A systematic approach to preventing intracanal

breakage of endodontic files

Sotokawa T. A systematic approach to preventing intracanal Tadashi Sotokawa
breakage of endodontic files. Endod Dent Traumatol 1990; 6: 1-2-46 Yamagishi Morioka, Iwate pref, Japan
60-62.

Abstract - This study was conducted to determine the effective-

ness of a method to prevent intracanal breakage of endodontic
files. An application schedule with a predetermined number of
periods of use for K-files of all sizes was implemented at the
author's clinic for a 3-year period. All the files used under this
schedule were discarded after the predetermined periods of use,
whether they displayed any deformity or not. During the 3-year
period, 1933 files (53.7 per month) were discarded after prepara-
tion of 3269 root canals. There were 5 file fractures (0.1 per
month) compared with 1.4fi:"acturesper month before the
adaption of this system. The monthly average of files discarded
during the 3-year research period was 53.7. Before the adoption Key words: root canal therapy; root canal instru-
of the trial system, the monthly average of discarded files was mentation; intracanal instrument fractures.
76.5. It is concluded that the experimental system effectively Tadashi Sotokawa, 1-2-46 Yamagishi Morioka,
reduced the incidence of intracanal instrument fi^actures and the Iwate pref., Japan.
total number of files consumed. Accepted for publication September 15, 1989.

It is an estabfished fact that endodontic files should
not be used beyond a certain period of time because
the wear they undergo during chnical use eventu-
ally leads to intracanal breakage (1). Sotokawa (2)
has pointed out that file deformations caused by
bending cause and advance metal fatigue, eventu-
ally resulting in breakage. Thus, to prevent break-
age, it would be advantageous to discard files in
which metal fatigue has occurred before they break.
However, it is not possible to distinguish fatigued
files with the naked eye. Therefore, a system has
been established whereby the instruments are dis-
carded after they have been used in the root canal
a certain number of times.
This study was conducted to determine the effec-
tiveness of this system in preventing intracanal
breakage of endodontic files during clinical practice.
Material and methods
Table 1 shows the periods of time that each size file
was used during the 3-year period.
Before the adoption of the system examined in
this study, all files used at the author's clinic were
systematically subjected to thorough visual inspec-
tion during use as a measure against breakage. Any
file exhibiting even the slightest deformity was dis-
carded.
Despite being subjected to extreme deformations,
7^08 and ^10 file sizes had very low breakage rates,
considering the relatively large numbers of these
files discarded. This may be attributed to frequent
visual inspection of the smallest instruments. Thus,
thorough visual inspection before, during, and after
use was thought to be the most effective measure to
prevent breakage.
File sizes j^l5 through jl25 broke frequently. Their
one-month use period was derived from the fact
that about one file in each of these sizes broke per
month.
Although no breakage was observed in p O files,
many were discarded because of partial reverse
twisting, indicating that they were prone to damage.
Accordingly, they were assigned a one-month use
period.
One file each in the sizes p 5 through #45 was
discarded per month on average because of deform-
ities observed under unaided visual inspection.
However, because 3 files each were always prepared
in the file tray for rotational use, a 3-month use
period was established for these file sizes.
For the sizes #50 through #60, one file each was

60
 Preventing intracanal breakage of endodentic files
Table 1. Predetermined periods of use for K-files All the files discarded during the 3-year period
File size
were recorded. The monthly numbers of discarded
files and broken files were recorded and compared
08-10 Until deformity Is observed with the numbers that had been attained during a
15-30 1 month 17-month period just before this system was adop-
35-45 3 months
50-60 6 months
ted. During the previous period, the files and the
70-120 1 year instrumentation technique used by the author had
been the same as the ones used in the present study.

discarded every 2 months. And likewise, since 3
each of these sizes were placed in the file tray for
rotational use, they were assigned a 6-month use
period.
File sizes /7^7O to /^120 required considerable time
to show wear. However, they were dulled consider-
ably after one year. A one-year use period was thus
derived for these sizes.
The instruments examined in this study were K-
files (Zipperer, Munich, FRG). They were placed
in a file tray containing 68 files: 6 files each of ;^08
to 1120, 4 files each of ;^25 to §80, and 1 files each
of ^90 to /^120. The instrumentation technique used
by the author for root canal preparation has been
the fiared technique as described by Weine (3). The
apical part of the root canal was enlarged mainly
to the sizes /^40 to ^80. All types of teeth were
treated.
At the end of each month, files that had reached
their limited time of use were discarded, whether
they displayed any deformity or not. They were
then replaced with new files of the same sizes.
Results
The results obtained before the adoption of the
experimental system (over the 17-month period) are
presented in Table 2. Over this period, 1493 root
canals (87.8 per month) were prepared. The total
number of discarded files was 1301 (76.5 per
month). Twenty-four file fractures (1.4 per month)
were observed in file sizes )^08 to ^55.
The results obtained after the adoption of the
system (over the 3-year period) are presented in
Table 3. Over this period, 3269 root canals (90.8
per month) were prepared. The total number of
discarded files was 1933 (53.7 per month). Five file
fractures (0.1 per month) were observed, 2 in files
^\0 and 3 in files ^15. No breakage was observed
in the file sizes from ^20 to ^120.
Discussion
The total number of fractures, 5 (0.1 per month),
was a remarkable decrease from the figure attained
before adoption of the experimental system (1.4

Table 2, K-files discarded before the adoption of the experimental system Table 3, K-files discarded after the adoption of the experimental system
(during 17-month period) (during 3-year period)

Discarded, but not Discarded because of Total number of Discarded, but not Discarded because of Total number of
File fractured files breakage discarded files File fractured files breakage discarded

#08 91 1 92 #08 54 0 54
#10 709 1 710 #10 507 2 509
#15 275 6 281 #15 613 3 616
#20 60 2 62 ^20 193 0 193
#25 19 9 28 #25 131 0 131
#30 62 0 62 #30 153 0 153
#35 13 1 14 #35 54 0 54
#40 9 0 9 #40 51 0 51
#45 19 1 20 #45 48 0 48
#50 6 1 7 #50 26 0 26
#55 3 2 5 #55 26 0 26
#60 7 0 7 #60 23 0 23
#70 2 0 2 17 0 17
#80 2 0 2 m 15 0 15
#90 0 0 0 m 5 0 5
#100 0 0 0 #100 4 0 4
#110 0 0 0 #110 4 0 4
#120 0 0 0 #120 4 0 4

Total 1277 24 1301 Total 1928 5 1933

(monthly average) (1,4) (76.5) (monthly average) (0.1) (53,7)

61
Sotokawa
per month). This suggested that a system with a
predetermined number of periods of use may effec-
tively reduce the incidence of intracanal instrument
fractures. Broken files were found only in #10 and
#15 file sizes, indicating that each of these file sizes
needed a time limit of use as well.
No breakage occurred in the file sizes #20 to #120,
indicating that the predetermined periods of use
prevented breakage in the larger files. Therefore, if
the time limits of use for all the file sizes are properly
set, this system could prevent breakage of all K-files
during clinical use.
There is obviously a connection between the
periods of use for files and their frequency of use
that should be taken into account before adopting
this system; an increase in the latter will shorten the
former.
The figure (53.7 per month) attained after the
adoption of the experimental system was propor-
tionally much smaller than the one before the adop-
tion of it, thus indicating the cost-effective potential
of this system.
By setting an appropriate use period for each file
size, it is possible to prevent file breakage caused by
bending deformations. Moreover, it can be assumed
that the adoption of such a system will not signifi-
cantly increase the number of files used.
Undoubtedly, file use periods are influenced by
62
such factors as file type, physical properties, fre-
quency of use, the operator's techniques, and file
maintenance. Consequendy, the schedule shown in
Table 1 is not universally applicable. However, the
findings of this study can serve as a practical and
informative guide to endodontists attempting to de-
vise their own system to prevent fracture.
Adoption of such a system would conceivably
ensure superior file conditions, allowing the endo-
dontist to perform more efficient root canal therapy
with less labor and strain.
Acknowledgements - I am grateful to Professor Ma-
sumi Ishibashi, Department of Endodontology,
Iwate Medical University School of Dentistry, for
critical review of the manuscript, and to Dr. Takeshi
Kawabata, the Research Institue for Iron Steel and
Other Metals, Tohoku University, for technical ad-
vice.
References
1. GROSSMAN LI. Endodontic practice. 10th ed. Philadelphia:
Lea & Febiger, 1981; 206-7.
2. SOTOKAWA T. An analysis of clinical breakage of root canal
instruments. J Endod 1988; 14: 75-82.
3. WEINE FS. Endodontic therapy. St. Louis: Mosby, 1972; 203-5.