Basic Research—Technology
The Efficacy of the WaveOne Reciprocating File
System versus the ProTaper Retreatment System
in Endodontic Retreatment of Two Different
Obturating Techniques
Ben Jorgensen, DDS, Anne Williamson, DDS, MS, Rene Chu, DDS, and Fang Qian, PhD
Abstract
Introduction: This ex vivo study aimed to evaluate the
efficacy of retreating GuttaCore (Dentsply Tulsa Dental
Specialties, Tulsa, OK) and warm vertically condensed
gutta-percha in moderately curved canals with 2
different systems: ProTaper Universal Retreatment
(Dentsply Tulsa Dental) and WaveOne (Dentsply Tulsa
Dental). Methods: Eighty mesial roots of mandibular
molars were used in this study. The mesiobuccal canals
in each sample were prepared to length with the Wave-
One Primary file (Dentsply Tulsa Dental). The canals
were obturated with either a warm vertical approach
or with GuttaCore and divided into 4 retreatment groups
with the same mean root curvature: warm vertical re-
treated with ProTaper, warm vertical retreated with
WaveOne, GuttaCore retreated with ProTaper, and Gut-
taCore retreated with WaveOne. The warm vertical
groups were obturated using a continuous-wave tech-
nique of gutta-percha compaction, and the GuttaCore
groups were obturated according to the manufacturer’s
instructions. After allowing sealer to set, each specimen
was retreated with either the ProTaper Universal Re-
treatment files D1, D2, or D3 or with the WaveOne Pri-
mary file to the predetermined working length. The time
taken to reach the working length was recorded. Instru-
ment fatigue and failure were also evaluated. Results:
The post hoc 2-sample t tests showed that the overall
mean total time taken to reach the working length for
the warm vertical groups was significantly greater
than that observed for the GuttaCore groups (mean =
87.11 vs 60.16 seconds, respectively), and the overall
mean total time taken to reach the working length for
WaveOne was significantly greater than that observed
for ProTaper (99.09 vs 48.18 seconds, respectively).
Two-way analysis of variance showed a significant
main effect for both the type of experiment groups
(F1,76 = 15.32, P = .0002) and the type of retreatments
(F1,76 = 54.67, P < .0001). Also, the WaveOne Primary
From the Department of Endodontics, University of Iowa, Iowa City, Iowa.
Address requests for reprints to Dr Anne Williamson, Department of Endodontics, University of Iowa, Iowa City, IA 52242. E-mail address: anne-williamson@uiowa.
edu
0099-2399/$ - see front matter
Copyright ª 2017 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2017.01.018
JOE — Volume 43, Number 6, June 2017
file underwent more separations than the ProTaper files. Conclusions: The WaveOne
Primary file underwent more separations and was unable to remove gutta-percha as
efficiently as the ProTaper Universal Retreatment files. Also, canals obturated with Gut-
taCore were retreated more efficiently and with fewer file separations than the canals
obturated using continuous wave of warm gutta-percha. (J Endod 2017;43:1011–1013)
Key Words
GuttaCore, ProTaper Universal Retreatment Files, WaveOne
T he persistence of bacte-
ria within the root ca-
nal system is the primary
Significance
This study examined the time required to remove
GuttaCore with WaveOne reciprocating files and
cause of endodontic fail-
ProTaper retreatment files as well as the time to fail-
ure after initial root canal
ure for each system. Clinical relevance is related to
treatment (1). To reduce
the number of retreatments required.
the bacterial loads during
retreatment, it is important
to remove the filling material and gain access to the apical foramen (2), which, in turn,
facilitates adequate cleaning, shaping, and disinfection of the root canal system.
Carrier-based obturation systems have been developed in an effort to simplify
obturation procedures. However, if posttreatment disease exists, carrier-based obtura-
tion may be more time-consuming or more difficult to completely remove (3, 4).
Recently, a carrier-based obturation system, GuttaCore (Dentsply Tulsa Dental Spe-
cialties, Tulsa, OK), which uses a proprietary cross-linked gutta-percha core, has
been developed. According to the manufacturer, GuttaCore can be removed with greater
ease than other carrier-based systems.
A novel file system, the WaveOne reciprocating system (Dentsply Tulsa Dental Spe-
cialties), has been developed as an efficient way to prepare canals with a single file.
Although there have been studies showing the efficacy of WaveOne in initial treatment
(5, 6), there has been little research in its use in retreatment.
Most retreatment studies have evaluated filling removal in straight canals. Only a
few have evaluated retreatments in curved canals (7–12). There may be an increased
incidence of file unwinding and separation in retreating canals with greater curvature
(10, 12). To date, no study has been published comparing retreatment efficacy and
efficiency with the WaveOne system in curved canals. The purpose of this study was
to evaluate the efficacy and time required to retreat GuttaCore and traditional gutta-
WaveOne vs ProTaper Retreatment System 1011
Basic Research—Technology
percha obturation with the WaveOne Primary file (Dentsply Tulsa Dental
Specialties) in moderately curved canals.
Methods
Eighty extracted mandibular first and second molars with 2 mesial
canals and without previous endodontic treatment, fractures, resorptive
defects, posts, pins, calcifications, or open apices were collected and
stored in 0.1% thymol. The mesial roots were radiographed from
both a buccolingual and proximal direction to determine canal curva-
ture (13). Samples with curvatures between 10 and 40 were used for
the study.
A size 10 K-type stainless steel file was advanced in the mesiobuc-
cal canal until visualized out of the apical foramen. This length was
measured from the cusp tip as a preliminary reference point. The refer-
ence point was then reduced with a #557 bur until a file with a stopper
set at 16 mm enabled the visualization of the tip of the file approximating
the major foramen. All subsequent instrumentation was performed at a
15-mm working length.
All samples were prepared by a single operator. A glide path was
created to size 20 K-type file using the passive step-back technique if
necessary. Instrumentation was then performed using the WaveOne Pri-
mary file (size 25/.08 [tip size] and variable taper) in reciprocation to
15 mm. During instrumentation, the canal was irrigated for 10 seconds
with 1 mL 3.0% sodium hypochlorite (NaOCl) between instrument
passes, and upon completion the smear layer was removed with
1 mL 17% EDTA for 1 minute followed by a final rinse of 1 mL 3.0%
NaOCl for 10 seconds. The canals were then dried with paper points.
The canals were randomly placed into 2 obturation groups (n = 40)
with the same mean curvature.
Obturation
Warm Vertical. Master gutta-percha cone Primary size (Dentsply
Tulsa Dental Specialties) was coated with AH Plus sealer (Dentsply Mail-
lefer, Ballaigues, Switzerland) and seated with tug back. Gutta-percha
was then seared with a System B condenser (Analytic Technology, Red-
mond, WA) at 250 C to within 3 mm of the working length (14). The
canal was then coated with sealer and backfilled with warm gutta-
percha from a Calamus (Dentsply Tulsa Dental Specialties) obturation
unit. Excess obturation material was removed at the orifice after
compaction.
GuttaCore. The apical canal diameter was assessed with a GuttaCore
size verifier. The canal was coated with a thin layer of AH Plus root canal
sealer. The GuttaCore obturator recommended for a size 25 .06 taper
preparation (ie, a size 25 obturator) was softened in an oven and slowly
inserted to the working length. The carrier was twisted off, and the canal
filling was compacted at the orifice.
After obturation, samples were radiographed from a buccolingual
dimension to determine the quality of fill. Accesses were sealed with
Cavit-3M (Henry Schein, Melville, NY), and samples were stored for
21 days at 37 C at 100% relative humidity. Samples were then subdi-
vided into 4 groups with the same mean root curvature for retreatment
with either ProTaper files D1, D2, and D3 or the WaveOne Primary file.
ProTaper Retreatment. Each canal was instrumented in a crown-
down fashion in the following sequence at 500 rpm: ProTaper Universal
Retreatment files D1, D2, and D3. In consideration of the region of the
canal each file is intended to clean, instrumentation was performed at a
predetermined length from the reference point (D1 at 5 mm, D2 at
10 mm, D3 at 15 mm, and F3 at 15 mm). One milliliter of 3.0% NaOCl
irrigation was dispensed after each file use. Files were discarded after 3
uses. After each use, the file was examined under the dental operating
microscope, and any unwindings or separations were recorded. The
1012 Jorgensen et al.
time in seconds to reach the predetermined working length including
change of instruments and irrigation time was recorded.
WaveOne Retreatment. Each canal was instrumented with a
WaveOne Primary file in reciprocation motion. The file was used in a
passive manner with flutes cleaned between passes. One milliliter of
3.0% NaOCl irrigation was dispensed after each pass. After each use,
the file was examined under the dental operating microscope, and
any unwindings or separations were recorded. The time in seconds
to reach the predetermined working length including change of instru-
ments and irrigation time was recorded.
Results
The total time to reach the working length is shown in Figure 1. The
mean total time taken to reach the working length using the ProTaper
files for the warm vertical group was significantly greater than that
observed in the GuttaCore group (P < .0001) (mean = 59.53 minutes
vs 36.83 minutes, respectively). Also, the mean total time taken to reach
the working length using the WaveOne file for the warm vertical group
was significantly greater than that observed in the GuttaCore group
(P = .0221) (mean = 114.7 seconds vs 83.48 seconds, respectively).
The mean total time taken to reach the working length during retreat-
ment of GuttaCore for WaveOne was significantly greater than that
observed in ProTaper (P < .0001) (mean = 83.48 seconds vs
36.83 seconds, respectively). The mean total time taken to reach the
working length during retreatment of the continuous wave for WaveOne
was significantly greater than that observed in ProTaper (P = .0002)
(mean = 114.7 seconds vs 59.53 seconds, respectively).
The post hoc 2-sample t test showed that the overall mean total
time taken to reach the working length for the warm vertical group
was significantly greater than that required for GuttaCore (mean =
87.11 vs 60.16 seconds, respectively), and the overall mean total
time taken to reach the working length for WaveOne was significantly
greater than that observed for ProTaper (99.09 vs 48.18 seconds,
respectively).
The results of 2-way analysis of variance showed a significant main
effect for both the type of experiment groups (F1,76 = 15.32, P = .0002)
and the type of retreatments (F1,76 = 54.67, P < .0001). In statistics, if
there is no significant interaction between the 2 variables (ie, 2 factors),
those 2 factors are described as ‘‘main effects.’’ The mean curvatures for
the experimental groups and events of instrument unwinding and sep-
aration are shown in Figure 2.
Discussion
Successful retreatment is contingent upon the ability to remove the
previous filling material and to gain access to spaces containing necrotic
Figure 1. Total time to reach working length using the ProTaper files for both
the warm vertical group and GuttaCore group.
JOE — Volume 43, Number 6, June 2017

Figure 2. Mean curvatures for experimental groups and events of instrument
unwinding and separations.
tissues and bacteria that may be responsible for endodontic failure (1).
Many previous studies have shown the inability to completely remove
root canal filling materials (10–12, 15). As a result, the current
study focused more on the ability to reestablish working length than
on completely removing gutta-percha from the canals.
The WaveOne file was developed to function as a single-file system.
The files are made out of M-Wire and are used in a reciprocation mo-
tion, which has been shown to provide good resistance to cyclic fatigue
(16). The effectiveness of WaveOne files in initial root canal treatment
has been supported by several studies (5, 6). However, very few studies
have shown its potential use in retreatment cases (17, 18). In a study by
Rios Mde et al (17), gutta-percha was removed as effectively and safely
with the WaveOne file as the ProTaper Universal Retreatment files. In
this study, single canals of maxillary incisors were used. Although the
retreatment techniques were shown to have no difference in the amount
of gutta-percha removed, the study did not address the efficiency of
gutta-percha removal. Also, there were no separations in the study,
which may have been a result of the canals having minimal curvature
as well as the files only being used for a single canal. The files were
each used for 3 canals in the current study because of the nature of
molar retreatments requiring treatment of predominantly greater
than 3 canals. The time required to reach the working length was signif-
icantly more in the current study with the WaveOne files than the Pro-
Taper files. The time required to reach the working length and the file
fatigue may have been a result of the increased root curvatures because
all of the separations occurred in the apical 3 mm.
In another study using moderately curved canals, Beasley et al
(12) reported some file fatigue and fractures in the D3 ProTaper files.
These findings correlate with the findings of the current study in that the
D3 file was the only ProTaper file that underwent significant deformity
or fractured during use. Unal et al (10) also noted more procedural
errors in removing filling materials with ProTaper Retreatment files
in curved canals. The tendency of ProTaper Retreatment files to unwind
and separate that was found in these studies may be related to the taper
of the ProTaper Retreatment files or the speed at which they rotate in
curved canals. Because procedural errors are less likely to occur in
straight canals, it seems reasonable to use the most efficient retreatment
strategy. However, the practitioner must consider such risks in the re-
treatment of curved canals.
Manufacturers of GuttaCore have designed their carrier to be easily
removed by rotary files. The carrier exhibits a low modulus of elasticity
JOE — Volume 43, Number 6, June 2017
Basic Research—Technology
and easily fractures under torsional loading. In the current study and
the study by Beasley et al (12), GuttaCore was significantly more efficient
to retreat. Although teeth have been successfully retreated in these
studies, the clinician is advised that GuttaCore retreatments should be
approached with care because the cross-linked gutta-percha core
has different mechanical properties, and proper recognition is key.
Future research is needed on techniques for removing fragments of Gut-
taCore carriers in the event of incomplete removal.
In conclusion, the WaveOne files underwent more file deformities
and fractures and required more time to retreat moderately curved ca-
nals than the ProTaper Universal Retreatment files. Also, GuttaCore was
removed more safely and efficiently than warm vertically condensed
gutta-percha regardless of the system used.
Acknowledgments
The authors deny any conflicts of interest related to this study.
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