Research

SEM analysis of morphological changes in manual

and rotary ProTaper instruments after use
Tiago André Fontoura de Melo and Elias Pandonor Motcy de Oliveira
present a study using scanning electron microscopy (SEM) to assess
deformation and wear in ProTaper manual and rotary instruments

As a result of the anatomy of root canals and their degree and

radius of curvature, nickel titanium (NiTi) endodontic
instruments are very often subjected to exaggerated states of
tension, compression, torsion and flexion, which provoke
plastic deformation and unexpected fractures.
Several studies have investigated instruments available in
the market with the aim of detecting possible factors that may
increase the chances of these morphological changes to occur
(Daugherty et al, 2001; Zelada et al, 2002; Yared et al, 2003;
Berutti et al, 2003; Martín et al, 2003; Viana et al, 2006). Some
of these studies have been able to show that many different
factors are involved in instrument failure, including the type of
instrument and the rotary system employed.
According to Berutti et al (2003) and Tripi et al (2006), the
CPD Aims and objectives
This clinical article aims to present a study using
scanning electron microscopy (SEM) to assess
deformation and wear in ProTaper manual and
rotary instruments.
Expected outcomes
Correctly answering the questions on page 33,
worth one hour of verifiable CPD, will
demonstrate you understand the results, which
showed that the instruments did not suffer
deformation; and that the rotary F1 instrument
showed the greatest rate of surface wear, but the
difference between the two experimental groups was
not statistically significant.

type of cross-section of the instrument has an influence on

increasing or reducing the possibility of failure. Wolcott and
SX S1 S2 F1 F2 F3 SX S1 S2 F1 F2 F3
Himel (1997) and Haïkel et al (1999) confirmed the same with
relation to taper. Regarding the use of engine-driven equipment,
it has been found that the rotational speed (Daugherty et al,
2001; Yared et al, 2001) and torque (Yared et al, 2001; Yared et
al, 2003) set on motors also have an influence on the risk of
premature instrument failure. Furthermore, other factors have
been investigated and related with instrument failure, such as
anatomy of the root canal being prepared (Zelada et al, 2002;
Martín et al, 2003) and operator’s experience (Baumann and
Roth, 1999; Sonntag et al, 2003).
Based on these previous findings, the purpose of this study Figures 1a and 1b: ProTaper system endodontic instruments
was to use scanning electron microscopy (SEM) to investigate
morphological changes in ProTaper manual and rotary
instruments, taking into account the region examined and the each type were analyzed, and each instrument was used five
number of uses. times. Inclusion of the 100 root canals in the two experimental
groups was performed randomly.
Materials and methods Once the pulp chamber had been opened, working length
One hundred mesiobuccal and mesiolingual root canals of was established by introducing a size #10 K-file (Dentsply/
lower first molars and mesiobuccal and distobuccal root canals Maillefer, Ballaigues, Switzerland) into the root canal and
of upper first molars with curvature degrees between 19º and subtracting 1mm from the point at which the file tip was
32º were selected. protruded from the apical foramen. Root canals in both
The study used 10 boxed sets of ProTaper manual experimental groups were prepared by the same operator,
instruments (Dentsply/Maillefer, Ballaigues, Switzerland) according to the manufacturer’s instructions.
(Figure 1a) and 10 boxed sets of ProTaper rotary instruments
(Figure 1b), with a total of 120 new endodontic instruments;
all instruments were 21mm long. Before each use, instruments Tiago André Fontoura de Melo gained his MSc in endodontics
were ultrasonically cleaned, brushed, dried and sterilized in an from the School of Dentistry, Universidade Luterana do Brasil –
autoclave. Canoas/RS, Brazil.
Two experimental groups were formed based on method of Elias Pandonor Motcy de Oliveira has a PhD in endodontics. He
instrumentation and type of instrument used. Each group was is a teacher at Universidade Luterana do Brasil – Canoas/RS,
comprised of 50 root canals prepared with manual (group A) Brazil.
and rotary (group B) S1 and F1 instruments; 10 instruments of

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Figure 2: Electron microscope image of a manual S1 instrument with more
than three areas of surface wear in the region examined
First, a size #10 K-file and a size #15 Flexo-File (Dentsply/
Maillefer, Ballaigues, Switzerland) were used until the
predefined working length was reached, with small oscillatory
and filing movements within the root canal. Next, the
preparation sequence was initiated in each group with a
ProTaper S1 instrument followed by an SX instrument until
resistance to further penetration was detected. ProTaper S1, S2
and F1 instruments were then used in sequence along the
working length. Root canal preparation was finished using
ProTaper F2 and F3 instruments at 1mm and 2mm from the
working length, respectively. Teeth in group B were prepared
using an X-Smart electric motor (Dentsply/Maillefer, Ballaigues,
Switzerland) with speed and torque control. The motor was
used at a rotational speed of 300rpm, with a torque of 2Ncm.
Prior to and during preparation (at each instrument
change), canals were irrigated with 2ml of sodium hypochlorite
solution at 1% (Pharmacy school of ULBRA, Canoas, Rio
Grande do Sul, Brazil).
In order to expedite SEM analysis, instruments were
mounted on a device, which allowed more than one instrument
at a time to be held. The instruments were mounted in
standardized positions, so that they would be identically
positioned at each microscopic analysis performed. All images
were acquired using a Philips XL 20 microscope (Philips
Electron Optics, Eindhoven, The Netherlands) running at
20kV with 100X magnification. With relation to the region
examined, two images of each instrument were obtained, one
at the tip and the other at 5mm from the tip.
SEM analysis of each instrument was carried out at three
different moments: the first was after the cleaning and
sterilization process, before the first use; the second was after
the first use; the third was after the last time each instrument
was used (fifth use). The two examiners assessed flute
distortion and surface wear, which were graded as follows:
1) Flute distortion:
• Score 1: no stretching, shortening or unwinding of flutes in
the region examined
• Score 2: stretching, shortening or unwinding of just one flute
in the region examined
• Score 3: stretching, shortening or unwinding of more than
one flute in the region examined.
2) Surface wear:
• Score 1: no wear in the region examined
• Score 2: between one and three areas with defects in the
region examined (moderate wear)
• Score 3: more than three areas with defects in the region
examined (severe wear).
8 ENDODONTIC PRACTICE SEPTEMBER 2010
7 EP Sept Melo.indd 2
Figure 3: Electron microscope image of a rotary F1 instrument with two areas
of surface wear close to the tip
Cases of instrument fracture were analyzed by the operator
during root canal preparation.
Prior to the statistical analysis, inter-examiner agreement
was calculated using the Kappa index; results were one (100%)
for flute distortion and 0.805 for surface wear. Analysis of
variance (ANOVA) was used for the statistical analysis of results,
with a significance level of 5%.
Results
Surface wear
No surface wear was observed before the first use, but the scores
obtained after the first and fifth uses revealed changes. Of the
total of 160 instruments, score 1 (no wear) was obtained in 145
(90.6%); score 2 (moderate wear) in 14 (8.8%); and score 3
(severe wear) was observed in one instrument (0.6%). Of the 15
images showing changes suggestive of surface wear, nine were
taken after the first use and six after the last use. Since there was
only one occurrence of score 3 (Figure 2), the variable was
dichotomized as absent or present.
With relation to possible interactions between surface wear
and the different factors analyzed, no association was found
between surface wear and instrumentation method, type of
instrument, number of uses or region examined. Neither were
there any significant lower order interactions with the main
effects, i.e. there were no significant results in terms of surface
wear in the present study (Table 1).
Only instrumentation method, region and the association of
method and instrument revealed P values close to the minimum
cutoff of 0.05 (5%) defined for statistical significance (Table 1).
When analyzing these three occurrences with relation to
instrumentation method, the rate of surface wear obtained with
the rotary method (0.092) was higher than the one obtained
with the manual method (0.033), with P = 0.058.
In terms of the regions examined, the rate of surface wear
observed at the tip of the instrument (Figure 3) was 0.092, a
higher result when compared to the region at 5mm from the tip,
0.033 (P = 0.058). Rotary instruments showed a greater
variation in surface wear results obtained at the tip of the
instrument (0.133) and at 5mm from the tip (0.050) when
compared with manual instruments (0.050 at the tip; 0.017 at
5mm from the tip). Finally, when comparing surface wear at the
two regions in groups A and B, the tips of rotary instruments
were found to present the greatest rates of surface wear.
Although no statistically significant differences were observed
in the interaction between method and instrument, the rotary
F1 instrument showed a greater tendency towards surface wear
(0.175; standard error = 0.061) with relation to the other
instruments analyzed (manual F1: 0.000; standard error =
0.000; S1 rotary and manual: 0.100; standard error = 0.048).
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Factors analyzed Degree of Sum of F P

freedom square

Instrumentation method 1 0.31 3.64 0.058

Type of instrument 1 0.01 0.07 0.785

Number of uses 1 0.01 0.07 0.785

Figure 4: Electron microscope image showing a manual S1 instrument with a Region 1 0.31 3.64 0.058
fracture at the tip that occurred during the fifth use Method + instrument 1 0.31 3.64 0.058

Method + number of uses 1 0.01 0.07 0.785

Instrument + number of uses 1 0.16 1.86 0.175

Distortion of flutes
All analyses of flute distortion resulted in score 1, i.e., no Method + instrument + number of uses 1 0.16 1.86 0.175
differences were observed in stretching, shortening or Method + region 1 0.06 0.67 0.415
unwinding of flutes with relation to method used, instrument Instrument + region 1 0.01 0.07 0.785
analyzed, region examined or number of uses.
Method + instrument + region 1 0.06 0.67 0.415

Number of uses + region 1 0.01 0.07 0.785

Fracture
Only one case of fracture was observed with the endodontic Method + number of uses + region 1 0.06 0.67 0.415
instruments used in this study. A manual S1 instrument Instrument + number of uses + region 1 0.06 0.67 0.415
fractured at the tip during the fifth use (Figure 4). The Method + instrument + number of uses + region 1 0.01 0.07 0.785
fractured segment was approximately 3mm long and was
Experimental error 144 12.10
located beyond the curvature of a distobuccal root canal of an
upper first molar. Corrected total 159 13.59

Discussion
One of the greatest concerns faced by endodontists when
using NiTi instruments for the preparation of root canals is
how many times each instrument can be used safely, without
risks of accident. Due to the increased flexibility and elastic
memory capacity of NiTi instruments, the detection or
visualization of morphological changes in the active part of
the instruments as a result of their use becomes very
difficult.
Our results revealed a greater rate of surface wear after the
first use when compared with the last (fifth) use. According to
Schäfer and Vlassis (2004), this can be explained by the fact
that, each time the instrument is used in contact with the root
canal walls, it undergoes a new machining process, and its
cutting edges wear off. This means that surface defects, such
as areas of surface wear, disappear from one use to another. In
the present study, the last SEM analysis, carried out after the
preparation of four other canals, revealed less defects than the
first analysis.
The increased rate of surface wear observed with rotary
ProTaper instruments when compared with manual ones may
be a result of the way they work, i.e., spinning at a constant
rotational speed within the root canal. The rotary method is
thus associated with less tactile sensitivity on the part of the
operator and with greater difficulty in controlling these
instruments, particularly with flattened and curved root
canals.
Finally, a greater rate of surface wear was observed at the
tips of instruments compared with the region at 5 mm from
the tip, a finding that may be due to the fact that the tip of the
instrument is the first active part to enter the interior of the
root canal and to deal with all the initial irregularities.
With relation to the distortion of flutes, no deformation
was observed in this study. According to Sattapan et al (2000),
deformation of rotary endodontic instruments is much more
Table 1: Interactions between metal loss and the different factors analyzed
dependent on the way in which the instruments are used than
on how many times they have been used.
In a study carried out by Ankrum et al (2004), other rotary
systems were assessed. The authors found a lower rate of
distortion (2.4%) for ProTaper instruments than for the other
systems analyzed: Profile (15.3%) and K3 (8.3%). Similarly,
Shen et al (2006) observed that ProTaper instruments offered
a lower rate of deformation (0.3%) in relation to the Profile
system (5%).
Only one single fracture was observed in our study (1.2%).
This finding is relevant to the extent that other studies, with
different experimental characteristics, observed a great
variation in fracture rates with ProTaper instruments: from
2.4% in the study of Wolcott et al (2006) to 14% in Cheung
et al (2007). In fact, the high fracture rate observed in the
clinical study carried out by Cheung et al (2007) seems to be
the result of instrument overuse in patients; our study and
that of Wolcott et al (2006), on the other hand, were carried
out in vitro. Therefore, the low fracture rate identified in our
study is in disagreement with the findings of Ankrum et al
(2004) and Shen et al (2006), who reported high fracture
rates but a low incidence of deformation associated with
ProTaper instruments.
The fracture occurred in our study was caused by flexural
fatigue, since no signs of stretching or shortening of the active
part of the endodontic instrument were present. According to
Pruett et al (1997), instruments can fracture without any prior
evidence of plastic deformation. In this sense, our finding
supports the assertions made by Cheung et al (2005),
according to which 89% of fractures of ProTaper instruments
were flexural, and by Shen et al (2006), who reported 95.5%

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of fractures of ProTaper instruments as a result of cyclic
flexural fatigue rather than torsion.
Fracture location, segment size and the number of uses
prior to fracture were in accordance with the literature. The
fracture occurred in the apical third, beyond the root canal
curvature, similarly to the description of Martín et al (2003),
Gênova et al (2004), Ankrum et al (2004) and Iqbal et al
(2006). The size of the fractured segment, i.e., 3mm long, is
in line with the 3-5mm variation reported in the studies by
Daugherty et al (2001), Fife et al (2004), Peng et al (2005)
and Viana et al (2006). Finally, with relation to the number of
uses, our fracture took place during the fifth use, the same
finding reported by Wolcott et al (2006) for the majority of
fractures.
Furthermore, in our study, the fracture occurred in an S1
instrument, which is in agreement with the study by Yared et
al (2003), where S1 instruments were found to suffer more
fractures than other instruments, and also with the study by
Shen et al (2006), in which 62% of fractures involved this
type of instrument. The high rate of fractures observed with
S1 instruments (S1) may have different explanations: first,
the small diameter of the S1 tip (0.185mm); second, the S1
ProTaper instrument is the first one to work against any
dentin resistance that may be present within the root canal;
third, the S1 instrument is used twice during the preparation
process, which is not the case with the other instruments
(SX, S2, F1, F2, and F3). On the other hand, our result
diverges from that reported by Gênova et al (2004); in these
authors’ study, of 12 fractures taking place while preparing
simulated canals with ProTaper instruments, four were
shaping and eight were finishing files.
Our fractured instrument was of the manual type. This
was probably due to the fact that the performance of
instrumentation movements as recommended by the
manufacturer was more difficult in manual instruments when
compared with rotary ones. The multi-taper feature of
ProTaper instruments prevented its free movement along the
root canal, increasing the time necessary to complete root
canal preparation when compared with the rotary method
and sometimes requiring previously used instruments to be
reutilized.
Conclusion
In summary, although we did not identify any statistically
significant differences regarding morphological changes in
manual and rotary ProTaper instruments, further studies
should be carried out to assess the peculiarities of each system
when facing a variety of clinical situations, aiming to increase
available information on the behavior of these instruments
during endodontic treatment. EP

References
Ankrum MT, Hartwell GR, Truitt JE (2004) K3 Endo, ProTaper, and ProFile Peng B, Shen Y, Cheung GS, Xia TJ (2005) Defects in ProTaper S1 instruments after
systems: breakage and distortion in severely curved roots of molars. J Endod clinical use: longitudinal examination. Int Endod J 38: 550-7
30: 234-7 Pruett JP, Clement DJ, Carnes DL Jr (1997) Cyclic fatigue testing of nickel-titanium
Baumann MA, Roth A (1999) Effect of experience on quality of canal preparation endodontic instruments. J Endod 23: 77-85
with rotary nickel titanium files. Oral Surg Oral Med Oral Pathol Oral Radiol Sattapan B, Nervo GJ, Palamara JE, Messer HH (2000) Defects in rotary nickel-titanium
Endod 88: 714-8 files after clinical use. J Endod 26: 161-5
Berutti E, Chiandussi G, Gaviglio I, Ibba A (2003) Comparative analysis of Schäfer E, Vlassis M (2004) Comparative investigation of two rotary nickel-titanium
torsional and bending stresses in two mathematical models of nickel titanium instruments: ProTaper versus RaCe. Part 1. Shaping ability in simulated curved canals.
rotary instruments: ProTaper versus Profile. J Endod 29: 15-9 Int Endod J 37: 229-38
Cheung GS, Bian Z, Shen Y, Peng B, Darvell BW (2007) Comparison of defects Shen Y, Cheung GS, Bian Z, Peng B (2006) Comparison of defects in ProFile and
in ProTaper hand-operated and engine-driven instruments after clinical use. Int ProTaper systems after clinical use. J Endod 32: 61-5
Endod J 40: 169-78
Sonntag D, Delschen S, Stachniss V (2003) Root-canal shaping with manual and rotary
Cheung GS, Peng B, Bian Z, Shen Y, Darvell BW (2005) Defects in ProTaper S1 Ni-Ti files performed by students. Int Endod J 36: 715-23
instruments after clinical use: fractographic examination. Int Endod J 38: Tripi TR, Bonaccorso A, Condorelli GG (2006) Cyclic fatigue of different nickel titanium
802-9 endodontic rotary instruments. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:
Daugherty DW, Gound TG, Comer TL (2001) Comparison of fracture rate, 106-14
deformation rate, and efficiency between rotary endodontic instruments driven Viana AC, Gonzalez BM, Buono VT, Bahia MG (2006) Influence of sterilization on
at 150rpm and 350rpm. J Endod 27: 93-5 mechanical properties and fatigue resistance of nickel titanium rotary endodontic
Fife D, Gambarini G, Britto Lr L (2004) Cyclic fatigue testing of ProTaper NiTi instruments. Int Endod J 39: 709-15
rotary instruments after clinical use. Oral Surg Oral Med Oral Pathol Oral Radiol Wolcott J, Himel VT (1997) Torsional properties of nickel titanium versus stainless steel
Endod 97: 251-6 endodontic files. J Endod 23: 217-20
Gênova AP, Antônio MP, Davidowicz H, Moura AA (2004) Evaluation of rate of Wolcott S, Wolcott J, Ishley D, et al (2006) Separation incidence of ProTaper rotary
fractures in ProTaper files in simulated canals. Rev Inst Ciências Saúde 22: 51-4 instruments: a large cohort clinical evaluation. J Endod 32: 1139-41
Haïkel Y, Serfaty R, Bateman G, Senger B, Allemann C (1999) Dynamic and Yared GM, Bou Dagher FE, Machtou P (2001) Influence of rotational speed, torque and
cyclic fatigue of engine-driven rotary nickel-titanium endodontic instruments. operator’s proficiency on Profile failures. Int Endod J 34: 47-53
J Endod 25: 434-40 Yared GM, Bou Dagher FE, Kulkarni K (2003) Influence of torque control motors and
Iqbal MK, Kohli MR, Kim JS (2006) A retrospective clinical study of incidence the operator’s proficiency on ProTaper failures. Oral Surg Oral Med Oral Pathol Oral
of root canal instrument separation in an endodontics graduate program: a Radiol Endod 96: 229-33
PennEndo database study. J Endod 32: 1048-52 Zelada G, Varela P, Martín B, Bahílio JG, Magán F, Ahn S (2002) The effect of rotational
Martín B, Zelada G, Varela P, et al (2003) Factors influencing the fracture of speed and the curvature of root canals on the breakage of rotary endodontic instruments.
nickel-titanium rotary instruments. Int Endod J 36: 262-6 J Endod 28: 540-2

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