is quite effective in not only removing silver points and
broken files but spreader and bur tips as well.
INSTRUMENTS USED FOR FILLING ROOT CANALS

Spreaders and pluggers are the instruments used to compact the gutta
percha into root canal during obturation.

HAND SPREADERS- made from stainless steel.

Designed to facilitate placement of accessory GP points around the
master cone during lateral compaction technique.
Not used routinely because excessive pressure on the root may fracture
the root.
FINGER SPREADERS

•Shorter in length which allows them to afford a greater degree of tactile

sense and allow them to rotate freely around their axis.
•They are standardised and color coded to match the size of GP points.
•Made from stainless steel or NiTi.
•Stainless steel spreaders may pose difficulty in penetration in curved
canals, may cause wedging and root fracture if forced during compaction.
•NiTi spreaders are recently introduced, they penetrate the curved canals and
produce less stresses during compaction. But they may bend under pressure
during compaction.
•So combination of both types is used. NiTi is used in compaction in apical
areas and stainless steel in coronal part of the canal.
HAND PLUGGERS

•Have diameter larger than spreader and have blunt end.

•Used to compact warm GP vertically into the root canal.
•Ca(OH)2 or MTA like materials may also be packed into the canals using
pluggers.

FINGER PLUGGERS

•Used for vertical compaction of GP.

•Have more tactile sensitivity than
hand plugger.
LENTULO SPIRALS

•Used for applying sealer cement to the root canal walls

before obturation.

•Can be used as hand or rotary instruments.

STERILISATION OF ENDODONTIC INSTRUMENTS -

•Hot Salt Sterilizer : Consists of a metal cup in which table salt is kept at a
temperature of 425*F[218*C] to 475*F[246*C].
Broaches,files and reamers are sterilized in 5 sec.
Absorbent points and cotton pellets in 10 sec.

•Glass bead steriliser : TEMPERATURE-218*C-246*C.

RC instruments- 5 secs
Absorbent points and cotton pellets- 10secs.
Infected endodontic instruments exposed for 3 secs to a laser
beam destroys microorganisms including spores.

•Dappen dishes can be sterilized before use by swabbing with

tincture of merthiolate under pressure.

•Gutta-percha cones may be kept in sterile screw capped vials

containing alcohol.
Various Irrigation Solutions in Endodontics
The use of irrigating solutions is an important part of effective
chemomechanical preparation.

IDEAL REQUIREMENTS OF AN IRRIGANT-

• It should have broad antimicrobial properties.
• Aid in the debridement of the canal system.
• Have the ability to dissolve necrotic tissue
• Have low toxicity level
• Be a good lubricant
• Have low surface tension to flow into inaccessible areas
• Be able to prevent the formation of smear layer during
instrumentation
Variables affecting irrigation-

-Concentration of irrigant- higher the concentration, more is the tissue

dissolving ability but higher conc. are more cytotoxic.

-The volume of the solution used- directly proportional to effectiveness

but also increases cytotoxicity.

-Canal diameter- wider the canal, better the debridement.

-The viscosity or surface tension of the solution- lower the S.T, better
the wettability.

-The diameter and depth of penetration of the irrigating needle- usually

27 or 28 gauze needle is preferred as it can go deeper in canal.

-Contact time with the tissue- effectiveness is directly proportional to

contact time.

-Temperature of the irrigant- shown that if NaoCl is warmed(60-70

degrees), effectiveness increases. exact mechanism unknown.
Commonly used irrigating solutions-

Chemically non-reactive-

•water
•Saline
•Local anaesthetic

Chemically active-

•Alkali’s like sodium hypochlorite

•Chelating agents like EDTA
•Oxidising agents like hydrogen peroxide, carbamide peroxide
•Antibacterial agents like chlorohexidine
•Acids like 30% HCl
•Enzymes like streptokinase
•Detergents like sodium lauryl sulphate
NORMAL SALINE

•Causes gross debridement and lubrication of canals.

•Since its very mild in action, it can be used as an adjunct to
chemical irrigant.
•Normal saline as 0.9% W/V is commonly used

Advantages-

•Biocompatible
•No adverse action even if extruded periapically because
osmotic pressure of normal saline is same as that of blood

Disadvantages-
•Doesn’t possess disinfecting/ antimicrobial properties
•Can’t clean microbial flora from inaccessible areas.
•Doesn’t remove smear layer
SODIUM HYPOCHLORITE
It is a clear, pale, green- yellow liquid with strong odour
of chlorine.
Advantages-
Antibacterial agent
Dissolves vital and non-vital tissue.
 Lubricant during instrumentation
Economical
Easily available

NaOCl has been criticized for

Unpleasant taste and odour

Relative toxicity, vapours can irritate the eyes
High surface tension
Irritant to tissues
Gingival inflammation
MECHANISM OF ACTION
It exerts its effects by oxidizing sulphydryl groups within bacterial
enzyme systems, thereby disrupting the metabolism of the
microorganism, resulting in the killing of the bacterial cells.

USE OF NaOCl IN COMBINATION WITH OTHER MEDICAMENTS-

-Tissue dissolving capacity is increased when canal is pretreated
with calcium hydroxide
-Bactericidal effect increases when it is combined with EDTA,
probably due to removal of smear layer by EDTA
-Greater reduction in microflora when combined with chlorhexidine
HYDROGEN PEROXIDE

It is clear, colorless liquid. Mainly 3% solution is used.

MECHANISM OF ACTION-

-it is highly unstable and easily decomposed by heat and light into
water and nascent oxygen.

-[O] causes bactericidal effect.

-It causes oxidation of bact. SH group of enzymes and interferes with
bacterial metabolism.
-[O] in contact with the necrotic tissue results in effervescence
which is thought to aid in mechanical debridement by dislodging
particles of necrotic tissue.

Used as an irrigant either alone or in combination with NaOCl(5.2%)

CHLORHEXIDINE

-most potent of the tested bis biguanides. Shows optimal

antimicrobial action b/w pH 5.5-7

MECHANISM OF ACTION-
It penetrates the cell wall and attacks the bacterial cytoplasmic
or inner membrane.
Has bacteriostatic effect in low conc.and bactericidal effect at
high conc.
Advantages and uses-
-2% solution is used as root irrigant
-0.2% solution used in controlling plaque
Disadvantages-
-unable to dissolve necrotic tissue remnants
-less effective on G-ve bact.
-activity reduced in the p/o organic matter
CHELATING AGENTS

These are chemicals that combine with metal

to form a chelate.
EDTA is most commonly used.

Functions-

-lubrication
-emulsification
-holding debris in suspension
-smear layer removal

Mechanism of action- it combines with the

metallic ions in medium which are needed for the
growth of m/o.

Uses-
•For dissolving dentin
•Helps in enlarging narrow canals
•Reduces time needed for debridement
Coronal portion of canal
of in vivo endodontically Longitudinal section of
treated tooth with EDTA. dentinal tubules shows thin
The tubules are opened, intertubular matrix.
and the canal is clean and
free of smear.
ULTRASONIC IRRIGATION

It has shown to clean the root canals better than conventional

methods. It causes continuous flow of an irrigant in the canal,
preventing accumulation of debris in the canal.

Mechanism of action-

The ultrasound device allow the endodontic irrigant to pass along the
ultrasonic files. The irrigant is activated by the ultrasonic energy
imparted from the energized instruments producing acoustic
streaming which dislodged the debris from the canal.

Advantages-
•Better cleansing effect
•Removes the smear layer efficiently

Disadvantages-
•Can lead to excessive cutting of canal walls and may damage the
finished preparation.
Removal of smear layer
Newer irrigating solutions-

•electrochemically activated solutions

•Ozonated water irrigation
•Ruddle’s solution
•Photo activated disinfection (PAD)
•A mixture of a tetracycline isomer, an acid and a detergent (MTAD)

MTAD

Introduced in 2000 as a final rinse for disinfection of root canal system.

-it disinfects the canal, removes the smear layer, opens dentinal tubules
and allows the antimicrobial agents to penetrate the entire root canal
system.

Composition-

Tetracycline : bacteriostatic broad spectrum antibiotic. It removes the

smear layer and promotes healing.

Citric acid : bactericidal in nature and removes the smear layer.

Detergent : decreases the surface tension.

Advantages

•effective solution for removal of most of the smear layer.

•Kills most significant bacterial stains, even those which seem to be

resistant to many intracanal medicaments.

•It is biocompatible.

•The high binding affinity of doxycycline present in MTAD for dentin

allows prolonged antibacterial effect (main difference between MTAD
and EDTA.
Under the guidance of-

Dr. Shalan Koul

Dr. Tallia
Dr. Harsheen
Dr. Divya Gupta